Pless M, Lessell S
Neuro-Ophthalmology Units, Brigham and Women's Hospital, Boston, Mass, USA.
Arch Ophthalmol. 1996 Jun;114(6):704-6. doi: 10.1001/archopht.1996.01100130696010.
To describe patients with orbital apex masses involving the optic nerve who enjoyed spontaneous improvement in visual function without therapy.
A retrospective chart review of cases in an academic neuro-ophthalmology practice identified three cases of tumorous compression of the optic nerve in which there was spontaneous improvement in visual function. Each patient had undergone a full neuro-ophthalmologic evaluation, followed up with serial imaging.
The first patient initially had a visual acuity of 2/200 and central visual field defects. Over a 4-year period, her visual acuity improved to 20/40 and her visual field expanded centrally. The second patient initially had a visual acuity of 20/40 and a cecocentral visual field defect. After a 4-year follow-up, her visual acuity had improved to 20/15 and her cecocentral defect had shrunk. The third patient had an initial visual acuity of 20/25, an afferent pupillary defect, and optic atrophy. Over a 2-year period she developed a paracentral scotoma and her visual acuity worsened to 20/30. In the next 2 years her visual acuity improved to 20/10 and her visual field normalized.
In exceptional instances, visual dysfunction from tumorous compression of the optic nerve in the orbital apex may spontaneously improve. Clinicians who use the natural history of visual loss in differential diagnosis should be aware that spontaneous remission is compatible with the presence of tumor.
描述患有累及视神经的眶尖肿物且未经治疗视觉功能却自发改善的患者。
对一家学术性神经眼科诊所的病例进行回顾性病历审查，确定了3例视神经肿瘤性压迫且视觉功能自发改善的病例。每位患者均接受了全面的神经眼科评估，并进行了系列影像学检查。
首例患者最初视力为2/200，有中心视野缺损。在4年期间，其视力提高到20/40，中心视野扩大。第二例患者最初视力为20/40，有中心暗点性视野缺损。经过4年随访，其视力提高到20/15，中心暗点缩小。第三例患者最初视力为20/25，有传入性瞳孔障碍和视神经萎缩。在2年期间，她出现旁中心暗点，视力恶化为20/30。在接下来的2年里，她的视力提高到20/10，视野恢复正常。
在特殊情况下，眶尖视神经肿瘤性压迫导致的视觉功能障碍可能会自发改善。在鉴别诊断中利用视力丧失自然病程的临床医生应意识到，自发缓解与肿瘤的存在是相符的。
