Schiefer Ulrich, Isbert Melanie, Mikolaschek Eva, Mildenberger Ingrid, Krapp Elke, Schiller Jan, Thanos Solon, Hart William
Department of Pathophysiology of Vision and Neuro-Ophthalmology, University Eye Hospital, Schleichstrasse 12-16, 72076 Tübingen, Germany.
Graefes Arch Clin Exp Ophthalmol. 2004 Jun;242(6):468-77. doi: 10.1007/s00417-004-0863-5. Epub 2004 Apr 7.
To evaluate pathogenetic mechanisms and frequency distribution of visual field defects (VFDs) in patients with chiasmal lesions. Secondly, to reconsider the existence of "Wilbrand's knee" as far as referable to the anterior junction syndrome.
Consecutive visual field records related to chiasmal lesions were retrieved from the Tuebingen Perimetric Database. In all cases, at least one eye was examined with the Tuebingen Automated Perimeter using a standardized grid of 191 static targets within the central 30 degrees visual field, and a threshold-related, slightly supraliminal strategy. VFDs were classified according to standard neuro-ophthalmological categories.
Results from 153 consecutive patients (65 male, 88 female) were evaluable. The majority (65%) of chiasmal lesions was due to pituitary adenoma, followed by craniopharyngioma (12%), astrocytoma (9%), and meningioma (8%). Vascular lesions in this region occurred rarely (2%). Three per cent of all patients had no final diagnosis. The majority (22%) of scotomas was attributable to involvement of the temporal hemifield in both eyes, with true bitemporal hemianopia being a very rare event (1%). Anterior junction syndrome, characterized by advanced visual field loss affecting the visual field centre in one eye and (possibly subtle) defects respecting the vertical midline in the fellow eye, was the second most frequent classifiable VFD (13%). Homonymous hemianopic VFDs occurred in 11% of all cases. Nine per cent of all patients exhibited monocular VFDs which did not respect the vertical midline, whereas in 3% of the subjects the monocular VFDs did not cross the vertical meridian. Binasal defects and posterior junction syndrome also occurred seldom (< 1%). Nineteen per cent of all visual field records of patients with chiasmal lesions had results, which could not be classified unequivocally, and an identical portion was rated normal.
In patients with chiasmal lesions, incomplete involvement of the temporal hemifields in both eyes was the most frequent event (22%), followed by anterior junction syndrome (13%). The latter entity at least clinically indicates the proximity of the pre-chiasmal ipsilateral optic nerve and decussating fibres emanating from the inferior nasal hemiretina of the fellow eye. However, this cannot provide conclusive evidence for the existence of anterior Wilbrand's knee.
评估视交叉病变患者视野缺损（VFDs）的发病机制及频率分布。其次，就前部交界综合征而言，重新审视“威尔布兰德膝”的存在。
从图宾根视野数据库中检索与视交叉病变相关的连续视野记录。在所有病例中，至少一只眼睛使用图宾根自动视野计，在中央30度视野范围内采用191个静态靶点的标准化网格以及与阈值相关的略高于阈值的策略进行检查。VFDs根据标准神经眼科类别进行分类。
153例连续患者（65例男性，88例女性）的结果可评估。大多数（65%）视交叉病变由垂体腺瘤引起，其次是颅咽管瘤（12%）、星形细胞瘤（9%）和脑膜瘤（8%）。该区域的血管病变很少见（2%）。3%的患者最终未确诊。大多数（22%）暗点归因于双眼颞侧半视野受累，真正的双颞侧偏盲非常罕见（1%）。前部交界综合征是第二常见的可分类VFD（13%），其特征为一只眼睛的视野中心出现严重视野缺损，而另一只眼睛（可能较轻微）存在垂直中线相关的缺损。所有病例中有11%出现同侧偏盲性VFDs。所有患者中有9%表现为不遵循垂直中线的单眼VFDs，而3%的受试者单眼VFDs未越过垂直子午线。双侧鼻侧缺损和后部交界综合征也很少见（<1%）。视交叉病变患者的所有视野记录中有19%的结果无法明确分类，相同比例的结果被评为正常。
在视交叉病变患者中，双眼颞侧半视野不完全受累是最常见的情况（22%），其次是前部交界综合征（13%）。后一种情况至少在临床上表明视交叉前同侧视神经与对侧眼鼻下视网膜发出的交叉纤维接近。然而，这不能为前部威尔布兰德膝的存在提供确凿证据。
