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视神经萎缩早中期中医诊疗

? 视神经萎缩的简介

? ? ? ? 视神经萎缩不是一个疾病的名称,而是指任何疾病引起视网膜神经节细胞和其轴突发生病变,致使视神经全部变细的一种形成学改变,为病理学通用的名词,一般发生于视网膜至外侧膝状体之间的神经节细胞轴突变性。视神经萎缩是视神经病损的最终结果。表现为视神经纤维的变性和消失,传导功能障碍,出现视野变化,视力减退并丧失。一般分为原发性和继发性两类,针灸主要治疗原发性和炎症引起的继发性视神经萎缩。除上述症状外,眼底检查尚可见视乳头颜色为淡黄或苍白色,境界模糊,生理凹陷消失,血管变细等。 临床表现:主要表现视力减退和视盘呈灰白色或苍白。正常视盘色调是有多种因素决定的。正常情况下,视盘颞侧颜色大多数较其鼻侧为淡,而颞侧色淡的程度又与生理杯的大小有关。    婴儿视盘色常淡,或是检查时压迫眼球引起视盘缺血所致。因此不能仅凭视盘的结构和颜色是否正常诊断视神经萎缩,必须观察视网膜血管和视盘周围神经纤维层有无改变,特别是视野色觉等检查,综合分析,才能明确视盘颜色苍白的程度。   视盘周围神经纤维层病损时可出现裂隙状或楔形缺损,前者变成较黑色,为视网膜色素层暴露;后者呈较红色,为脉络膜暴露。如果损害发生于视盘上下缘区,则更易识别,因该区神经纤维层特别增厚,如果病损远离视盘区,由于这些区域神经纤维导变薄,则不易发现。视盘周围伴有局灶性萎缩常提示神经纤维层有病变,乃神经纤维层在该区变薄所致。   虽然常用眼底镜检查即可发现,但用无赤光检眼镜和眼底照像较易检查。视盘小血管通常为9~10根,如果视神经萎缩,这些小血管数目将减少。同时尚可见视网膜动脉变细和狭窄、闭塞,但该现象不是所有视神经萎缩皆有,一般球后视神经萎缩无影响,如果视神经萎缩伴有视网膜血管改变,则必须直接影响视网膜血管,才能发生视网膜血管的改变。   常用的视神经萎缩分原发性和继发性二种:前者视盘境界清晰,生理凹陷及筛板可见;后者境界模糊,生理凹陷及筛板不可见。视野检查应注意适用小的红色视标,可见中心暗点,鼻侧缺损、颞侧岛状视野、向心性视野缩小至管状视野双颞侧偏盲等。色觉障碍多为后天获得性,红绿色障碍多见,色相排列检查法优于一般检查法。眼底荧光血管造影早期意义不大,晚期可见视盘荧光减弱和后期强荧光。视觉电生理检测包括视网膜电图(ERG)、眼电图(EOG)和视诱发电位(VEP)等对诊断病情及预后等均有一定的辅助意义。 病因病理: 视神经萎缩由多种原因均可引起,常见有缺血、炎症、压迫、外伤和脱髓鞘疾病等如下: 1.颅内高压致继发性视神经萎缩 2.颅内炎症,多见于结核性脑膜炎或视交叉蛛网膜炎 3.视网膜病变 1)炎症 2)青光眼后。 3)视网膜色素变性 4)Refsum病 5)黑蒙性家族性痴呆 . 4.视神经炎和视神经病变 ⑴血管性,如缺血性视神经病变 视神经萎缩 ⑵脱髓鞘病 ⑶维生素缺乏 ⑷由于铅或其他金属类等中毒 ⑸带状疱疹 ⑹梅毒性 5.压迫性所致 6.外伤 7.代谢性疾病,如糖尿病、神经节苷脂病等 8.遗传性疾病 眼电图 9.营养性视神经萎缩 10.杂类 常规治疗措施   病因治疗为首要的。一旦视神经萎缩,要使之痊愈几乎不可能,但是其残余的神经纤维恢复或维持其功能是完全可能的。因此应使患者充满信心及坚持治疗。 常规药物治疗中常用的包括神经营养药物如维生素B1、B12、ATP及辅酶A等,血管扩张药及活血化淤药类如菸酸、地巴唑、维生素E、维脑路通、复方丹参等。近年来通过高压氧、体外反搏穴位注射654-2等均已取得一定效果。针刺治疗早已证明有效。尚应提及的是,禁止吸烟及饮烈性酒,增强机体体质,对于病情的恢复有着不可或缺的作用。 中医的辩证施治 中医称为青盲,青盲多由视瞻昏渺、高风内障等瞳神疾病日久失治演变而成。 魏氏中医眼科的治疗经验: 视神经萎缩因为具有不可逆性的特点,即视神经一旦受损,很难恢复,故我们提倡早期治疗,魏氏中医眼科魏鸿友主任多年来通过运用祖辈秘方验方,结合四十多年来临床实践对于诊疗该病早中期在控制病情发展,改善视力等方面取得了丰富的治疗经验。许多患者视力得到了恢复和改善。使许多失去治疗信心的患者重新燃起了对光明的希望,事实说明有些疾病并不是不能治疗的,关键在于诊断病因明确、抓住时机尽早治疗很关键。

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