Department of Ophthalmology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea.
Invest Ophthalmol Vis Sci. 2011 Oct 10;52(11):7966-73. doi: 10.1167/iovs.11-7450.
To investigate the time course of visual field recovery and changes of retinal ganglion cells (RGCs) after chiasmal decompression using standard automated perimetry (SAP), optical coherence tomography (OCT), and photopic negative response (PhNR).
Nineteen patients undergoing chiasmal decompression surgery were prospectively assessed before and 1 and 3 months after surgery. The same examinations were conducted in nine patients at 6 months after surgery. Mean deviation and temporal visual field sensitivity (1/Lambert) of SAP, retinal nerve fiber layer (RNFL) thickness, and ganglion cell complex (GCC) area measured by OCT and PhNR/b-wave ratio were analyzed. Preoperative measurements were compared with those of 20 eyes of normal controls. Postoperative measurements were compared with preoperative data. The relationships among SAP, OCT, and PhNR measurements throughout the observation periods were evaluated by linear and logarithmic regressions.
Before surgery, all parameters in patients were significantly worse than those in normal controls. After surgery, the visual field was significantly improved, but RNFL thickness and GCC area were significantly reduced for 3 months. The PhNR/b-wave ratio was also reduced, but not significantly. Six months after surgery, average RNFL thickness, GCC area, and PhNR/b-wave ratio showed significant improvements by 2.82%, 2.66%, and 8.72%, respectively, than those at 3 months. Visual fields were significantly correlated with RNFL thickness, GCC area, and PhNR/b-wave ratio.
Visual field recovery and changes of RGCs after chiasmal decompression have similar aspects and are significantly correlated. However, prolonged retrograde degeneration progressed for some period, even after surgical decompression and visual field recovery preceded demonstrable retinal regeneration.
使用标准自动视野计（SAP）、光学相干断层扫描（OCT）和光刺激负波（PhNR）来研究视交叉减压后视野恢复和视网膜神经节细胞（RGC）变化的时间过程。
前瞻性评估 19 例接受视交叉减压手术的患者，分别在术前、术后 1 个月和 3 个月进行评估。9 例患者在术后 6 个月进行了相同的检查。分析 SAP 的平均偏差和颞侧视野敏感度（1/Lambert）、OCT 测量的视网膜神经纤维层（RNFL）厚度和节细胞复合体（GCC）面积以及 PhNR/b 波比。将术前测量值与 20 只正常对照眼进行比较。将术后测量值与术前数据进行比较。通过线性和对数回归评估整个观察期内 SAP、OCT 和 PhNR 测量值之间的关系。
术前，患者的所有参数均明显差于正常对照组。手术后，视野明显改善，但 3 个月时 RNFL 厚度和 GCC 面积明显下降。PhNR/b 波比也降低，但无统计学意义。术后 6 个月，平均 RNFL 厚度、GCC 面积和 PhNR/b 波比分别比术后 3 个月增加了 2.82%、2.66%和 8.72%。视野与 RNFL 厚度、GCC 面积和 PhNR/b 波比显著相关。
视交叉减压后视野恢复和 RGC 变化具有相似的方面，且显著相关。然而，即使在手术减压后，逆行性变性仍在一定时间内持续进展，且在视力恢复之前，视网膜再生就已经出现。
