Soni Chetan R, Johnson Lenworth N
Neuro-Ophthalmology Unit, Mason Eye Institute, University of Missouri-Columbia, Columbia, MO 65212, USA.
Eur J Ophthalmol. 2010 Mar-Apr;20(2):429-36. doi: 10.1177/112067211002000226.
Animal models have provided information on the tensile strength of the optic nerve, but to our knowledge no in vivo study of the tensile strength of the human optic nerve has been reported. Accordingly, we present 3 cases of stretch optic neuropathy, an often unrecognized cause of vision loss from thyroid eye disease.
Observational study of thyroid-associated stretch optic neuropathy.
Three cases of stretch optic neuropathy were identified. Visual acuity was better than 20/40. Two patients had arcuate scotoma. Moderate to severe proptosis of 25 to 33 mm was present, without evidence of apical orbital compression. Two patients had retinal hemorrhages suggesting venous stasis retinopathy; the venous stasis retinopathy resolved after orbital decompression. Orbital decompression resulted in improvement of visual function. The rate of decibel sensitivity loss on automated perimetry was estimated at -0.042 dB/da in one case, with complete blindness projected to occur within 785 days from the onset of visual symptoms.
Stretch optic neuropathy presents initially as neuropraxia with temporary visual loss. Orbital decompression should be considered for treatment before permanent and irreversible visual loss ensues.
动物模型已提供有关视神经拉伸强度的信息，但据我们所知，尚无关于人类视神经拉伸强度的体内研究报道。因此，我们报告3例牵拉性视神经病变，这是一种甲状腺眼病导致视力丧失但常未被认识的原因。
对甲状腺相关性牵拉性视神经病变进行观察性研究。
确诊3例牵拉性视神经病变。视力优于20/40。2例患者有弓形暗点。存在25至33毫米的中度至重度眼球突出，无眶尖受压迹象。2例患者有视网膜出血提示静脉淤滞性视网膜病变；眼眶减压后静脉淤滞性视网膜病变消退。眼眶减压导致视觉功能改善。1例患者自动视野检查中分贝敏感度丧失率估计为-0.042 dB/天，预计从视觉症状出现起785天内会完全失明。
牵拉性视神经病变最初表现为神经失用伴短暂视力丧失。在永久性和不可逆性视力丧失发生之前，应考虑眼眶减压治疗。
