Watanabe I, Iijima H, Imai M
Department Ophthalmology, Yamanashi Medical College, Japan.
Nippon Ganka Gakkai Zasshi. 1991 Oct;95(10):986-94.
Fifty-four eyes of 41 patients with optic nerve disease demonstrating acute visual field defects without any traumatic, compressive, or other known etiology were classified into four categories. Those showing poor recovery of visual field defects were ischemic optic neuropathy which was subclassified into either anterior ischemic optic neuropathy (AION) or posterior ischemic optic neuropathy (PION) according to the ophthalmoscopic changes in the optic nerve head. Those showing good recovery of visual field defects were idiopathic optic neuritis which was subclassified into either papillitis or retrobulbar neuritis according to the ophthalmoscopic pathology of the optic disc. Patients with ischemic optic neuropathy were significantly older than those with optic neuritis. All eyes with optic neuritis showed good recovery of vision, whereas those with ischemic optic neuropathy showed varying outcomes of vision. With regard to the pattern of field defect, central or paracentral scotoma was predominant in all but eyes with AION in which altitude defect predominated. Pale swelling of the optic nerve head and angiographic evidence of circulatory disturbance in the optic disc or adjacent choroid were common findings in eyes with AION, whereas such findings were never observed in eyes with papillitis. The amplitude of pattern visual evoked potential was significantly lower in eyes with PION than in those with retrobulbar optic neuritis. Four patients classified as optic neuritis developed into multiple sclerosis in the follow-up study. It was concluded that poor recovery of visual field defect is one of the most convincing evidences for the diagnosis of ischemic optic neuropathy.
41例视神经疾病患者共54只眼，这些患者表现为急性视野缺损，且无任何外伤、压迫或其他已知病因，被分为四类。视野缺损恢复较差的是缺血性视神经病变，根据视神经乳头的眼底镜检查变化，又进一步分为前部缺血性视神经病变（AION）或后部缺血性视神经病变（PION）。视野缺损恢复良好的是特发性视神经炎，根据视盘的眼底镜病理表现，又进一步分为视乳头炎或球后视神经炎。缺血性视神经病变患者的年龄显著大于视神经炎患者。所有视神经炎患者的视力均恢复良好，而缺血性视神经病变患者的视力恢复情况各不相同。关于视野缺损的模式，除了以高度缺损为主的AION患者的眼睛外，所有患者的中央或旁中央暗点均占主导。视神经乳头苍白肿胀以及视盘或相邻脉络膜循环障碍的血管造影证据是AION患者眼睛的常见表现，而视乳头炎患者的眼睛从未观察到这些表现。PION患者眼睛的图形视觉诱发电位幅度显著低于球后视神经炎患者。在随访研究中，4例被归类为视神经炎的患者发展为多发性硬化症。得出的结论是，视野缺损恢复较差是诊断缺血性视神经病变最有说服力的证据之一。
