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目的 探讨鼻咽癌放疗后并发视神经视网膜病变患者的临床特征。方法 对 34例 (68只眼 )鼻咽癌放疗后出现视功能障碍及眼底病变的患者进行视力、眼底、荧光眼底血管造影 (FFA)及视野检查。结果 眼底病变分视乳头型和视网膜型。视乳头型以视乳头水肿或苍白萎缩为主 ;视网膜型以视网膜棉绒样斑、出血、血管异常或黄斑病变为主。 34例患者中 ,65 7% (2 2 34)在放疗后 3年内出现视功能障碍及眼底病变。FFA检查 :88 1 % (59 67)的患眼视乳头有缺血影像 ,65 7% (44 67)的患眼黄斑拱环缺损 ,79 1 % (53 67)的患眼有微动脉瘤 ,53 7% (36 67)的患眼出现视网膜内毛细血管无灌注区等微循环障碍的表现 ,视野检查伴有象限缺损和不规则暗点。结论 鼻咽癌放疗后 ,首发病变为毛细血管闭塞及微循环障碍 ,继而小动、静脉闭塞或静脉阻塞 ,从而导致视乳头、黄斑及视网膜慢性缺血缺氧。视神经萎缩、黄斑缺血或新生血管膜导致玻璃体出血及视网膜脱离是鼻咽癌放疗后致盲的主要原因
Objective To investigate the clinical features of patients with nasopharyngeal carcinoma complicated with optic neuropathy after radiotherapy. Methods Visual acuity, fundus, fundus fluorescein angiography (FFA) and visual field examination were performed in 34 patients (68 eyes) with visual dysfunction and fundus lesions after radiotherapy. The results of retinopathy lesions retinal and retinal type. Optic papilla type mainly papilledema or pale atrophy; retinal lint-like spot, bleeding, vascular abnormalities or macular degeneration. Of the 34 patients, 65.7% (2 of 34) developed visual dysfunction and fundus lesions within 3 years of radiotherapy. FFA examination: 88% of 59 67 eyes had an ischemic image of the ophthalmoscope, 65 7% (44 67) had a macular arch defect, 79 1% (53 67) had a microaneurysm, 53 7% (36 67) of the affected eyes showed microcirculation disturbance such as noninvasive area of capillaries in the retina, visual field examination accompanied by quadrant defects and irregular dark spots. Conclusion After radiotherapy of nasopharyngeal carcinoma, the first lesion is capillary occlusion and microcirculation disturbance, followed by small movement, vein occlusion or vein occlusion, resulting in chronic ischemia and hypoxia of the optic nerve, macula and retina. Optic atrophy, macular ischemia or neovascular membrane lead to vitreous hemorrhage and retinal detachment is the main cause of blinding after radiotherapy of nasopharyngeal carcinoma