轻型间接视神经损伤的临床诊断分析

目的对轻型间接视神经损伤的临床特点进行分析。方法回顾性分析我院2009年1月-2012年4月的11例轻型间接视神经损伤临床特点，包括患者的主诉、受伤特点、眼部体征（视力、瞳孔、眼底变化）及辅助检查（视野、视觉诱发电位）并对治疗效果进行总结。结果11例病例的临床特点：患者有患侧颞部及眶区的直接损伤史的受伤特点；视力下降轻；患眼相对传入性瞳孔阻滞（relativeafferentpupillarydefect，RAPD）阳性；视野：检查有普遍光敏感度下降现象及中心暗点或旁中心暗点或视野缺损；视觉诱发电位（visual-evokedpotential，VEP）示有波幅下降或稍下降或时间延迟；眼眶CT及颅脑CT检查阴性。药物治疗后11例患者复查视野、视觉诱发电位较前改善甚至恢复，其中8例急性外伤患者视力得到完全恢复，3例视力得到明显提高。结论通过对患者主诉、特点、瞳孔异常、视野和视觉诱发电位的分析，能有效的诊断有无视神经的轻度损伤，早期诊治有助于视力恢复。

CLINICAL ANALYSIS OF SLIGHTLY INDIRECT OPTIC NERVE INJURY

Objective： To analyze and summarize the clinical characteristics of slightly indirect optic nerve injury. Methods： A retrospective analysis of the clinical characteristics of 11 cases of light indirect optic nerve injury from January 2009 to April 2012 was done, including the patients＇ chief complaints, injury characteristics, eye signs （visual acuity, pupil, fundus changes）, and laboratory examinations （vision, visual-evoked potential） and the therapeutic effects was summarized. Results： The clinical features of the 11 cases are as follow, patients having direct injuries of the ipsilateral temporal and orbitofrontal area; slight vision loss; relative afferent pupillary defect, RAPD positive of the injured eye; visual field： universal light sensitivity decline and center or pericentral scotoma or visual field defects; visual-evoked potential （VEP） shows decreased or slightly decreased amplitude or time delay; orbital CT or brain CT is negative. After drug treatment, reexamination of the 11 cases showed recovery of vision and visual evoked potential, or even better than before, including 8 cases full recovery and 3 cases visual acuity significantly improved. Conclusion： It is effective to diagnose the mild optic nerve injury by analyzing the characteristics of patients＇ chief complaints, pupil abnormalities, vision and visual-evoked potential,＇ early diagnosis will be beneficial to vision recovery.