Department of Neurology, Functional Imaging Unit, Glostrup Hospital and University of Copenhagen, 2600 Glostrup, Denmark.
Neurology. 2010 Jan 19;74(3):252-8. doi: 10.1212/WNL.0b013e3181ca0135.
Acute optic neuritis occurs with and without papillitis. The presence of papillitis has previously been thought to imply an anterior location of the neuritis, but imaging studies seeking to test this hypothesis have been inconclusive.
This prospective observational cohort study included 41 patients with unilateral optic neuritis and 19 healthy volunteers. All patients were evaluated and examined within 28 days of onset of symptoms. The peripapillary retinal nerve fiber layer thickness (RNFLT), an objective quantitative measure of optic nerve head edema, was measured by optical coherence tomography and the length and location of the inflammatory optic nerve lesion were evaluated using MRI.
Ophthalmoscopically, 34% of the patients had papillitis. The retinal nerve fiber layer in affected eyes (mean 123.1 microm) was higher during the acute phase than that of fellow eyes (mean 98.1 microm, p < 0.0001) and higher than that in healthy control eyes (mean 97.1 microm, p < 0.0001). The RNFLT was related to the length of the optic nerve lesion (p = 0.0002), but not to the location of the optic nerve lesions (p = 0.72).
In this study of the acute phase of optic neuritis, the degree of optic nerve head edema depended upon the extent of the optic nerve lesion, but not on its location. This suggests that factors other than inflammation, such as compromised venous drainage, vascular leakage, impaired axonal transport, and other mechanisms, are involved in the development of optic nerve head edema in optic neuritis.
急性视神经炎可伴有或不伴有视盘炎。先前认为视盘炎的存在意味着神经炎位于前部，但寻求验证这一假说的影像学研究尚无定论。
本前瞻性观察性队列研究纳入了 41 例单侧视神经炎患者和 19 名健康志愿者。所有患者均在症状发作后 28 天内接受评估和检查。通过光学相干断层扫描测量视盘周围视网膜神经纤维层厚度（RNFLT），这是视神经头水肿的客观定量测量指标，并通过 MRI 评估炎症性视神经病变的长度和位置。
眼底镜检查发现，34%的患者有视盘炎。受累眼的视网膜神经纤维层（平均 123.1μm）在急性期高于对侧眼（平均 98.1μm，p<0.0001），也高于健康对照组（平均 97.1μm，p<0.0001）。RNFLT 与视神经病变的长度相关（p=0.0002），但与视神经病变的位置无关（p=0.72）。
在这项视神经炎急性期的研究中，视神经头水肿的程度取决于视神经病变的范围，而与病变位置无关。这表明，除炎症外，其他因素（如静脉回流受损、血管渗漏、轴突运输受损和其他机制）也参与了视神经炎视神经头水肿的发生。
