Sergott R C, Cohen M S, Bosley T M, Savino P J
Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pa 19107.
Arch Ophthalmol. 1989 Dec;107(12):1743-54. doi: 10.1001/archopht.1989.01070020825022.
Optic nerve sheath decompression surgery improved visual function for 12 of 14 patients with progressive nonarteritic ischemic optic neuropathy (NAION). Visual recovery was maintained in all patients during a follow-up period of 6 to 18 months (average, 11 months). Seven patients had experienced a previous NAION in the eye that was not operated on that did not improve spontaneously. Surprisingly, 2 of these 7 eyes with long-standing decreased vision demonstrated some visual improvement after surgery on the contralateral, acutely affected eye. Spontaneous visual improvement did not occur in an age- and sex-matched control group of 12 patients with similar entry-level visual acuity and field loss. Only 1 of 3 patients with sudden, nonprogressive visual loss secondary to NAION improved after surgery. In a control group with nonprogressive NAION, 2 of 15 eyes (14 patients) demonstrated spontaneous improvement. Optic nerve sheath decompression improves visual loss due to progressive NAION, a disorder without any previously effective therapy. However, for acute, nonprogressive NAION, surgery for a small number of patients did not improve the natural history of the disease.
视神经鞘减压手术使14例进行性非动脉炎性缺血性视神经病变（NAION）患者中的12例视觉功能得到改善。在6至18个月（平均11个月）的随访期内，所有患者的视力恢复情况均得以维持。7例患者在未接受手术治疗的患眼中曾发生过一次NAION，且视力未自发改善。令人惊讶的是，这7例长期视力下降的患眼中，有2例在对侧急性受累眼接受手术后视力出现了一定程度的改善。在一个年龄和性别匹配的对照组中，12例患者具有相似的初始视力和视野缺损情况，但未出现自发的视力改善。3例因NAION导致突发、非进行性视力丧失的患者中，只有1例术后视力得到改善。在非进行性NAION的对照组中，15只眼（14例患者）中有2只眼出现了自发改善。视神经鞘减压可改善因进行性NAION导致的视力丧失，此前该疾病并无有效的治疗方法。然而，对于急性、非进行性NAION，少数患者接受手术并未改变疾病的自然病程。
