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目的研究远达性外伤性视神经病变的眼底变化,为临床诊治提供理论依据。方法选取2003年4月至5月诊治的远达性外伤性视神经病变2例(2眼)。结果随诊3月,2例(2眼)治疗前无光感,治疗后仍无光感,VEP重度异常(WEP波幅正常,潜伏期延长)。结论远达性外伤性视神经病变,初期眼底无明显病理改变的视力丧失。它约占脑部闭合性损伤的0.5%~5%,最多见于交通事故,尤其摩托车和自行车事故最多,其次为高坠及暴力击伤所致。主要表现为头部、额部,尤其是眉弓颞上部受到撞击而产生的视力障碍。发病机制尚不十分明了,部分学者认为,与眶顶和额区的减速碰撞所致机械性牵拉,轴索断裂,传导阻滞有极大关系。但视神经血管痉挛、梗塞、压迫和撕裂引起的局部血管机能不全和血液循环障碍可能是更重要的原因。远达性外伤性视神经病变的视力恢复不可预测,手术治疗效果很难肯定,提倡早期大剂量、冲击量皮质类固醇应用对挽救视力尤为重要,同时应用活血化瘀通络、扩张眼底血管,改善视力障碍。
Objective To study the changes of ocular fundus of traumatic optic neuropathy of Yuanda and to provide theoretical basis for clinical diagnosis and treatment. Methods Two cases (2 eyes) of distal traumatic optic neuropathy diagnosed and treated from April to May 2003 were selected. Results Follow-up in March, 2 cases (2 eyes) had no light sensation before treatment, no light sensation after treatment, and severe VEP abnormality (normal WEP amplitude and prolonged latency). Conclusion As far as traumatic optic neuropathy, there is no loss of visual acuity in the early fundus. It accounts for about 0.5% ~ 5% of brain closed injuries, most often seen in traffic accidents, especially motorcycle and bicycle accidents, followed by high fall and violent wounds. Mainly for the head, forehead, especially the upper eyebrow temporal impact caused by visual impairment. The pathogenesis is not yet clear, some scholars believe that with the orbital roof and the deceleration deceleration due to mechanical traction, axonal rupture, block has a great relationship. However, local vascular insufficiency and blood circulation disorders caused by optic nerve vasospasm, infarction, oppression and tearing may be more important reasons. Vision traumatic optic neuropathy visual acuity recovery unpredictable, the effect of surgery is difficult to be sure, to promote early high-dose, impact of corticosteroid application is particularly important to save eyesight, at the same time application of blood circulation, expanding blood vessels, improve vision obstacle.