Changes of visual field defect in patients with acute solitary occipital lobe cerebral infarction before and after treatment

Abstract

Objective To observe the changes in visual field defect before and after treatment in patients with acute solitary occipital lobe cerebral infarction. Methods From January 2017 to May 2019, 59 patients with hemianopsia who were diagnosed as acute occipital lobe cerebral infarction in Henan Provincial People's Hospital were selected. There were 35 males (59.3%) and 24 females (40.7%); aged from 50 to 72 years, with an average age of 62.86±6.10 years. There were 23 patients of right occipital cerebral infarction and 36 patients of left occipital cerebral infarction. Lesions involved 41 patients in the striated area, 8 patients involved the occipital pole, and 23 patients involved visual radiation. All patients underwent standard medical treatment. All patients underwent visual field examination before treatment, and modified rankin scale (mRS) was used to evaluate the level of visual disability after cerebral infarction. At 1, 3, and 6 months after treatment,54 patients underwent at least one visual field examination in outpatient or inpatient follow-up visits, and 5 patients were lost to follow-up; 49 patients received repeated mRS scores. The visual field defect and mRS score of patients before and after treatment were compared and analyzed. The improvement of visual field defect in the horizontal direction exceeding 10°or the vertical direction exceeding 15°was defined as improvement, otherwise it was defined as no improvement. According to the type of visual field defect, the patients were divided into two groups: complete homonymous hemianopia and incomplete homonymous hemianopia. The cumulative visual field improvement rate of the two groups of patients was calculated. An mRS score of 0 to 2 was defined as a good prognosis, and >2 was defined as a poor prognosis. Results Before treatment, of the 59 patients, 47 were complete homonymous hemianopsia and 12 were incomplete. Of the 47 patients with complete homonymous hemianopia, 26 patients had hemianopia on the right side of both eyes, 21 patients had hemianopia on the left side of both eyes; 32 patients with macular avoidance (72.3%). Among the 12 patients of incomplete homonymous hemianopia, 10 patients of quadrant blindness included 6 patients of upper quadrant and 4 patients of lower quadrant; 2 patients of partial isotropic hemianopia on one side. Of the 54 patients reviewed after treatment, the visual field improved at the last follow-up of 25 patients (46.3%), and there was no improvement in 29 patients (53.7%). The cumulative visual field improvement rate of 47 patients with complete hemianopia hemianopia before treatment was 37.2% (16/43). The cumulative visual field improvement rate of 11 patients with incomplete isotropic hemianopia before treatment was 81.8% (9/11). There was a statistically significant difference in cumulative visual field improvement between the two groups of patients (χ2 = 7.011, P<0.05). Before treatment, 59 patients had mRS scores of 1 to 2 points in 15 patients (25.4%), and 44 patients with 2 points or more (74.6%). Of the 49 patients reviewed after treatment, 28 (57.1%) had a good prognosis and 21(42.9%) had a poor prognosis. Conclusions The visual field defect of patients with homonymous hemianopsia after acute occipital infarction may be improved after treatment. The improvement mostly occurs within 1 m after treatment, and patients with incomplete homonymous hemianopsia have more significant improvements than those with complete homonymous hemianopsia. Key words: Occipital lobe; Cerebral infarction; Visual fields; Hemianopsia