Gaze Evoked Deformations of the Peripapillary Retina in Papilledema and Ischemic Optic Neuropathy
Gaze Evoked Deformations of the Peripapillary Retina in Papilledema and Ischemic Optic Neuropathy
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DOI：
10.1167/iovs.16-19931
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发表时间：
2016-09-01
影响因子：
4.4
通讯作者：
Sibony, Patrick A.
中科院分区：
文献类型：
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作者：
Sibony, Patrick A.
目的.研究水平眼球运动对视乳头水肿、前部缺血性视神经病变（AION）患者和正常眼的视乳头周围基底膜层（ppBM层）形态的影响。使用视神经的谱域光学相干断层扫描（SD-OCT）轴向光栅来分析ppBM层的形状。我们比较了80例患者（45例视乳头水肿，15例AION和20例正常眼）两种眼位（内收10度至15度和外展30度至40度）的注册图像。水平眼球运动会导致视乳头水肿患者的ppBM层出现相对“跷跷板状”形状变形。内收时，基底膜开口（BMO）的颞侧有相对的后移位，鼻侧有相对的前移位（P = 0.001）。绑架时的模式正好相反。正常眼和AION显示相似但较小的形状变化，主要影响内收时的颞侧。正常眼与AION的形态差异有统计学意义（P = 0.03），AION的形态差异有统计学意义（P = 0.01）。水平眼球运动影响ppBM层的形状。内收时，正常和AION的变形导致BMO颞侧的后移位。相比之下，视乳头水肿的变形更大，涉及颞侧和鼻侧，可能是因为脑脊液压力对巩膜凸缘的变化和视神经鞘的液压硬化。凝视引起的变形的临床重要性是未知的，但重复运动可能是各种视神经病变的发生或进展的一个因素。
PURPOSE. To examine the effects of horizontal eye movements on the shape of the peripapillary basement membrane layer (ppBM layer) in patients with papilledema, anterior ischemic optic neuropathy (AION) and normal eyes.METHODS. Spectral-domain optical coherence tomography (SD-OCT) axial rasters of the optic nerve were used to analyze the shape of the ppBM layer. We compared registered images in two eye positions: 10 degrees to 15 degrees of adduction and 30 degrees to 40 degrees of abduction from 80 patients (45 with papilledema, 15 with AION, and 20 normal eyes).RESULTS. Horizontal eye movements induce a relative "seesaw-like" shape deformation of the ppBM layer in patients with papilledema. On adduction, there is a relative posterior displacement temporal to the basement membrane opening (BMO) and an anterior displacement nasally (P = 0.001). The pattern reverses in abduction. Normal eyes and AION display similar but smaller changes in shape predominantly affecting the temporal side on adduction. The shape difference was significantly different for normal eyes (P = 0.03) and for AION (P = 0.01).CONCLUSIONS. Horizontal eye movements affect the shape of the ppBM layer. The deformation in normals and AION, in adduction, causes posterior displacement temporal to the BMO. In contrast, the deformations in papilledema are larger, involving temporal and nasal sides, presumably because of shifts in cerebrospinal fluid pressure against the scleral flange and hydraulic stiffening of the optic nerve sheath. The clinical importance of gaze-induced deformations is unknown but repetitive motion may be a factor in the genesis or progression of a variety of optic neuropathies.