垂体腺瘤的中心视野与误诊分析

目的 分析垂体腺瘤患者双眼的中心视野及其后极部的眼底改变。 方法 应用Humphrey instruments 750型电脑视野分析仪和TopconTRC-50x眼底照相机，对手术前70例垂体腺瘤患者行全阈值静态中心视野及眼底检查。 结果 视力损害者占64.3%，视野损害者占80.7%，眼底改变者占46.4%。而以视力减退为首诊症状者占45.7%，其中28.6%曾被误诊为眼科疾病。 结论 误诊因素主要是患者以视力减退为首诊症状，且多无视野缺 损主诉及同时伴有眼科疾病症状。因此，在眼科临床诊断过程中，对于原因不明的视力下降和解释不清的视神经萎缩，均应把视野作为常规检查，避免漏诊、误诊。 （中华眼底病杂志，2003，19：18-19）     

垂体腺瘤视功能损害与误诊分析

垂体腺瘤是较常见的颅内良性肿瘤，因在患病过程中常伴有对视方面的损害而易误诊。通过对２６０例患者的临床观察。其中视力损害者占７２．５％，视野损害者占６３．３％，而以视力减退为首诊症状者占４４．６％，其中２２．４％曾被误诊为眼科疾病，误诊因素主要是患者以视力减退为首诊症状，垂体瘤的全身症状不典型及在患垂体瘤的同时伴有某些眼部疾病，基于上述因素眼科医师在临床诊断过程中对视力，视野异常的患者需要进行综合分     

垂体腺瘤对视功能损害的临床观察

目的：探讨垂体腺瘤对眼视功能损害的临床表现。方法：对126例（252只眼）垂体腺瘤患者进行视力、视野、荧光眼底血管造影（Fundusfluoresceinangiography，FFA）、图形视诱发电位（Patternvisualevokedpotential，PVEP）及眼底检查。结果：视力下降186只眼，占73．8％。眼底原发性视神经萎缩130只眼，占51．6％。视野缺损156只眼，占69．6％。PVEP异常160只眼，占88．9％。26．2％的患者以眼部异常为首诊症状．其中16．7％曾被诊断为眼科疾病。结论：垂体腺瘤可引起视功能的损害，充分认识垂体腺瘤在眼部的临床特点，有助于早期诊断及时治疗。     

首诊眼科的儿童颅内肿瘤三例

很多颅脑肿瘤患者发病初期可表现为神经眼科症状,患者常首诊于眼科,典型的初期症状是进行性视力下降,伴或不伴视神经萎缩、视野缺损和眼外肌麻痹等[1]。当肿瘤未累及视路或累及初期,视功能损害常不明显,患者也可同时伴有眼部疾病,遮掩了肿瘤引起的视功能损害;儿童患者往往因主诉表达不清,视野检查难以配合等更容易误诊、漏诊[2]。笔者回顾近期3例首诊于我院眼科而最终被诊断为颅脑肿瘤患儿临床资料,现报告如下。     

垂体腺瘤200例眼部表现与MRI特点的相关性分析

目的:分析垂体腺瘤患者200例的眼部表现,并探讨MRI特点及与眼部表现的关系.方法:回顾性分析垂体腺瘤患者200例的眼部表现,89例MRI特点及与眼部表现的相关性.结果:有眼部表现者135例(67.5%),首诊于眼科者74例(37.0%),视力下降128例(64.0%),视野缺损132例(66.0%),视乳头水肿5例(2.5%),视神经萎缩31例(15.5%),颅神经麻痹14例(7.0%),眼球突出3例(1.5%).MRI明确诊断者84例(94.4%),肿瘤向鞍上生长者67例(75.3%),其中引起视力下降53例,视野缺损55例,视神经萎缩12例,视乳头水肿3例.向鞍旁生长者44例(49.4%),其中引起动眼神经麻痹4例,外展神经麻痹1例,三叉神经麻痹1例.向下侵入蝶窦者24例(27.0%),向后累及斜坡或压迫大脑脚者4例(4.5%),向前累及鼻咽部者3例(3.4%),累及额叶、颞叶、胼胝体、侧脑室任一者5例(5.6%).结论:垂体腺瘤可引起视力下降、视野缺损等多种眼部表现,很多患者首诊于眼科.     

鞍区肿瘤的视器症状（附407例病例分析）

蝶鞍区是颅内肿瘤的好发部位,鞍区肿瘤约占颅内肿瘤的15％。主要有垂体腺瘤,颅咽管瘤,脑膜瘤,胶质瘤等。而其中以垂体腺瘤最为常见,约占鞍区肿瘤的70％。由于鞍区位于颅底,肿瘤早期常常缺乏颅内高压及其他神经系统阳性体征。但视神经和视交叉常可遭受肿瘤的压迫;或因肿瘤引起视交叉腹面中央区供血障碍,而出现视力减退和视野缺损。故病人多首次就诊于眼科。由于视器症状常能给本症的诊断提供重要的参考资料,如果眼科医生缺乏神经眼科知识,就可能发生漏诊和误诊,而延误治疗时机。本文仅从视器症状的变化,对近10年来我院407例鞍区肿瘤进行分析,从而对鞍区肿瘤的眼科诊断提供临床依据。     

垂体腺瘤的眼部改变

垂体腺瘤发病率仅次于胶质瘤和脑膜瘤而居第三位 ,占10 .4%～ 11% ,由于蝶鞍位于颅底 ,远离脑组织和脑室系统 ,如发生肿瘤常缺乏颅内高压征和神经系统体征 ,尤以早期为甚 ,但蝶鞍区是视神经交叉的重要部位 ,早期即可出现视力和视野障碍 ,故一般患者多先就诊眼科 [1 ]。本文总结了 41例垂体腺瘤的眼部改变 ,供眼科和神经外科临床诊治参考。一、临床资料自 1999～ 2 0 0 1年经眼科检查和神经外科手术资料较完整的垂体腺瘤病例 41例 ,其中男 2 4例 ,女 17例 ,年龄在 16～ 78岁。单纯视功能障碍者 11例 ,伴内分泌障碍者 2 1例 ,两者共 3 2例 ,占…     

垂体瘤误诊为球后视神经炎13例

垂体瘤误诊为球后视神经炎１３例李崇林彭秀军＊（苏州市第四医院眼科２１５００１，＊北京海军总医院眼科）垂体肿瘤早期常无颅内高压及其它神经系统的阳性体征，主要表现为视力下降和视野缺损，患者常常首诊于眼科。本文对误诊为球后视神经炎的１３例垂体瘤病例总结分析...     

眼科误诊的脑肿瘤21例临床分析

脑肿瘤（主要是鞍区肿瘤）压迫和损害现路时即可直接或间接影响视功能，引起视力减退和视野缩小。部分脑肿瘤病人以视功能损害为首发症状，同时伴有或不伴有其他全身症状，但首诊眼科时这些病人易被误诊或漏诊，从而延误了治疗。本文收集了1990年1月～1993年6月在我院神经外科进行手术治疗的ZI例眼科误诊的脑肿瘤，分析和讨论了误诊、漏诊的原因以及视野检查等在脑肿瘤诊断中价值，旨在提示眼科医生注意和重视，并为早期诊断脑肿瘤提供参考。临床资料一、一般资料：本组共ZI例，均首诊眼科，男7例，女14例，年龄15～64岁，平均425岁。入院…     

眼科检查和功能性磁共振在垂体腺瘤研究中的应用进展

垂体腺瘤是颅内最常见的良性肿瘤,其症状主要为视功能受损和内分泌激素紊乱。由于垂体与视交叉的特殊位置关系,视力下降和视野缺损多为首发症状,患者常常首诊于眼科。视野检查和光学相干断层扫描(OCT)可判断视野缺损程度和眼底情况,电生理检查可明确视神经是否受损,均可作为垂体腺瘤患者视功能的评估指标。磁共振作为影像学工具,其衍生技术——功能性磁共振,近年来用于研究垂体腺瘤瘤体质地及视神经完整性。此类全面详细的检查可以帮助患者明确最佳治疗时机,提高生活质量。本文针对眼科各项检查(视野、OCT和电生理)和功能性磁共振在垂体腺瘤中的应用进行简要综述。     

颅咽管瘤患者的视功能损害研究

目的探讨颅咽管肿瘤患者视功能检查的重要意义及眼科医生对于颅咽管瘤患者的早期诊断的重要性。方法回顾性分析2010．7—2013．6在我院南区神经外科手术证实的73名颅咽管瘤患者的临床资料包括术前的视力、视野检查结果。结果73名颅咽管瘤患者男女比例一致,41—60岁患者所占比例最高。52％患者首发症状为视功能障碍,视力下降的患者中有71％双眼视力均低于0.3。偏盲性视野占68．6％。结论重视颅咽管瘤患者的视功能损害情况,有助于眼科医生早期诊断颅咽管瘤,有助于神经外科医生的术前、术后评估,达到控制肿瘤、降低复发率的目的。     

垂体瘤患者眼部表现临床分析

目的:分析垂体瘤患者的眼部表现。方法:对180例360眼诊断明确的垂体瘤患者进行视力、双眼中心视野及眼底检查。结果:视力损害者236眼(65.6%),视野损害者296眼(82.2%),眼底改变者168眼(46.7%)。结论:垂体瘤可引起视功能损害,视野检查在垂体瘤患者的诊断中具有重要价值。     

Patterns of visual loss associated with pituitary macroadenomas

Purpose: To describe the patterns of visual loss associated with pituitary macroadenomas compressing the anterior visual pathway.
Method: A prospective survey of 29 patients with pituitary macroadenomas who presented to the neurosurgical unit at St Vincent's Hospital, Melbourne. Selected patients had histologically verified pituitary macroadenomas, and visual defects (acuity, colour and/or field loss) consistent with anterior visual pathway compression.
Results: All patients had visual field defects detected on perimetry, and the majority were asymmetrical. Bitemporal defects were most common but field defects ranged from monocular defects to generalised constriction. Four patients (13.8%) did not report visual symptoms, and of those who had symptoms, blurred vision was the most common complaint. Ninety-six per cent of eyes had field loss, 56% had decreased colour vision, 46% had decreased acuity, 31% had optic disc pallor, and 2% had an ophthalmoplegia.
Conclusions: Patients with visual pathway compression by pituitary macroadenomas may be asymptomatic despite having field defects. Perimetry is the most sensitive method of identifying compression, followed by colour vision, visual acuity, then the presence of optic atrophy. Automated static threshold perimetry appears to show early field defects better than manual kinetic perimetry. All patients with pituitary macroadenomas should have thorough ophthalmological examinations, including perimetry to document visual deficits secondary to compression.     

Vision-related quality of life in patients with pituitary adenoma

PURPOSE: To evaluate the vision-related quality of life (VR-QOL) in patients with pituitary adenoma. DESIGN: Prospective, consecutive, comparative case series. METHODS: A VR-QOL questionnaire was distributed to 154 patients with pituitary adenoma and 81 normal controls. These were presurgical patients. VR-QOL was measured using the 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25). The influence of various factors on VFQ-25 score was assessed, including age, logarithm of the minimum angle of resolution best-corrected visual acuity (logMAR BCVA), critical flicker fusion frequency, Humphrey static perimetry scores, and the duration of ocular symptoms. RESULTS: The VFQ-25 composite score was significantly lower in patients with pituitary adenoma than in the normal controls (P < .001), with significant differences in all subscales except for color vision. The VFQ-25 composite score in patients with pituitary adenoma was significantly correlated with logMAR BCVA, mean deviation (MD) and corrected pattern standard deviation (CPSD) of Humphrey perimetry, critical flicker fusion frequency, and the duration of ocular symptoms. Stepwise multiple regression analysis revealed that MD score in the better-seeing eye (r = 0.69; P < .001) and the duration of ocular symptoms associated with pituitary adenoma (r = -0.36; P < .001) were significantly related to the VFQ-25 composite score. CONCLUSIONS: The VR-QOL is significantly deteriorated in patients with pituitary adenoma. The degree of visual field defect in the better-seeing eye and duration of ocular symptoms were found to be significantly related to the decline of VR-QOL in these patients.     

Clinical features associated with lesions other than pituitary adenoma in patients with an optic chiasmal syndrome

PURPOSE: Pituitary adenomas are the most common cause of an optic chiasmal syndrome, and treatment of these lesions is considerably different from the treatment of most of the other lesions in this region. Although the diagnosis of a pituitary adenoma is usually inferred from the results of neuroimaging, lesions other than pituitary adenomas can have an appearance that suggests an adenoma. The objective of our study was to determine whether there are clinical findings that suggest a lesion producing a chiasmal syndrome is something other than a pituitary adenoma. DESIGN: Retrospective, case-controlled, analysis of medical record data. METHODS: The records of the Neuro-Ophthalmology Unit of the Wilmer Eye Institute were searched for patients with a chiasmal syndrome who had been evaluated before treatment and for whom pathologic or laboratory confirmation of the etiology was available. Presenting clinical features of these patients were recorded, and analyses with both a single variable and multiple variables were performed to determine whether there were any features that could identify with a high degree of probability the etiology of the lesion producing the syndrome. RESULTS: The search revealed 149 patients who met the inclusion criteria, including 90 patients with pituitary adenomas and 59 patients with other lesions. Variables that were highly suggestive of an etiology other than pituitary adenoma included symptomatic visual loss, younger age, unilateral optic disk pallor, a relative afferent pupillary defect, and an absolute or a complete visual field defect or one was greater inferiorly than superiorly. CONCLUSION: Although no single clinical feature can be used to determine the specific nature of a lesion that produces an optic chiasmal syndrome, certain features are highly suggestive of an etiology other than pituitary adenoma. When these features are present, the likelihood that a suprasellar lesion is a pituitary adenoma is much lower, regardless of the appearance on neuroimaging.     

Visual function in patients with choroidal neovascularization resulting from age-related macular degeneration: the importance of looking beyond visual acuity.

PURPOSE: A detailed understanding of overall quality of vision may help primary care physicians, optometrists, and general ophthalmologists to improve the care of patients with choroidal neovascularization (CNV) resulting from age-related macular degeneration (AMD). METHODS: Published literature was reviewed using Medline searches and the authors' knowledge of the field. RESULTS: Both visual acuity and contrast sensitivity are strongly associated with the ability to perform vision-related activities of daily living. CNV resulting from AMD often leads to scotoma, which is also strongly associated with the ability to perform everyday activities such as reading and driving. Contrast sensitivity and visual field extent may be better predictors of many abilities than visual acuity. Laser photocoagulation, verteporfin therapy, and pegaptanib sodium have been proven to reduce the risk of visual acuity loss in patients with CNV resulting from AMD. Laser photocoagulation frequently causes scotoma, but data on its effects on other aspects of overall quality of vision are scarce. Verteporfin therapy has been shown to also reduce the risk of contrast sensitivity loss and has been associated with stabilization or reduction of scotoma size. Treatment effects beyond visual acuity have not been investigated for pegaptanib. Detailed assessment of overall quality of vision also aids the design of vision rehabilitation programs tailored to the needs of individual patients. CONCLUSIONS: Understanding the impact of vision loss on patients with CNV resulting from AMD and assessing treatment benefits requires assessment of overall quality of vision. Primary care physicians and optometrists have an important role in ensuring that patients receive the best possible care, which can be aided by prompt referral to an ophthalmologist or retina specialist and collaboration with low-vision specialists and optometrists who together can make detailed assessments of overall quality of vision, implement appropriate treatment, and design effective rehabilitation strategies.     

Pituitary adenoma and visual function. The prognostic value of clinical, ophthalmological and neuroradiologic findings in 51 patients subjected to operation

The series studied included 51 patients subjected to operation for pituitary adenoma. The visual status was analysed both pre- and postoperatively. The pre- and postoperative parameters were compared with clinical information, ophthalmological and neuroradiological findings with a view to an evaluation of their prognostic value. In 36 patients with chromophobe adenoma, visual field defects were present in 92% before the operation; visual function improved in 62% and returned to normal in 24%. Among 15 patients with eosinophil or mixed adenoma, only two (13%) had visual field defects pre-operatively. In those patients where operation was followed by a distinct visual improvement, the pre-operative ophthalmological findings were as follows: visual acuity greater than 6/24, normal optic discs, visual field defects up to two quadrants, and pneumoencephalographic findings suggestive of only a small suprasellar tumour.     

An audit of disease diagnoses made by optometrists

Background : Several Australian ophthalmologists have sworn affidavits that, in their opinion, optometrists have deficient training in the detection of eye disease and systemic disease having ocular manifestations, and are unable to detect a number of medical conditions having ocular manifestations. The deponents swore that optometrists could not make a medical diagnosis because they lack medical Hampton, Victoria training. To test these opinions this report details a prospective comparison of diagnoses made by three optometrists with the diagnosis subsequently made by the ophthalmologist or physician to whom the patients were referred. Methods : All referrals made to ophthalmologists or physicians were recorded, together with the optometrists' diagnoses, which were recorded prior to referral. On receipt of the medical practitioner's report, his or her diagnosis was recorded and compared with the optometrist's diagnosis. Results : Four patients referred to ophthalmologists were lost to follow-up. Agreement between the optometrist's and ophthalmologist's diagnoses was unequivocally correct in 114 (93.4 per cent) of the 122 referrals for which follow-up was available. The optometric diagnoses of ophthalmic disease were correct, but incomplete, in six cases and, in two cases (Saltzman's dystrophy and Chandler's syndrome), the optometrist's diagnosis was inappropriate. Referrals to family physicians totalled 18, of which three were lost to follow-up. Of the remaining 15 patients referred, 12 diagnoses (70 per cent) were correct and three were incorrect. The three incorrect diagnoses were one case of suspected cranial arteritis and two cases of suspected diabetes, or impaired glucose tolerance. There were 38 separate diagnostic conditions referred to ophthalmologists and 11 separate conditions referred to general physicians. Conclusions : The optometrists who conducted this study were able to make diagnoses over a wide range of ocular and systemic diseases. These diagnoses were substantially in agreement with the diagnoses made by ophthalmologists and general physicians. This suggests that die training and clinical experience of optometrists can be adequate to provide a high standard of primary eye care and that optometrists are able to detect disease conditions that require referral to medical practitioners.