Luneau Katie, Newman Nancy J, Biousse Valérie
Departments of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
Neurologist. 2008 Nov;14(6):341-54. doi: 10.1097/NRL.0b013e318177394b.
Anterior ischemic optic neuropathy (AION) is the most common cause of acute optic neuropathy after age 50, but may also occur in younger patients. The diagnosis is clinical and includes painless visual loss associated with a relative afferent pupillary defect and disc edema. In almost all cases, there is an underlying crowded optic nerve with a small cup-to-disc ratio. The visual prognosis is usually poor, although up to 43% of patients may improve over time. The fellow eye is involved in up to 15% of patients within 5 years, but the risk of recurrence in the same eye is less than 5%. There is no treatment for acute nonarteritic AION but it is essential to evaluate these patients for underlying treatable atheromatous vascular risk factors. A coagulation workup should also be considered in younger patients. It is essential to rule out giant cell arteritis in all patients over the age of 50 with ischemic optic neuropathies. Posterior ischemic neuropathy (in which the optic nerve is normal acutely) is rare and should be considered a diagnosis of exclusion.
前部缺血性视神经病变（AION）是50岁以后急性视神经病变最常见的病因，但也可能发生于较年轻的患者。诊断依靠临床症状，包括与相对传入性瞳孔障碍及视盘水肿相关的无痛性视力丧失。几乎在所有病例中，都存在潜在的视神经拥挤，杯盘比小。视力预后通常较差，不过高达43%的患者视力可能随时间改善。在5年内，对侧眼累及率高达15%，但同一只眼复发风险低于5%。急性非动脉炎性AION尚无治疗方法，但评估这些患者潜在的可治疗动脉粥样硬化血管危险因素至关重要。对于较年轻的患者，也应考虑进行凝血检查。对于所有50岁以上患有缺血性视神经病变的患者，排除巨细胞动脉炎至关重要。后部缺血性神经病变（急性时视神经正常）罕见，应作为排除性诊断。
