ISSN 1673-3770 CN 37-1437/R
山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (4): 56-59.doi: 10.6040/j.issn.1673-3770.1.2020.051
• 眼缺血综合征多学科精准诊疗 临床研究 • 上一篇 下一篇
王宗沂,曲进锋
To explore the best method for diagnosis and treatments of post-surgical posterior ischemic optic neuropathy(PION). MethodsReview the medical records of a 78-year-old female patient who presented with sudden vision loss in her right eye on the fourth day after phacoemulsification and implantation of a posterior chamber intraocular lens in other hospital. After the electrophysiological examination and fundus fluorescein angiography, the patient was diagnosed as posterior ischemic optic neuropathy after cataract surgery in his right eye. She was administered with a retrobulbar injection of Anisodamine and placed on steroid pulse therapy. ResultsOn the 19th day after treatment, her visual acuity had recovered to 0.05. ConclusionThis is a rare case, and since post-surgical posterior ischemic optic neuropathy(PION)has no definite and effective treatment yet, active vigilance should be maintained before surgery. Detailed systemic history and physical examination are important for patients with high risks of developing PION, especially for evaluating their systemic hemodynamics. To sum up, PION should be considered in patients who have sudden severe vision loss and/or visual field defects with no obvious changes in the fundus after excluding other optic nerve diseases.
摘要： 目的 探讨手术相关性后部缺血性视神经病变诊断及治疗的最佳方法。 方法 复习1例78岁女性患者的病历资料。其于外院行白内障超声乳化联合后房型人工晶体植入术后4 d,诉右眼突发视力下降而就诊,经眼电生理检查及眼底荧光素血管造影,诊断为右眼白内障术后后部缺血性视神经病变,行右球后注射山莨菪碱及激素冲击治疗。 结果 治疗第19天右眼视力恢复至0.05。 结论 此为一罕见病例,且由于后部缺血性视神经病变(PION)尚无确切有效的治疗方法,应于术前警惕本病的发生,对PION高危患者详细询问病史并对其做必要的全身检查,特别是评估其全身血管血流动力学情况非常重要。对于中老年人突发视力急剧严重下降伴或不伴视野缺损,眼底又无明显改变者,在排除其他原因导致的视神经疾病后,应考虑PION的可能。
中图分类号:
| [1] | Teja S, Patel VR. Ischemic optic neuropathies: diagnosis and management[J]. Int Ophthalmol Clin, 2019, 59(3): 39-57. doi:10.1097/IIO.0000000000000282. |
| [2] | 程蓓, 王启常. 后部缺血性视神经病变的研究进展[J]. 国际眼科杂志, 2017, 17(9): 1682-1684. doi:10.3980/j.issn.1672-5123.2017.9.19. CHENG Bei, WANG Qichang. Research advance of posterior ischemic optic neuropathy[J]. International Eye Science, 2017;17(9):1682-1684. doi:10.3980/j.issn.1672-5123.2017.9.19. |
| [3] | Reddy A, Foroozan R, Edmond JC, et al. Dilated superior ophthalmic veins and posterior ischemic optic neuropathy after prolonged spine surgery[J]. J Neuroophthalmol, 2008, 28(4): 327-328. doi:10.1097/WNO.0b013e318175c86c. |
| [4] | Maramattom BV, Sundar S, Thomas D, et al. Postoperative posterior ischemic optic neuropathy(Pion)following right pterional meningioma surgery[J]. Ann Indian Acad Neurol, 2016, 19(3): 374-376. doi:10.4103/0972-2327.186826. |
| [5] | 武艳燕, 韦企平. 脊柱手术后双眼后部缺血性视神经病变1例[J]. 中国中医眼科杂志, 2016,26(3):165-6. doi:10.13444/j.cnki.zgzyykzz.2016.03.007. |
| [6] | Khan AA, Hussain SA, Khan M, et al. MRI findings of bilateral posterior ischemic optic neuropathy in postcardiac transplant patient[J]. Neurologist, 2012, 18(5): 313-315. doi:10.1097/NRL.0b013e3182675360. |
| [7] | Berg KT, Harrison AR, Lee MS. Perioperative visual loss in ocular and nonocular surgery[J]. Clin Ophthalmol, 2010, 4: 531-546. doi:10.2147/opth.s9262. |
| [8] | Becker EJ, Herwig MC, Holz FG, et al. Orbital metastasis of a previously unknown lung carcinoma mimicking posterior ischemic optic neuropathy[J]. Ophthalmologe, 2015, 112(6): 525-528. doi:10.1007/s00347-014-3176-z. |
| [9] | Lysandropoulos AP, Carota A. Diagnostic pitfalls: posterior ischemic optic neuropathy mimicking optic neuritis[J]. Clin Neurol Neurosurg, 2011, 113(2): 162-163. doi:10.1016/j.clineuro.2010.10.002. |
| [10] | 田国红, 孙兴怀. 压迫性视神经病的诊断要点[J]. 中国眼耳鼻喉科杂志, 2015, 15(1): 65-70. doi: 10.14166/j.issn.1671-2420.2015.01.025. |
| [11] | 李锐, 李勇, 谢洪涛, 等. 眼压波动对人工晶体植入术患者眼底黄斑及视盘血流密度的影响分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 89-92. doi: 10.6040/j.issn.1673-3770.0.2019.280. LI Rui, LI Yong, XIE Hongtao, et al. Effects of intraocular lens implantation and postoperative intraocular pressure fluctuations on the fundus macular and optic disc vascular density[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 89-92. doi: 10.6040/j.issn.1673-3770.0.2019.280. |
| [12] | Hayreh SS. Ischemic optic neuropathies—where are we now?[J]. Albrecht Von Graefes Arch Fur Klinische Und Exp Ophthalmol, 2013, 251(8): 1873-1884. doi:10.1007/s00417-013-2399-z. |
| [13] | Hayreh SS. Management of ischemic optic neuropathies[J]. Indian J Ophthalmol, 2011, 59(2): 123-136. doi:10.4103/0301-4738.77024. |
| [1] | 张国民,王茂华,高松,吴文斌,虞幼军. 持续灌流模式耳内镜下粘连性中耳炎手术疗效分析[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 16-19. |
| [2] | 王新萌,姬俊雅,于浩南,付鸿臣,王翔,郑泽坤,李艳,钟莹莹. 急性闭角型青光眼超声乳化联合房角分离术后屈光预测准确性分析[J]. 山东大学耳鼻喉眼学报, 2026, 40(2): 74-79. |
| [3] | 卢朝阳, 翟兆雪, 王慧康, 邵丽婷, 张宇. 新冠肺炎治疗引发糖尿病酮症酸中毒合并鼻眶脑型毛霉菌病1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 90-94. |
| [4] | 高娟娟,许嘉,陈雯婧,梁思超,郭振平,陈俊言,郭翔,伊海金. 保留面神经功能的面神经鞘瘤次全切除手术治疗[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 8-16. |
| [5] | 刘玉柱,陈尧,苑铁君,李春森,李波. 喉纤维肉瘤1例并相关文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 133-137. |
| [6] | 陈涛,姜洋,李莹. SMILE矫正PRK术后屈光回退1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 148-153. |
| [7] | 黄旗,邓旭雯,王佩佩,陈烨群,古学军. 基于EyeSi手术模拟器评估眼科医师白内障手术水平[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 83-88. |
| [8] | 汪盛,黄旭东. 铁死亡与年龄相关性白内障的研究新进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 161-168. |
| [9] | 王再兴,唐志元,李定波,石照辉,曾宪海,张秋航. 鼻咽癌放疗后肿瘤复发及颅底骨坏死引起颈内动脉破裂的治疗方案[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 49-58. |
| [10] | 孙芳,谢楚波,邱前辉. 营养指标对鼻咽癌放射性颅底坏死患者创面修复影响的回顾性分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 59-68. |
| [11] | 姜知临,朱瑞楷,邱前辉. 基于影像学对咽旁颈内动脉走行的观察与分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 69-76. |
| [12] | 吴家荣,邱前辉. 颅底筋膜组织在早期复发性鼻咽癌内镜手术中的临床意义[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 108-113. |
| [13] | 郭荣昌,刘晴航,王洪增,孙树军. 巨大鼻眼贯通、颅底嵌顿异物损伤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 135-141. |
| [14] | 张中华,王辉,王俊鑫,张美玲,张建,张恩东,潘新良. 腋窝入路腔镜手术和传统颈部开放手术治疗T1甲状腺癌的安全性和有效性对比研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 161-167. |
| [15] | 邹嵩,许保源,张金星,陈巧婷,李健祥. ABCLOVE嗓音训练法对声带良性增生性病变手术患者嗓音功能的影响[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 32-37. |
|
||