Chen Y, Xue X, Liu F J, Wang S R, Zhou C, Wang M Z, Zhang X X
Department of Ophthalmology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Department of Ophthalmology, Beijing Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Zhonghua Yi Xue Za Zhi. 2023 Jan 31;103(4):259-264. doi: 10.3760/cma.j.cn112137-20220910-01918.
To compare the therapeutic effects of optic nerve sheath fenestration (ONSF) and medication on papilledema induced by cerebral venous thrombosis (CVT). Patients with papilledema induced by CVT in Beijing Tiantan Hospital and Xuanwu Hospital from January 2017 to July 2022 were retrospectively enrolled and were divided into two groups according to the treatment strategies they underwent, with 76 cases (107 eyes) in ONSF group and 35 cases (69 eyes) in medication group. The degree of papilledema was evaluated by the modified Frisén's grading (grade 0-1 was defined as mild, grade 2-3 was moderate, and grade 4-5 was severe edema). The mean defect (MD) of visual field, the degree of papilledema, and the mean retinal nerve fiber layer (RNFL) thickness in different subgroups were compared between baseline versus 1 month after ONSF or medication. There were 76 cases in ONSF group (26 males and 50 females), and aged (35.3±11.4) years. Meanwhile, there were 35 cases in medication group (22 males and 13 females), and aged (35.2±11.0) years. Compared with baseline, MD were improved in both moderate [(-8.4±6.6) vs (-11.8±8.6) db, =0.021] and severe [(-8.1±5.3) vs (-11.4±6.9) db, <0.001] papilledema subgroups after ONSF, while there was an improvement in mild papilledema subgroup [(-1.5±5.3) vs (-3.4±5.1) db, <0.001] after medication. The papilledema (Frisén's scores) in both ONSF group (<0.001) and medication group (=0.010) was improved. Compared with baseline, the mean RNFL decreased in mild [(78.5±13.5) vs (91.0±17.4) μm, =0.002], moderate [(126.6±67.6) vs (154.8±77.9) μm, =0.011] and severe [(179.0±70.9) vs (230.6±89.7) μm, =0.001] papilledema subgroups after ONSF, while the mean RNFL decreased [(142.0±29.3) vs (158.8±22.7) μm, =0.020] in moderate papilledema subgroup after medication. ONSF might attenuate CVT-mediated papilledema, and improve the visual function in patients with moderate and severe papilledema. Likewise, patients with mild papilledema could also get benefit from medication.
比较视神经鞘开窗术（ONSF）与药物治疗对脑静脉窦血栓形成（CVT）所致视乳头水肿的疗效。回顾性纳入2017年1月至2022年7月在北京天坛医院和宣武医院因CVT导致视乳头水肿的患者，根据其接受的治疗策略分为两组，ONSF组76例（107只眼），药物治疗组35例（69只眼）。采用改良的弗里森分级法评估视乳头水肿程度（0 - 1级定义为轻度，2 - 3级为中度，4 - 5级为重度水肿）。比较ONSF或药物治疗前基线与治疗1个月后不同亚组的视野平均缺损（MD）、视乳头水肿程度及视网膜神经纤维层（RNFL）平均厚度。ONSF组76例（男26例，女50例），年龄（35.3±11.4）岁。同时，药物治疗组35例（男22例，女13例），年龄（35.2±11.0）岁。与基线相比，ONSF术后中度[（-8.4±6.6）dB对（-11.8±8.6）dB，P = 0.021]和重度[（-8.1±5.3）dB对（-11.4±6.9）dB，P < 0.001]视乳头水肿亚组的MD均改善，而药物治疗后轻度视乳头水肿亚组[（-1.5±5.3）dB对（-3.4±5.1）dB，P < 0.001]的MD改善。ONSF组（P < 0.001）和药物治疗组（P = 0.010）的视乳头水肿（弗里森评分）均改善。与基线相比，ONSF术后轻度[（78.5±13.5）μm对（91.0±17.4）μm，P = 0.002]、中度[（126.6±67.6）μm对（154.8±77.9）μm，P = 0.011]和重度[（179.0±70.9）μm对（230.6±89.7）μm，P = 0.001]视乳头水肿亚组的RNFL平均厚度降低，而药物治疗后中度视乳头水肿亚组的RNFL平均厚度降低[（142.0±29.3）μm对（158.8±22.7）μm，P = 0.020]。ONSF可能减轻CVT介导的视乳头水肿，并改善中度和重度视乳头水肿患者的视觉功能。同样，轻度视乳头水肿患者也可从药物治疗中获益。
