Levy Richard L, Miller Neil R
The Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
Ann Acad Med Singap. 2006 Mar;35(3):151-7.
Radiation-induced optic neuropathy (RON) is an infrequent but devastating consequence of radiation exposure to the visual pathways, usually following months to years after the treatment of paranasal or intracranial tumours. Hyperbaric oxygen (HBO) therapy is one of several therapies that have been tried for this condition. The purpose of this review is to describe the clinical characteristics of RON, the rationale for the use of HBO in this condition, and the available clinical data on its safety and efficacy.
MEDLINE searches were performed on radiation optic neuropathy, hyperbaric oxygen therapy, and similar terms, and selected references were reviewed. The results were combined with the experience at our own institution.
RON typically follows a fulminant course with characteristic symptoms, examination findings, and imaging. The threshold for prior radiation exposure depends upon the delivery system used and patient characteristics. Therapy with anticoagulants or steroids has been unsuccessful. While there are case reports in the literature of successful treatment with HBO, therapy with HBO has to be initiated soon after the onset of vision loss, and even then yields variable results at best.
There is still no consistently successful treatment for RON. HBO may be attempted in selected cases, but the prognosis for preservation of vision remains grim.
放射性视神经病变（RON）是视觉通路受到辐射照射后一种罕见但极具破坏性的后果，通常发生在鼻旁窦或颅内肿瘤治疗后的数月至数年。高压氧（HBO）治疗是针对这种病症尝试过的几种治疗方法之一。本综述的目的是描述RON的临床特征、在这种病症中使用HBO的理论依据以及关于其安全性和有效性的现有临床数据。
对放射性视神经病变、高压氧治疗及类似术语进行了医学文献数据库（MEDLINE）检索，并对选定的参考文献进行了综述。结果与我们自己机构的经验相结合。
RON通常呈暴发性病程，具有特征性症状、检查结果和影像学表现。既往辐射暴露的阈值取决于所使用的放疗系统和患者特征。抗凝剂或类固醇治疗均未成功。虽然文献中有HBO治疗成功的病例报告，但HBO治疗必须在视力丧失后尽快开始，即便如此，其效果充其量也不尽相同。
对于RON仍然没有始终成功的治疗方法。在某些选定的病例中可以尝试HBO治疗，但视力保留的预后仍然严峻。
