Garg Anubhav, Margolin Edward, Micieli Jonathan A
Faculty of Medicine (AG), University of Toronto, Toronto, Canada ; Department of Ophthalmology and Vision Sciences (EM, JAM), University of Toronto, Toronto, Canada ; Division of Neurology (EM, JAM), Department of Medicine (JAM), University of Toronto, Toronto, Canada; and Kensington Vision and Research Centre, University of Toronto, Toronto, Canada.
J Neuroophthalmol. 2022 Mar 1;42(1):e225-e229. doi: 10.1097/WNO.0000000000001340. Epub 2021 Jul 27.
To determine differential diagnosis and visual outcomes of patients with no light perception (NLP) vision related to neuro-ophthalmic conditions.
Retrospective case series of patients seen at tertiary neuro-ophthalmology practices. Patients were included if they had NLP vision any time during their clinical course. Outcome measures were final diagnosis, treatment, and visual outcome.
Seventy-two eyes of 65 patients were included. The average age was 57.6 (range 18-93) years, and 58% were women. The Most common diagnosis (21 patients) was compressive optic neuropathy (CON) with meningioma being the most common culprit (12). Other diagnoses included optic neuritis (ON) (11 patients), infiltrative optic neuropathies (8), posterior ischemic optic neuropathy (7), nonarteritic anterior ischemic optic neuropathy (4), arteritic anterior ischemic optic neuropathy (3), ophthalmic artery occlusion (3), nonorganic vision loss (3), radiation-induced optic neuropathy (2), cortical vision loss (1), retinitis pigmentosa with optic disc drusen (1), and infectious optic neuropathy (1). Ten patients recovered vision: 7 ON, 2 infiltrative optic neuropathy, and 1 CON. Corticosteroids accelerated vision recovery in 7 of the 11 patients with ON to mean 20/60 (0.48 logMAR) over 9.0 ± 8.6 follow-up months. Eleven patients deteriorated to NLP after presenting with at least LP; their diagnoses included CON (3), ophthalmic artery occlusion (2), infiltration (2), ON (1), posterior ischemic optic neuropathy (1), arteritic anterior ischemic optic neuropathy (1), and radiation-induced optic neuropathy (1).
NLP vision may occur because of various diagnoses. Vision recovery was mainly seen in patients with ON. Serious systemic conditions may present or relapse with NLP vision, which clinicians should consider as an alarming sign in patients with known malignancies.
确定无光感（NLP）且与神经眼科疾病相关的患者的鉴别诊断及视觉预后。
对在三级神经眼科诊所就诊的患者进行回顾性病例系列研究。纳入在临床过程中任何时间出现NLP视力的患者。观察指标为最终诊断、治疗及视觉预后。
纳入65例患者的72只眼。平均年龄为57.6岁（范围18 - 93岁），58%为女性。最常见的诊断（21例患者）为压迫性视神经病变（CON），其中最常见的病因是脑膜瘤（12例）。其他诊断包括视神经炎（ON）（11例患者）、浸润性视神经病变（8例）、后部缺血性视神经病变（7例）、非动脉炎性前部缺血性视神经病变（4例）、动脉炎性前部缺血性视神经病变（3例）、眼动脉阻塞（3例）、非器质性视力丧失（3例）、放射性视神经病变（2例）、皮质视力丧失（1例）、伴有视盘玻璃疣的视网膜色素变性（1例）以及感染性视神经病变（1例）。10例患者视力恢复：7例ON、2例浸润性视神经病变和1例CON。11例ON患者中有7例在平均9.0±8.6个月的随访期内，使用皮质类固醇后视力恢复至平均20/60（0.48 logMAR）。11例患者在至少出现光感（LP）后视力恶化为NLP；其诊断包括CON（3例）、眼动脉阻塞（2例）、浸润（2例）、ON（1例）、后部缺血性视神经病变（1例）、动脉炎性前部缺血性视神经病变（1例）和放射性视神经病变（1例）。
NLP视力可能由多种诊断引起。视力恢复主要见于ON患者。严重的全身性疾病可能表现为NLP视力或在NLP视力时复发，临床医生应将其视为已知恶性肿瘤患者的警示信号。
