Sun Ming-Hui, Liao Yaping Joyce
Department of Ophthalmology (MHS, YJL), Stanford University School of Medicine, Stanford, California; and Department of Ophthalmology (MHS), Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
J Neuroophthalmol. 2017 Sep;37(3):258-264. doi: 10.1097/WNO.0000000000000521.
The optic nerve head is vulnerable to ischemia leading to anterior ischemic optic neuropathy (AION), the most common acute optic neuropathy in those older than 50 years of age.
We performed a cross-sectional study of 55 nonarteritic anterior ischemic optic neuropathy (NAION) eyes in 34 patients to assess clinical outcome and perform structure-function correlations.
The peak age of NAION onset was between 50 and 55 years. Sixty-seven percent of patients presented with their first event between the ages of 40 and 60 years, and 32% presented at ≤50 years. Those with NAION onset at age ≤50 years did not have significantly better visual outcome per logMAR visual acuity, automated perimetric mean deviation (PMD) or optical coherence tomography (OCT) measurements. Kaplan-Meier survival curve and multivariate Cox proportional regression analysis showed that age >50 years at NAION onset was associated with greater risk of second eye involvement, with hazard ratio of 20. Older age at onset was significantly correlated with greater thinning of the ganglion cell complex (GCC) (P = 0.022) but not with logMAR visual acuity, PMD, or thinning of retinal nerve fiber layer (RNFL). Using area under receiver operating characteristic curve analyses, we found that thinning of RNFL and GCC was best able to predict visual outcome, and that mean RNFL thickness >65 μm or macular GCC thickness >55 μm significantly correlated with good visual field outcome.
We showed that NAION onset at age >50 years had a greater risk of second eye involvement. Patients with OCT mean RNFL thickness >65 μm and mean macular ganglion cell complex thickness >55 μm had better visual outcomes.
视神经乳头易受缺血影响，导致前部缺血性视神经病变（AION），这是50岁以上人群中最常见的急性视神经病变。
我们对34例患者的55只非动脉性前部缺血性视神经病变（NAION）眼进行了横断面研究，以评估临床结局并进行结构-功能相关性分析。
NAION发病的高峰年龄在50至55岁之间。67%的患者首次发病年龄在40至60岁之间，32%的患者发病年龄≤50岁。发病年龄≤50岁的NAION患者，根据对数最小分辨角视力、自动视野平均偏差（PMD）或光学相干断层扫描（OCT）测量，其视力结局并无显著更好。Kaplan-Meier生存曲线和多变量Cox比例回归分析显示，NAION发病时年龄>50岁与对侧眼受累风险更高相关，风险比为20。发病时年龄较大与神经节细胞复合体（GCC）变薄更显著相关（P = 0.022），但与对数最小分辨角视力、PMD或视网膜神经纤维层（RNFL）变薄无关。通过受试者工作特征曲线下面积分析，我们发现RNFL和GCC变薄最能预测视力结局，且平均RNFL厚度>65μm或黄斑GCC厚度>55μm与良好的视野结局显著相关。
我们表明，NAION发病年龄>50岁时对侧眼受累风险更高。OCT平均RNFL厚度>65μm且平均黄斑神经节细胞复合体厚度>55μm的患者视力结局更好。
