Kommerell G
Abteilung Neuroophthalmologie und Schielbehandlung, Universitäts-Augenklinik, Freiburg.
Bull Soc Belge Ophtalmol. 1990;236:21-33.
Diseases of the visual pathway: early detection and therapy. Manual kinetic perimetry is faster in the detection of lesions of the visual pathway than automated static perimetry. When cases with a comparable reduction of visual acuity are considered, color desaturation is more pronounced in lesions of the visual pathway than in opacities of the optic media. Search for an afferent pupil defect allows the differential diagnosis between functional and unilateral organic visual impairment: in the case of bilateral visual impairment, a combination of VEP and pattern ERG is suitable for this differentiation. In chronic papilledema, secondary atrophy can best be detected in the arcuate retinal nerve fibers. Fistulation of the dural sheath of the optic nerve prevents visual loss in chronic papilledema. A similar operation could be useful in the progressive form of anterior ischemic optic neuropathy. Recently, the mitochondrial DNA mutation associated with Leber's hereditary optic neuropathy was identified. Prolactin secreting pituitary adenomas shrink with bromocriptine treatment.
早期检测与治疗。在检测视觉通路病变方面，手动动态视野检查比自动静态视野检查更快。当考虑视力下降程度相当的病例时，视觉通路病变中的颜色饱和度降低比视神经介质混浊更为明显。寻找传入性瞳孔缺陷有助于鉴别功能性和单侧器质性视力损害：在双侧视力损害的情况下，视觉诱发电位（VEP）和图形视网膜电图（pattern ERG）联合应用适用于这种鉴别。在慢性视乳头水肿中，继发性萎缩在视网膜弓形神经纤维中最易被检测到。视神经硬膜鞘造瘘可防止慢性视乳头水肿导致视力丧失。类似的手术可能对前部缺血性视神经病变的进行性形式有用。最近，与Leber遗传性视神经病变相关的线粒体DNA突变已被确定。分泌催乳素的垂体腺瘤经溴隐亭治疗后会缩小。
