Fukuchi Mariko, Kishi Shoji, Li Danjie, Akiyama Hideo
Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
Graefes Arch Clin Exp Ophthalmol. 2016 Dec;254(12):2355-2360. doi: 10.1007/s00417-016-3408-9. Epub 2016 Jun 14.
To report dynamic changes in the retinal ganglion cell layer (GCL) and visual function in acute and chronic optic neuritis (ON).
Sixteen eyes (15 patients) with acute ON were followed for 3.5 to 31 months (average, 10.2). The best-corrected visual acuity (BCVA) and thickness of the GCL plus the inner plexiform layer (GCL+IPL) were measured 4 to 13 times between baseline and the final visit using the ganglion cell analysis software in the Cirrus HD-OCT [high-definition optical coherence tomography] instrument. Goldmann perimetry was performed at baseline and at the final visit.
The thickness of the GCL+IPL at baseline was within normal limits in the affected (80.4 ± 4.9 microns) and unaffected fellow eyes (80.5 ± 5.0 microns). Rapid thinning to 69 ± 7.3 microns occurred during month 1 in the affected eyes, slowing during month 2, and then reaching a minimum level (63.6 ± 8.7 microns). In contrast, BCVA was lowest (mean ± standard deviation logarithm of the minimum angle of resolution, -1.29 ± 0.96) in 11 eyes at baseline, increased markedly to -0.15 ± 0.37 during month 1, and reached a maximum level (-0.18 ± 0.19) during month 2 and (-0.02 ± 0.23) at the final visit. The BCVA in the other five eyes fluctuated during month 1, increased markedly during month 2, and then reached a maximum plateau (-0.07 ± 0.20). The patterns of visual field defects at baseline were varied, and were determinants of BCVA. The visual field largely recovered in 11 eyes, but small central scotomas in four eyes and an enlarged blind spot in one eye remained at the final visit. Eyes with the least GCL+IPL thinning at month 1 or 2 had the least depression in the final deviation map.
In acute ON, the progression toward irreversible ganglion cell loss occurs rapidly during months 1 and 2. In contrast, visual function recovers rapidly during the same period. Remodeling of the neural network may occur between the photoreceptors and the reduced numbers of ganglion cells during the first months of ON. The small number of residual ganglion cells appears to compensate for the initial visual dysfunction.
报告急性和慢性视神经炎（ON）中视网膜神经节细胞层（GCL）的动态变化及视觉功能。
对16只患急性ON的眼睛（15例患者）进行了3.5至31个月（平均10.2个月）的随访。在基线期至最后一次随访期间，使用Cirrus HD-OCT[高分辨率光学相干断层扫描]仪器中的神经节细胞分析软件，对最佳矫正视力（BCVA）以及GCL加内层神经纤维层（GCL+IPL）的厚度进行了4至13次测量。在基线期和最后一次随访时进行了Goldmann视野检查。
患眼（80.4±4.9微米）和对侧未受累眼（80.5±5.0微米）在基线期时GCL+IPL的厚度均在正常范围内。患眼在第1个月迅速变薄至69±7.3微米，在第2个月变薄速度减慢，然后达到最低水平（63.6±8.7微米）。相比之下，11只眼睛在基线期时BCVA最低（最小分辨角对数的平均值±标准差，-1.29±0.96），在第1个月显著提高至-0.15±0.37，并在第2个月达到最高水平（-0.18±0.19），在最后一次随访时为（-0.02±0.23）。另外5只眼睛的BCVA在第1个月波动，在第2个月显著提高，然后达到最高平稳水平（-0.07±0.20）。基线期时视野缺损模式各异，且是BCVA的决定因素。11只眼睛的视野大部分恢复，但在最后一次随访时，4只眼睛仍有小的中心暗点，1只眼睛的盲点扩大。在第1个月或第2个月GCL+IPL变薄最少的眼睛，在最终偏差图中的凹陷最小。
在急性ON中，在第1和第2个月期间，不可逆的神经节细胞丢失进展迅速。相比之下，视觉功能在同一时期迅速恢复。在ON的最初几个月内，神经网络可能在光感受器和数量减少的神经节细胞之间发生重塑。少量残留的神经节细胞似乎可代偿最初的视觉功能障碍。
