Visual Neurophysiology and Neurophthalmology Unit, IRCCS - Fondazione Bietti, Via Livenza 1, 00198, Rome, Italy.
Graefes Arch Clin Exp Ophthalmol. 2021 May;259(5):1297-1308. doi: 10.1007/s00417-020-05023-w. Epub 2021 Jan 7.
To study whether there is a correlation between the macular and optic nerve morphological condition and the retinal ganglion cells (RGCs) and visual pathways' function, and to investigate whether visual acuity (VA) changes might be related to the morpho-functional findings in chronic non-arteritic ischemic optic neuropathy (NAION).
In this retrospective study, 22 patients (mean age 62.12 ± 6.87) with chronic unilateral NAION providing 22 affected and 22 fellow eyes without NAION (NAION-FE), and 20 (mean age 61.20 ± 7.32) healthy control subjects were studied by spectral domain optical coherence tomography (Sd-OCT) for investigating macular thickness (MT) and volume (MV) of the whole (WR), inner (IR) and outer retina (OR), and the peripapillary retinal nerve fiber layer thickness (RNFL-T) measured overall and for all quadrants. Also, simultaneous 60' and 15' pattern electroretinogram (PERG) and visual evoked potentials (VEP) and VA were assessed. Differences of MT and MV of WR, IR, OR, and RNFL-T overall and for all quadrants, PERG amplitude (A), VEP implicit time (IT), and A and VA values between NAION eyes and controls were assessed by one-way analysis of variance. Pearson's test was used for regression analysis. A p value < 0.01 was considered as significant.
In NAION eyes as compared to NAION-FE eyes and controls, significant (p < 0.01) changes of MT, MV of WR and IR, RNFL-T, 60' and 15' PERG A, VEP IT and A, and VA were found. No significant (p > 0.01) OR changes were observed between groups. In NAION eyes, significant (p < 0.01) correlations between MV of WR and IR and 15' PERG A were found. Overall, RNFL-T values were significantly correlated (p < 0.01) with those of 60' PERG A and VEP IT and A; temporal RNFL-T values were correlated (p < 0.01) with 15' PERG A and VEP IT and A ones. Temporal RNFL-T, MV-IR, and 15' PERG A as well as VEP IT were significantly (p < 0.01) correlated with VA. Significant (p < 0.01) linear correlations between 60' and 15' PERG A findings and the corresponding values of 60' and 15' VEP A were also found.
Our findings suggest that in chronic NAION, there is a morpho-functional impairment of the IR, with OR structural sparing. VA changes are related to the impaired morphology and function of IR, to the temporal RNFL-T reduction and to the dysfunction of both large and small axons forming the visual pathway.
研究黄斑和视神经形态状况与视网膜神经节细胞（RGCs）和视觉通路功能之间是否存在相关性，并探讨慢性非动脉炎性前部缺血性视神经病变（NAION）中视力（VA）变化是否与形态-功能发现有关。
在这项回顾性研究中，研究了 22 名（平均年龄 62.12±6.87 岁）患有慢性单侧 NAION 的患者，这些患者提供了 22 只受累眼和 22 只无 NAION 的对侧眼（NAION-FE），以及 20 名（平均年龄 61.20±7.32 岁）健康对照组，通过频域光学相干断层扫描（Sd-OCT）研究整个视网膜（WR）、内视网膜（IR）和外视网膜（OR）的黄斑厚度（MT）和体积（MV），以及整个和所有象限的视盘周围视网膜神经纤维层厚度（RNFL-T）。同时，还评估了同步 60'和 15' 图形视网膜电图（PERG）和视觉诱发电位（VEP）以及 VA。通过单因素方差分析评估 NAION 眼与对照组之间 WR、IR、OR 和 RNFL-T 整体和所有象限的 MT 和 MV、PERG 振幅（A）、VEP 潜伏期（IT）以及 A 和 VA 值的差异。Pearson 检验用于回归分析。p 值<0.01 被认为具有统计学意义。
与 NAION-FE 眼和对照组相比，NAION 眼的 MT、WR 和 IR 的 MV、RNFL-T、60' 和 15' PERG A、VEP IT 和 A、以及 VA 发生了显著（p<0.01）变化。各组之间未观察到 OR 显著（p>0.01）变化。在 NAION 眼中，WR 和 IR 的 MV 与 15' PERG A 之间存在显著（p<0.01）相关性。总体而言，RNFL-T 值与 60' PERG A 和 VEP IT 和 A 值显著相关（p<0.01）；颞侧 RNFL-T 值与 15' PERG A 和 VEP IT 和 A 值显著相关（p<0.01）。颞侧 RNFL-T、MV-IR 和 15' PERG A 以及 VEP IT 与 VA 显著相关（p<0.01）。60' 和 15' PERG A 发现与相应的 60' 和 15' VEP A 值之间存在显著（p<0.01）线性相关性。
我们的研究结果表明，在慢性 NAION 中，IR 存在形态和功能损伤，OR 结构保持完好。VA 变化与 IR 的形态和功能受损、颞侧 RNFL-T 减少以及形成视觉通路的大、小轴突功能障碍有关。
