Department of Ophthalmology and Visual Sciences, Dalhousie University, and Nova Scotia Health Authority, Halifax, Canada.
PLoS One. 2023 May 18;18(5):e0286007. doi: 10.1371/journal.pone.0286007. eCollection 2023.
Post-acute non-arteritic ischemic optic neuropathy (NAION) and glaucomatous optic neuropathy (GON) can be difficult to differentiate clinically. Our objective was to identify optical coherence tomography (OCT) parameters to help differentiate these optic neuropathies.
We compared 12 eyes of 8 patients with NAION and 12 eyes of 12 patients with GON, matched for age and visual field mean deviation (MD). All patients underwent clinical assessment, automated perimetry (Humphrey Field Analyzer II; Carl Zeiss Meditec, Dublin, CA, USA), and OCT imaging (Spectralis OCT2; Heidelberg Engineering, Heidelberg, Germany) of the optic nerve head and macula. We derived the neuroretinal minimum rim width (MRW), peripapillary retinal nerve fibre layer (RNFL) thickness, central anterior lamina cribrosa depth, and macular retinal thickness.
MRW was markedly thicker, both globally and in all sectors, in the NAION group compared to the GON group. There was no significant group difference in RFNL thickness, globally or in any sector, with the exception of the temporal sector that was thinner in the NAION group. The group difference in MRW increased with increasing visual field loss. Other differences observed included lamina cribrosa depth significantly greater in the GON group and significantly thinner central macular retinal layers in the NAION group. The ganglion cell layer was not significantly different between the groups.
The neuroretinal rim is altered in a dissimilar manner in NAION and GON and MRW is a clinically useful index for differentiating these two neuropathies. The fact that the difference in MRW between the two groups increased with disease severity suggests distinct remodelling patterns in response to differing insults with NAION and GON.
急性后非动脉炎性缺血性视神经病变（NAION）和青光眼性视神经病变（GON）在临床上可能难以区分。我们的目的是确定光学相干断层扫描（OCT）参数，以帮助区分这些视神经病变。
我们比较了 8 例 NAION 患者的 12 只眼和 12 例 GON 患者的 12 只眼，这些患者的年龄和视野平均偏差（MD）相匹配。所有患者均接受临床评估、自动视野计（Humphrey Field Analyzer II；Carl Zeiss Meditec，Dublin，CA，USA）和视神经头和黄斑 OCT 成像（Spectralis OCT2；Heidelberg Engineering，Heidelberg，Germany）。我们得出了神经视网膜最小边缘宽度（MRW）、视盘周围视网膜神经纤维层（RNFL）厚度、中央前筛板深度和黄斑视网膜厚度。
与 GON 组相比，NAION 组的 MRW 在全局和所有象限中均明显增厚。除颞侧象限外，RNFL 厚度在全局或任何象限中均无明显组间差异，而颞侧象限的 NAION 组较薄。随着视野丧失的增加，组间差异增大。观察到的其他差异包括 GON 组的筛板深度明显更大，NAION 组的中央黄斑视网膜层明显变薄。两组之间的节细胞层无明显差异。
NAION 和 GON 中的神经视网膜边缘以不同的方式改变，MRW 是区分这两种神经病变的有用临床指标。两组之间的 MRW 差异随着疾病严重程度的增加而增加，这表明 NAION 和 GON 对不同损伤的反应存在不同的重塑模式。
