摘要目的:观察糖皮质激素不同剂量和给药方式治疗非动脉炎性前部缺血性视神经病变(NAION)的效果。方法:回顾性病例对照研究。纳入郑州大学第一附属医院2019年3月至2022年3月NAION 182例(182只眼)。患者按不同治疗方式分为4组：A组，67例，行小剂量甲泼尼龙琥珀酸钠静脉注射；B组，62例，行大剂量甲泼尼龙琥珀酸钠静脉注射；C组，23例，行小剂量甲泼尼龙琥珀酸钠静脉注射联合地塞米松及消旋山莨菪碱球后注射；D组，30例，行小剂量甲泼尼龙琥珀酸钠静脉注射联合地塞米松玻璃体内植入剂(傲迪适，ozurdex)植入。随访3个月，比较4组视力、视野平均缺损(MD)、模式标准差(PSD)及视网膜神经纤维层厚度(RNFL)。结果:治疗后1个月及3个月，C、D组视力改善优于A组( HAC＝2.03、 HAD＝2.32， PAC＝0.043、 PAD＝0.020； HAC＝2.93、 HAD＝2.01， PAC＝0.003、 PAD＝0.044)。治疗后1个月，4个组MD总体比较，差异无统计学意义( H＝9.59， P＝0.055)。治疗后3个月，B、D组改善优于A组( HAB＝2.35、 HAD＝2.52， PAB＝0.019、 PAD＝0.012)。治疗前后4个组间MD和RNFL比较差异无统计学意义( P>0.05)。 结论:小剂量糖皮质激素联合地塞米松及消旋山莨菪碱球后注射和小剂量糖皮质激素联合傲迪适植入对NAION患者的视力改善最明显，大剂量糖皮质激素和小剂量糖皮质激素联合傲迪适植入剂植入的视野改善最明显。

abstractsObjective:To observe the efficacy of different doses and administration methods of glucocorticoids in the treatment of non-arteritic anterior ischemic optic neuropathy (NAION).Methods:This was a retrospective case control study. A total of 182 eyes of 182 patients with NAION in the First Affiliated Hospital of Zhengzhou University from Mar. 2019 to Mar. 2022 were included. The patients were divided into four groups, based on different treatment methods. In the group A, 67 eyes of 67 patients received low-dose intravenous injection of methylprednisolone sodium succinate; in the group B, 62 eyes of 62 patients received high-dose intravenous injection of methylprednisolone sodium succinate; in the group C, 23 eyes of 23 patients received low-dose intravenous injection of methylprednisolone sodium succinate combined with retrobulbar injection of dexamethasone and racemic anisodamine; in the group D, 30 eyes of 30 patients received low-dose intravenous injection of methylprednisolone sodium succinate combined with dexamethasone intravitreal implant (ozurdex). The follow-up period was 3 months.The visual acuity, mean deviation (MD) of visual field, pattern standard deviation (PSD) and retinal nerve fiber layer (RNFL) before and after treatment were observed and compared among 4 groups.Results:At 1 and 3 months after treatment, the visual acuity improvement of group C and D was better than that of group A ( HAC=2.03, HAD=2.32, PAC=0.043, PAD=0.020; HAC=2.93, HAD=2.01, PAC=0.003, PAD=0.044). There was no significant difference in MD of visual field among the four groups at 1 month after treatment ( H=9.59, P=0.055). At 3 months after treatment, the improvement of MD in the groups B and D was better than that of group A ( HAB=2.35, HAD=2.52; PAB=0.019, PAD=0.012). There was no significant difference in PSD and RNFL among the four groups before and after treatment ( P>0.05). Conclusion:Low dose glucocorticoids combined with retrobulbar injection of dexamethasone and racemic anisodamine and low dose glucocorticoids combined with dexamethasone intravitreal implant shows the most significant visual improvement for NAION.High dose glucocorticoids and low dose glucocorticoids combined with dexamethasone intravitreal implant shows the most significant visual field improvement.