MRI Histogram Texture Feature Analysis of the Optic Nerve in the Patients with Optic Neuritis / 中国医学科学杂志(英文版)

Objective To evaluate the optic nerve impairment using MRI histogram texture analysis in the patients with optic neuritis.Methods The study included 60 patients with optic neuritis and 20 normal controls. The coronal T2 weighted imaging (T2WI) with fat saturation and enhanced T1 weighted imaging (T1WI) were performed to evaluate the optic nerve. MRI histogram texture features of the involved optic nerve were measured on the corresponding coronal T2WI images. The normal optic nerve (NON) was measured in the posterior 1/3 parts of the optic nerve. Kruskal-Wallis one-way ANOVA was used to compare the difference of texture features and receiver operating characteristic (ROC) curve were performed to evaluate the diagnostic value of texture features for the optic nerve impairment among the affected optic nerve with enhancement (ONwEN), affected optic nerve without enhancement (ONwoEN), contralateral normal appearing optic nerve (NAON) and NON.Results The histogram texture Energy and Entropy presented significant differences for ONwEN vs. ONwoEN (both P=0.000), ONwEN vs. NON (both P=0.000) and NAON vs. NON (both P<0.05). ROC analysis demonstrated that the area under the curve (AUC) of histogram texture Energy were 0.758, 0.795 and 0.701 for ONwEN vs. ONwoEN, ONwEN vs. NON and NAON vs. NON, AUC of Entropy were 0.758, 0.795 and 0.707 for ONwEN vs. ONwoEN, ONwEN vs. NON and NAON vs. NON.Conclusions The altered MRI histogram texture Energy and Entropy could be considered as a surrogate for MRI enhancement to evaluate the involved optic nerve and normal-appearing optic nerve in optic neuritis.

Neuro - ophthalmological manifestations of neurosyphilis in 22 cases / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the characteristics of neurological ophthalmology manifestation of patients with neurosyphilis. · METHODS: Retrospective and nonrandomized case analysis were used. Totally 22 cases of 39 eyes were included. They were 17 males and 5 females, aged from 34 to 65 years old. The average age were 49. 6 years old. ·RESULTS: The optic nerve atrophy presented in 11 cases of 22 eyes. One eye of them accompanied by left eye oculomotor nerve palsy;5 eyes in 3 cases expressed as optic neuritis acute phase;neuroretinitis appeared in 4 cases of 6 eyes; 1 case of 2 eyes expressed as chorioretinitis accompanied by optic disc edema; central retinal artery occlusion were found in 1 case of 1 eye. Argyll-Robertson pupil was as only manifestation in 2 cases of 3 eyes. In all cases, Argyll-Robertson pupil signs can be seen in 19 eyes. Treponema pallidum particle agglutination test ( TPPA) were positive in all 22 cases. Syphilis rapid plasma reactin test ( RPR ) were positive in 19 of 21 cases. All patients underwent lumbar puncture and cerebrospinal fluid were detected for RPR, cerebrospinal fluid protein, white blood cell count. Cerebrospinal fluid RPR were positive in 13 cases. Cerebrospinal fluid protein were greater than 450mg/L in 18 cases. Cerebrospinal fluid white blood cell count were greater than 5/mm3 in 13 cases. · CONCLUSION: Neurosyphilis involving neuro -ophthalmology often occurs in middle-aged men and subacute onset. Both eyes can suffered from optic nerve disease simultaneously or sequencely. A few can be expressed as other cranial nerve palsy, which may lead to misdiagnosis. Considering medical history, clinical manifestations, ophthalmic examination, serum and cerebrospinal fluid laboratory tests can improve the diagnostic rate.

Research Advances in Biomarkers for Demyelinating Optic Neuritis / 中国医学科学院学报

Optic neuritis refers to all inflammatory diseases in the optic nerve. The most common type is demyelinating optic neuritis. Biomarkers can indicate its pathophysiological process and thus are useful in disease diagnosis and treatment. This article reviews the known biomarkers for demyelinating optic neuritis.

Research progress of SlRT1 as a target for the treatment of age - related retinal disease / 国际眼科杂志(Guoji Yanke Zazhi)

Silent information regulator protein 1 (SlRT1) is one of the sirtuins and belongs to histone deacetyase. lts activity depends on nicotinamide adenine dinucleotide ( NAD+) and is regulated by NAD+. Experimental and clinical studies have shown the neuro-protective effect of SlRT1 in the pathogenesis of age-related eye diseases. ln this review, the relationship between SlRT1 activator and apoptosis in the retinal cells were discussed. The review also points to SlRT1 as a potential therapeutic target for the clinical management of age-related retinal disease.

Diagnosis and treatment characteristics of radioactive optic neuropathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore the diagnosis and treatment methods of radioaction-induced optic neuritis ( RION) through the clinical dates of 17 patients. METHODS: It was a retrospective case series study. From August 2008 to October 2013, 17 cases (24 eyes) of Rion clinical dates from Chinese PLA General Hospital were studied. The diagnosis methods including visual acuity, pupil, fundus, visual field, fundus fluorescein angiography (FFA), visual electrophysiological testing, and head MRI. To analysis the clinical date of patients with diagnosis of RION by statistical description. RESULTS: The deterioration degree of vision: 13 eyes were classified as Ⅳ, 9 eyes as Ⅲ, 2 eyes as II. Ten eyes RAPD ( + ) , visual electrophysiology is extinguished. The retina of 5 eyes showed flame hemorrhages and cotton wool spots exudation. Optic nerve head edema in one eye. T1 - weighted MRI enhanced in 19 eyes which showed optic nerve of the intracranial and intratubal segments abnormal changed, optic chiasm and pituitary stalk signal abnormalities and enhancement of the optic nerve. Tortuous optic nerves and rough edges were observed in 5 eyes. Treatment effect: 4 eyes of visual acuity improved, 1 eye from blindness to light perception,1 eye from 0. 08 to 0. 2, 1 eye from 0. 4 to 0. 6,1 eye from 0. 04 to 0. 15, the rest of the cases did not see any improvement. CONCLUSION: The unique clinical manifestation of RION can provide objective basis for clinical diagnosis in time, but there have not been proven any effective treatments.

Analysis of retinal nerve fiber layer thickness and macular thickness in unaffected female carrier of Leber hereditary optic neuropathy / 中华实验眼科杂志

Background Researches documented that retinal nerve fiber layer thickness (RNFLT) in unaffected carriers of Leber hereditary optic neuropathy (LHON) becomes thickened in different quadrants to different degrees.But the change of their macular thickness is still unclear.Objective This study was to clarify RNFLT and macular thickness by optical coherence tomography (OCT) in unaffected female carriers of LHON families.Methods Five female LHON patients (5 eyes) from 5 LHON families,eighteen unaffected female carriers (18eyes) from 18 LHON families and twenty-five age-matched healthy female controls (25 eyes) were included in this study.The patients and genetic carriers were diagnosed in PLA General Hospital from 2011 September to 2012 October.Regular ocular examination were performed followed by OCT measurement of retinas.The Optic Disc Cube 200×200 and Macular Cube 200×200 protocols were used during the OCT measurement.Average (360°) RNFLT,RNFLT at four quadrantic sections,cube average macular thickness and macular thickness of nine Early Treatment Diabetic Retinopathy Study (ETDRS) sub-areas were compared among the LHON genetic carriers,LHON patients and normal controls.Results Compared to the normal control group,significant reduced values were seen in temporal,superior,nasal and inferior side of sub-area macular thickness in the LHON female carriers (P=0.022,0.046,0.024,0.008).In addition,but no significant differences were found in cube average thickness,central subarea macular thickness,temporal,superior,nasal and inferior side of lateral sub-area macular thickness,average RNFLT,and temporal,superior,nasal and inferior quadrant RNFLT between the LHON female carriers and normal controls (P=0.102,0.051,0.238,0.663,0.1 10,0.104,0.419,0.371,0.158,0.063,0.563).Compared to the unaffected female carrier group,female patients showed significant reductions in cube average macular thickness,temporal,superior,nasal and inferior side of sub-area macular thickness,temporal,superior,nasal and inferior side of lateral sub-area mac ular thickness,average R NFLT and temporal,superior,and inferior quadrant RNFLT (P =0.000,0.000,0.000,0.007,0.002,0.002,0.000,0.000,0.040,0.000,0.016,0.000,0.000) except for the central subarea macular thickness and nasal quadrant RNFLT (P=0.388,0.580).Conclusions Unaffected LHON female carriers show a normal peripapillary RNFLT,but the macular thickness at medial sub-area is thinner.This first report offers an information of macular structure change in unaffected LHON female carriers,which suggest that macular damage appears prior to RNFLT change.

Ocular manifestations of intracranial germinomas: three cases report and literature review / 中华医学杂志(英文版)

Intracranial germinomas are malignant neoplasms of gonadal origin, which have some features in terms of age, sex, and clinical manifestations. They mainly occur in children and adolescents. Patients with intracranial germinomas mainly manifest with hypothalamic pituitary axis dysfunction and/or compression syndromes. Visual disturbance is one of the most significant clinical presentations, which is mainly caused by tumor cell infiltration into the optic pathway. In this article, we present three cases of patient with intracranial germinoma to analyze the ocular manifestations. All the three patients presented with endocrine symptoms in the early stage and with visual disturbances (including decreased visual acuity and visual field defects) later. In general, germinoma is diagnosed by its characteristic radiological appearance, supported by tumor markers and/or stereotactic biopsy. However, decisive diagnoses were established when ocular manifestations were presented. A suspicion for germinoma should be considered, when young patients manifest visual disturbances accompanied by endocrine symptoms.

A study of correlation analysis on ocular ischemic disease and carotid stenosis / 中华实验眼科杂志

Background Carotid stenosis is one of the important causes of ocular ischemic diseases,To study their relationship is helpful for us to classify and manage the ocular ischemic diseases.Objective This study was to investigate the correlation between ocular ischemic diseases and carotid stenosis.Methods Twenty patients with internal carotid artery stenosis rate more than 60％ defined by digital subtraction angiography(DSA) or magnetic resonance angiography (MRA) were selected,including 9 patients with lateral carotid artery stenosis and 11 patients with bilateral carotid artery stenosis.The best corrected visual acuity,intraocular pressure and fundus examinations were carried out,and the peak systolic velocity (PSV) and end diastolic velocity (EDV) of the central retinal artery(CRA) were detected with color doppler flowimaging (CDFI).The resistance index(RI) was calculated by the formula RI =PSV- EDV/PSV.The correlation between internal carotid artery stenosis rate and PSV or RI was evaluated by Spearman rank correlated analysis.Results The subjective inanifestations included transient amaurosis in 77.4％ frequency and visual blur in 22.6％ frequency in the 31 carotid artery stenosis.Twelve eyes(38.7％ ) appeared the ocular vascular abnormality.Other 2 patients were diagnosed as hypoperfusion retinopathy complicated by neovascular glaucoma.A negative relationship was found between internal carotid artery stenosis rate and PSV of CRA ( r =-0.41,R2 =0.168,P =0.021 ＜0.05 ),but no significant relationships was found between internal carotid artery stenosis rate and RI ( r =- 0.26,R2 =0.068,P =0.159 ).Conclusions Carotid artery stenosis can cause the of ocular ischemic symptoms.The characteristics of retinal hemodynamics is the type of low speed and normal resistance.

Ophthalmic demonstration of intracranial aneurysms / 眼科

Objective To study the relationship between ophthalmic changes and intracranial aneurysms.Design Retrospective case series.Participants 91 patients with intracranial aneurysms.Methods We analyzed retrospectively patients with intracranial a- neurysms hospitalized in Department of Neurosurgery,PLA General Hospital from Jan.2005 to Dec.2007.Patients with ophthalmic changes underwent digital subtraction angiography,and were treated by surgery or intervention therapy.Main Outcome Measures Dif- ferent locations,sizes of aneurysms and directions of its tops,situation of ophthalmic changes.Result 23 patients (25.27%) had oph- thalmic changes in 91 patients with intracranial aneurysms.12 cases(52.17%)harbored posterior communicating aneurysms.Aneurysms of petrosal segment internal carotid artery and paraclinoid internal carotid artery were both 2 cases(8.70%).Aneurysm of ophthalmic in- ternal carotid artery,anterior cerebral artery,middle cerebral artery,posterior inferior cerebellar artery,intracavernous primary trigemi- nal artery,carotid bifurcation was all 1 case (4.35%).The main ophthalmic demonstration of posterior communicating aneurysms was various degrees of oculomotor nerve palsy.Aneurysm of paraclinoid usually was accompanied by visual acuity decreasing,aneurysm of primary trigeminal artery by abducens nerve palsy and aneurysm of petrosal segment internal carotid artery by paroxysmal diplopia re- spectively.All patients before treatment lacked detailed ophthalmic examinations.The longest follow-up after treatment was 1 year.No improvement appeared in patients underwent intervention therapy.Patients underwent neck clipping had no or limited improvements. Conclusion Half of intracranial aneurysms patients with ophthalmic changes are posterior communicating aneurysms,and its main oph- thalmic change is oculomotor nerve palsy.The patients with intracranial aneurysms should be consultated by oculists in time.

Pay much attention to neovascular glaucoma caused by hypoperfusion retinopathy / 眼科

Neovascular glaucoma is a rare and severe complication of hypoperfusion retinopathy.The appearance of hypoperfu- sion retinopathy complicating neovascular glaucoma in ophthalmolscopy and fundus fluorescein angiography shows a special feature. Neovascular glaucoma occurs when new fibrovascular tissues proliferate onto the chamber angle and obstruct the trabecular meshwork. The stenosis or occlusion of internal carotid artery is the most common reason of hypoperfusion retinopathy in elder people.Early recog- nition and treatment of patients with carotid occlusive diseases may prevent more serious complications.

Incidence of cerebral venous sinus thrombosis in patients with idiopathic intracranial hypertension / 眼科

Objective To explore the rate of incidence of cerebral venous sinus thrombosis(CVST)in patients with idiopathic in- tracranial hypertension(IIH).Design Restrospective case series.Participants 92 cases with idiopathic intracranial hypertension.Meth- otis All patients diagnosed with papilledema from January 1,2000 through May 1,2007 at our ophthalmology center.Consecutive pa- tients with a diagnosis of papilledema were identified.Patients with space-occupying lesions,hydrocepbalus,or meningitis were excluded. The remaining patients were evaluated with lumbar puncture,magnetic resonance imaging(MRI)and magnetic resonance venography (MRV).Main Outcome Measures The rate of incidence of cerebral venous sinus thrombosis(CVST)in patients with idiopathic in- tracranial hypertension(IIH).Results Excluding patients with mass lesions,meningitis,or hydrocephalus,the occurrence of CVST was 7 (7.6%)of 92 patients with presumed IIH.One additional patients had a diagnosis of suspected CVST.Cerebral venous sinus thrombosis was diagnosed in 1 of the 7 patients with MRI alone,whereas it was evident in all 7 patients with MRV.Conclusions Cerebral venous si- nus thrombosis accounts for 7.6% of patients with presumed IIH in our ophthalmology services.Magnetic resonance venography in com- bination with MRI is recommended to identify this subgroup of patients.(Ophthalmol CHN,2007,16:410-413)

Clinical analysis of vertebral-basilar insufficiency caused by related ophthalmologic signs / 眼科

Objective To analyze the ophthalmologic characteristics and examinations which caused by vertebral-basilar insuffi- ciency.Design Retrospective case series.Participants 469 eases of vertebral-basilar insufficiency.Methods Retrospective analysis of 469 cases of vertebral-basilar insufficiency patients with ophthalmologic signs' features,incidence,the main cause,color Doppler flow imaging and(or)digital subtraction angiography clearly stenosis location,the degree of stenosis from July 1st 2005 to July ist 2007 in PLA General Hospital.Main Outcome Measures Ophthalmologic signs' related reasons and supplementary examination.Results 96 cases were with the corresponding eye symptoms(20.4%).Vision decreased in 83 cases,diplopia was in 56 cases,ipsilateral hemiopia quadrant blind in 12 cases and depending on deformation in 10 cases,fundus arteriosclerosis in 72 cases,nystagmus in 39 cases,the eye movement disorder in 16 cases.Among 96 patients with associated ocular symptoms,75 patients with color Doppler flow imaging (CDFI)showed unilateral vertebral artery abnormal in 66 cases(88%),among those blood flow velocity decreased in 26 cases,17 cases with vascular plaque stenosis,thinning in 20 cases,3 cases with complete occlusion;different bilateral vertebral artery abnormal in 9 cases(12%),among those velocity dropped in 4 cases,two cases with vascular plaque stenosis and thinning in 3 cases.Forty-five cases with the digital subtraction angiography(DSA),left vertebral artery was abnormal in 24 cases,18 cases with stenosis,occlusion in 5 cas- es,abnormal bending in 1 case.Right vertebral artery was abnormal in 16 cases,13 cases with stenosis,occlusion in 3 cases.Bilateral vertebral artery stenosis was found in 2 cases;vertebral artery stenosis was in 3 patients.Conclusion Vertebral-basilar insufficiency may cause eye-related symptoms,therefore,vision acuity decrease,fundus 'arteriosclerosis,diplopia and nystagmus symptoms are more likely for patients with vertebral-patients with basilar artery insufficiency performance of the eye.(Ophthalmol CHN,2002,16:406-410)