摘要
目的 评价视神经减压术与大剂量皮质激素对外伤性视神经病变的治疗作用和影响预后的相关因素。 方法 外伤性视神经病变 40例 40只眼 ,14例施行经颅、经鼻窦内窥镜和经眶筛途径视神经减压术 ;11例应用大剂量皮质激素 (地塞米松 1mg/ kg 5例 ,甲泼尼龙 30 mg/ kg 6例 )治疗 ;15例在院外采用自选非特殊疗法治疗。根据最终视力和治疗后近期视力变化 ,评价手术、大剂量皮质激素和非特殊疗法治疗的疗效 ,并通过多因素分析筛选影响视力预后的相关因素。 结果 40例患者中最终视力无光感者 19例 ,占 47.5 % ;光感～ 0 .0 2者 12例 ,占 30 .0 % ;0 .0 5以上者 9例 ,占 2 2 .5 %。大剂量皮质激素治疗组的优势比为 2 .96 (P=0 .0 12 5 ) ,最终视力明显好于手术治疗组 (P=0 .0 0 5 )和非特殊治疗组 (P=0 .0 2 3) ;治疗后近期有效率比手术治疗组高 (P=0 .0 2 4)。伤后无光感比有光感以上视力对最终有无视力恢复的危险度增加 2 .14倍 (P=0 .0 34 9)。 结论 大剂量皮质激素对外伤性视神经病变有治疗作用 ;手术减压效果不肯定 ;外伤后无光感是视力预后不良的危险因素。
Objective [WT5”BZ]To evaluate the treatment of surgery and high dose corticosteroid relevant factors to prognosis in traumatic optic neuropathy. [WT5”HZ]Methods [WT5”BZ]Forty patients (40 eyes) with traumatic optic neuropathy were enrolled.Optic nerve decompression using transcranial approaches,sinus endoscopy and orbital ethmoidal sinus rout were performed in 14 patients.Eleven patients were treated with high dose corticosteroids (5 cases with 1 mg/kg dexamethasone,6 cases with 30 mg/kg methylprednisolone) and 15 patients received nonspecific management chose by themselves.The outcomes of visual acuity in short term and final stage were compared between surgery,high dose corticosteroid and nonspecific treatment.Multiple variable analysis was done to determine the factors affecting the outcome of visual acuity.[WT5”HZ] Results [WT5”BZ]No light perception were found in 19 cases (19 out of 44 cases,47.5%),whereas visual acuity was light perception to 0.02 in 12 cases (30.0%) and 0.05 or better in 9 cases (22.5%).The odds ratio of high dose corticosteroid to nonspecific therapy was 2.96 (P=0.0125).The final visual acuity in patients treated with high dose corticosteroid were better than other two groups (P=0.005,P=0.023,respectively).The short term (within 3 days) effective rate was higher in corticosteroid therapy group than operated group (P=0.024).No light perception following optic nerve trauma appeared to be more danger as 2.14 folds (P=0.0349) than those with light perception or better in term of final visual acuity outcome. [WT5”HZ]Conclusions High dose corticosteroid may be benefit to traumatic optic neuropathy.The treatment in traumatic optic neuropathy using optic nerve decompression needs to be determined.No light perception at initial is an important risk factor in the outcome. [WT5”HZ]
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2000年第2期75-77,共3页
Chinese Journal of Ocular Fundus Diseases
关键词
外伤性视神经病变
皮质激素
大剂量
眼外科手术
WT5”BZ]Optic nerve diseases/drug therapy
Optic nerve diseases/surgery
Optic nerve/injuries
Adrenal cortex hormones
Prognosis
