Beardsley T L, Brown S V, Sydnor C F, Grimson B S, Klintworth G K
Am J Ophthalmol. 1984 Jan;97(1):62-77. doi: 10.1016/0002-9394(84)90447-1.
Of 11 patients (eight women and three men, ranging in age from 16 to 48 years) who had sarcoidosis of the optic nerve that caused decreased visual acuity and visual field abnormalities, only two were known to have sarcoidosis at the time the visual impairment developed. Four patients had granulomas involving the optic nerve head, four had granulomatous inflammation of the orbital or intracranial optic nerve or chiasm, and three had retrobulbar neuritis. All 11 patients had histologically confirmed idiopathic noncaseating granulomatous inflammation and eight of the 11 had abnormalities compatible with sarcoidosis in chest roentgenograms. In the three patients in whom the serum level of angiotensin-converting enzyme was determined, it was increased in one and normal in the other two. Computed tomography of the anterior visual pathways was the single most useful neurodiagnostic study. Treatment with corticosteroids was beneficial in six of the 11 cases. These cases demonstrated that sarcoidosis should be included in the differential diagnosis of any inflammatory or compressive lesion involving the anterior visual pathways.
11例视神经结节病患者（8名女性和3名男性，年龄在16至48岁之间）出现视力下降和视野异常，其中仅2例在视力损害出现时已知患有结节病。4例患者的肉芽肿累及视神经乳头，4例患者的眶内或颅内视神经或视交叉有肉芽肿性炎症，3例患者患有球后视神经炎。所有11例患者经组织学证实均为特发性非干酪性肉芽肿性炎症，11例中有8例胸部X线片显示有与结节病相符的异常表现。在测定了血清血管紧张素转换酶水平的3例患者中，1例升高，另2例正常。计算机断层扫描是前视觉通路最有用的单一神经诊断检查。11例中有6例使用皮质类固醇治疗有效。这些病例表明，结节病应纳入涉及前视觉通路的任何炎症性或压迫性病变的鉴别诊断中。
