Bartz-Schmidt K U, Schmitz-Valckenberg P
Augenabteilung, Koblenz, Bundesrepublik Deutschland.
Fortschr Ophthalmol. 1990;87(5):467-70.
Two patients with optic nerve disease are reported. The first patient was 20 years old and had suffered a closed head injury 1 year earlier. She presented with an incongruous right hemianopsia; retinal nerve fiber layer photography disclosed an infragenicular lesion and descending atrophy of the medial postchiasmal parts of the optic tract. The second patients was 24 years old. He had had depressed visual acuity in his right eye for 7 h before presentation. Perimetry showed a quadrant anopsia of the lower nasal field. The diagnosis made on the basis of fluorescein-angiography was recurrent retinochorioiditis with acute occlusion of an arterial branch. Retinal nerve fiber layer photography in this early stage showed a more pronounced nerve fiber pattern in the area normally supplied by the occluded artery, most probably caused by axoplasmic edema; along the course nerve fibers showed ascending atrophy in this circumscribed area. In both cases papillometry had given no evidence of any alteration in the area of the neuroretinal rim. In contrast to glaucomatous optic atrophy, localized disturbances of perfusion apparently cannot be detected by examination of the area of the neuroretinal rim of the optic nerve. In nonglaucomatous optic nerve diseases retinal nerve fiber layer photography is more informative.
报告了两名视神经疾病患者。第一名患者20岁，1年前曾遭受闭合性头部损伤。她表现为不对称性右侧偏盲；视网膜神经纤维层摄影显示视束膝下病变及视交叉后内侧部分下行性萎缩。第二名患者24岁。就诊前右眼视力下降7小时。视野检查显示下鼻象限盲。荧光素血管造影诊断为复发性视网膜脉络膜炎伴动脉分支急性闭塞。在这个早期阶段，视网膜神经纤维层摄影显示在正常由闭塞动脉供血的区域神经纤维模式更为明显，很可能是由轴浆水肿引起；沿神经纤维走行，在这个局限性区域可见上行性萎缩。在这两个病例中，视乳头测量均未显示神经视网膜边缘区域有任何改变。与青光眼性视神经萎缩不同，通过检查视神经的神经视网膜边缘区域显然无法检测到局部灌注障碍。在非青光眼性视神经疾病中，视网膜神经纤维层摄影提供的信息更多。
