Vuong Laurel N, Hedges Thomas R
New England Eye Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
Curr Opin Ophthalmol. 2017 Nov;28(6):573-578. doi: 10.1097/ICU.0000000000000428.
Neuroophthalmologists and neurosurgeons are often asked by their patients what their visual prognosis will be after decompression of an optic chiasm lesion. Previous methods have been studied but have not provided consistent guidance. However, a recent algorithm which allows for retinal ganglion cell analysis from optical coherence tomography (OCT) may be more helpful.
Recent studies have shown that ganglion cell layer complex (GCC) measurements from OCT strongly correlate with the visual field loss associated with compressive optic neuropathies. For example, GCC measurements show corresponding binasal thinning with bitemporal hemianopia. Some investigators have also shown that more preserved GCC thickness is preoperatively associated with better postsurgical outcome. Interestingly, some patients experience almost complete recovery of visual fields despite considerable GCC thinning, and others may have GCC loss before they develop demonstrable visual field defects.
GCC measurements on OCT strongly correlate with visual field defects from optic chiasm compressive lesions and may help with regard to prognosis following treatment. However, considerable visual recovery is possible despite persistent GCC loss.
神经眼科医生和神经外科医生经常被患者问及视交叉病变减压术后的视觉预后情况。以往的方法虽已被研究,但并未提供一致的指导。然而,一种最近可通过光学相干断层扫描(OCT)对视网膜神经节细胞进行分析的算法可能更有帮助。
最近的研究表明,OCT测量的神经节细胞层复合体(GCC)与压迫性视神经病变相关的视野缺损密切相关。例如,GCC测量显示与双颞侧偏盲对应的双鼻侧变薄。一些研究者还表明,术前GCC厚度保留得越多,术后结果越好。有趣的是,一些患者尽管GCC明显变薄,但视野几乎完全恢复,而另一些患者在出现可证实的视野缺损之前可能就已经出现GCC丢失。
OCT上的GCC测量与视交叉压迫性病变导致的视野缺损密切相关,可能有助于治疗后的预后评估。然而,尽管GCC持续丢失,仍有可能实现显著的视力恢复。