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目的归纳乙胺丁醇中毒性视神经病变(EON)患者的临床特点,并探讨其预后。设计回顾性病例系列。研究对象2011年6月至2015年6月解放军总医院EON患者18例36眼。方法分析所有入组患者的病例资料,记录其人口学特征、临床表现。跟踪随访6~50个月,进一步分析其预后。主要指标人口学特征、矫正视力、色觉、视野、视网膜神经纤维层(RNFL)厚度、视觉诱发电位(VEP)、结核病侵袭部位及预后。结果平均发病年龄(40.56±12.57)岁,全部为双眼发病,其中男性11例(61.1%)。30眼(83.3%)色觉障碍。17例双眼视野缺损类型一致,23眼(63.9%)呈中心视野缺损。初诊时矫正视力0.09±0.59(手动~0.25)。乙胺丁醇每日剂量(17.06±5.62)mg/kg,服用时间(5.97±5.12)个月。随访时间(30.27±16.18)个月。停乙胺丁醇后,6例(33.3%)患者视力较前提高(初始视力0.17±0.67 vs.治疗后视力0.33±0.49),视力改善(6例)和视力未改善(12例)的两组患者之间的每日服药剂量分别为(13.31±3.98)mg/kg和(18.50±3.15)mg/kg(P=0.037)。随访中8例(16眼)复查相干光断层扫描,视盘颞侧、上方、鼻侧所对应的RNFL不同程度较前变薄。结论乙胺丁醇中毒性视神经病变多见于中老年男性,易累及双眼,约1/3的患者停药同时给予治疗后视力可好转。
Objective To summarize the clinical features of patients with etomidate toxic optic neuropathy (EON) and to investigate their prognosis. Design retrospective case series. Subjects From June 2011 to June 2015, 18 patients with EON in PLA General Hospital were enumerated. Methods All patients were enrolled in the study, and their demographic characteristics and clinical manifestations were recorded. Follow-up 6 to 50 months, further analysis of its prognosis. MAIN INDICATIONS Demographic characteristics, corrected visual acuity, color vision, visual field, thickness of retinal nerve fiber layer (RNFL), visual evoked potential (VEP), tuberculosis invasion site and prognosis. Results The average age of onset was (40.56 ± 12.57) years old, all of whom had binocular disease, including 11 males (61.1%). 30 eyes (83.3%) with color vision disorders. Seventeen eyes had the same type of defect, and 23 eyes (63.9%) had central visual field defect. The corrected visual acuity was 0.09 ± 0.59 (manual ~ 0.25) at first visit. Ethambutol daily dose (17.06 ± 5.62) mg / kg, taking time (5.97 ± 5.12) months. Follow-up time (30.27 ± 16.18) months. Six patients (33.3%) had higher vision (0.17 ± 0.67 vs 0.33 ± 0.49 vs 0.33 ± 0.49, respectively), improved visual acuity (6), and uncorrected visual acuity (12) after ethambutol was stopped The daily dose was 13.31 ± 3.98 mg / kg and 18.50 ± 3.15 mg / kg, respectively (P = 0.037). Follow-up in 8 cases (16 eyes) review of coherent light tomography, optic disc temporal, upper, nasal corresponding RNFL thinner than before. Conclusion Ethambutol toxic optic neuropathy more common in middle-aged men, easy to affect both eyes, about 1/3 of patients with withdrawal while given treatment can improve visual acuity.