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Ischemic optic neuropathy is classified into anterior and posterior ischemic optic neuropathy depending upon the part of optic nerve involved. In anterior optic neuropathy, optic nerve head is involved and in posterior ischemic optic neuropathy(PION) retrobulbar portion is involved. There is sudden loss of vision in both the entities but there are optic disc changes in anterior optic neuropathy while in posterior ischemic optic neuropathy optic disc is normal initially. Etiologically, posterior ischemic optic neuropathy is divided into non arteritic non-surgical, arteritic and perioperative non arteritic posterior ischemic optic neuropathy.
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Objective:To construct and evaluate a screening and diagnostic system based on color fundus images and artificial intelligence (AI)-assisted screening for optic neuritis (ON) and non-arteritic anterior ischemic optic neuropathy (NAION).Methods:A diagnostic test study. From 2016 to 2020, 178 cases 267 eyes of NAION patients (NAION group) and 204 cases 346 eyes of ON patients (ON group) were examined and diagnosed in Zhongshan Ophthalmic Center of Sun Yat-sen University; 513 healthy individuals of 1 160 eyes (the normal control group) with normal fundus by visual acuity, intraocular pressure and optical coherence tomography examination were collected from 2018 to 2020. All 2 909 color fundus images were as the data set of the screening and diagnosis system, including 730, 805, and 1 374 images for the NAION group, ON group, and normal control group, respectively. The correctly labeled color fundus images were used as input data, and the EfficientNet-B0 algorithm was selected for model training and validation. Finally, three systems for screening abnormal optic discs, ON, and NAION were constructed. The subject operating characteristic (ROC) curve, area under the ROC (AUC), accuracy, sensitivity, specificity, and heat map were used as indicators of diagnostic efficacy.Results:In the test data set, the AUC for diagnosing the presence of an abnormal optic disc, the presence of ON, and the presence of NAION were 0.967 [95% confidence interval ( CI) 0.947-0.980], 0.964 (95% CI 0.938-0.979), and 0.979 (95% CI 0.958-0.989), respectively. The activation area of the systems were mainly located in the optic disc area in the decision-making process. Conclusion:Abnormal optic disc, ON and NAION, and screening diagnostic systems based on color fundus images have shown accurate and efficient diagnostic performance.
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Non-arteritic anterior ischemic optic neuropathy (NAION) is an optic neuropathy that usually occurs in people over 50 years old.The pathogenesis of NAION remains unknown, and there is no recognized effective treatment.The animal model of NAION established by photodynamic method has similar fundus and electrophysiological changes to clinical NAION.In recent years, studies on the pathological mechanisms of NAION based on animal models have found that axonal structure destruction, demyelination and inflammatory cells infiltration in the region of optic nerve infarction, accompanied by secondary retinal ganglion cells apoptosis.There are a wide range of drugs for NAION based on animal models, including glucocorticoids, granulocyte colony-stimulating factor, prostaglandin J2, anti-vascular endothelial growth factor, neurotrophic factors, effective drugs for glaucoma or central nervous system damage, etc.Routes of administration include systemic administration, intravitreal injection or topical application of eye drops.The neuroprotective effects of some drugs in animal models provide a basis for clinical screening of new therapeutic drugs.In this review, the animal models of NAION, pathophysiology and treatment based on animal models were summarized.
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Corona virus disease 2019 (COVID?19) has been documented to have a spectrum of neuro?ophthalmic manifestations. However, bilateral non?arteritic anterior ischemic optic neuropathy (NAION) post?COVID?19 has not been reported in the literature. We studied the case of a 45?year?old male who presented to our outpatient department (OPD) with bilateral blurring of vision following an episode of COVID?19, 1 month back. Examination and investigations were conclusive of a bilateral NAION. The patient was given a trial of oral steroids. However, the vision loss could not be recovered. Thus, through this case report, we would like to highlight the importance of a close follow?up of patients following COVID?19 infection to detect any sequelae
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@#Nonarterial anterior ischemic optic neuropathy(NAION)is a group of common optic nerve diseases that seriously endanger visual function. It is resulted from insufficient perfusion of the posterior ciliary artery, which causes acute ischemia, structural and functional disorders of the optic nerve, and ultimately leads to hypopsia and even vision loss. The etiology and pathogenesis of this disease is complex. It is nowadays considered that multiple factors including local anatomy, risk of systemic vascular cause this disease together, which result in no clear, unified and recognized treatment. Early detection, diagnosis and treatment are of great significance in the prognosis of NAION. Possible therapeutic methods include etiological treatment, drug therapy, traditional Chinese medicine(TCM)treatment, combined medication, optic nerve sheath decompression, adjuvant treatments and exosomes. With the continuous development and application of various anti-NAION drugs in recent years, a variety of therapeutic methods have been proposed, especially with the exosomes as the research focus. In order to better treat NAION with improvement of the cure rate and guidance for clinical work, this paper mainly reviews the progress in the treatment of NAION in recent years.
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AIM: We sought to identify key genes related to nonarteritic anterior ischemic optic neuropathy(NAION)and provide bioinformatics support for elucidating the pathogenesis of NAION.METHODS: Based on rat GSE43671 dataset, which was acquired from GEO, we identified modular genes with highly correlated clinical phenotype by WGCNA package in the R language. Then Gene Ontology(GO)and Kyoto encyclopedia of genes and genomes(KEGG)analysis were performed with ClusterProfiler package. In addition, Cytoscape was used to screen potential key genes and establish miRNA-key genes network.RESULTS: There were 22 modules identified from the GSE43671 dataset by the WGCNA method, among which the blue module has the highest correlation coefficient. GO enrichment analysis suggested that the genes in the module mainly manifest in the epithelial tube morphogenesis and other biological processes, receptor complex and other cell components, and structural constituent of eye lens and other molecular functions. KEGG suggested that the genes in the module mainly relate to signaling pathways including neuroactive ligand-receptor interaction, human papillomavirus, MAPK and PI3K/Akt. There were 10 key genes screened by PPI network and Cytoscape including Psmb9, Psma7, Map3k14, Psme1, Nfkb1, Rela, Psma5, Relb, Psmb4 and Nfkb2, and 6 miRNA were predicted as miR-383-5p, miR-9a-5p, miR-155-5p, miR-223-3p, miR-495 and miR-325-3p.CONCLUSION: Using the WGCNA method to screen out the relevant pathways, key genes, and microRNA for NAION, it provides a theoretical basis for exploring pathogenesis and treatment methods of NAION, however, more animal and cell experiments are needed to further validate.
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@#AIM: To explore the therapeutic effects and safety of dexamethasone intravitreal implant(DEX)on non-arteritic anterior ischemic optic neuropathy(NAION), and responses to the different course of disease.<p>METHODS: Totally 70 patients(70 eyes)in the First Affiliated Hospital of Zhengzhou University diagnosed with NAION from January 2018 to December 2020 were obtained retrospectively as combination treatment group and routine treatment group. 35 patients(35 eyes)in each group received usual care(methylprednisolne pluse therapy, microcirculation improvement and neurotrophic treatment), and combination treatment group also received a dexamethasone intravitreal implant. The best corrected visual acuity(BCVA), mean damage(MD)and pattern standard deviation(PSD)of the visual field, mean thickness of the retinal nerve fiber layer(RNFL)and intraocular pressure(IOP)were compared between the two groups, and two groups with a different course of disease before and 3mo after treatment.<p>RESULTS: BCVA and MD improved in both groups at 3mo after treatment(<i>P</i><0.05). The PSD in the combination treatment group was not significantly different before and after treatment(<i>P</i>>0.05). The PSD at 3mo after treatment in the routine treatment group was worse than before treatment(<i>P</i><0.05). BCVA, MD, and PSD in the combination treatment group had better improvement than in the routine treatment group at 3mo after treatment(<i>P</i><0.05). Visual acuity improvement rate in the combination treatment group was higher than in the routine treatment group at 3mo after treatment(<i>P</i><0.05). There was no obvious difference in RNFL thickness between the two groups(<i>P</i>>0.05). BCVA, PSD and effective rate in the combination treatment group had better improvement than in the routine treatment group in disease course ≤ 15d at 3mo after treatment(<i>P</i><0.05), and no apparent difference in the group of disease course > 15d(<i>P</i>>0.05). There was a mild and controllable increase in IOP in the combination treatment group compared to routine treatment group.<p>CONCLUSION: Dexamethasone intravitreal implant can promote BCVA and the recovery of visual function for the long term. It is deemed safe and effective in treating NAION, with better therapeutic effects within 2wk after onset.
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Nonarteritic anterior ischemic optic neuropathy (NAION) is a common type of acute optic neuropathy in elderly, characterized by optic disc edema and visual field defect.At present, there is no generally accepted treatment, and the treatment of NAION is to control systemic disease and other risk factors, reduce optic disc edema, nurture nerve and improve microcirculation.In recent years, intravitreal drug injection has been used as a new therapy of NAION.It can make drug reach the target issue in the eye rapidly and maintain a relatively high concentration, which can enhance the efficacy without causing severe systemic complication.In this article, the effect of intravitreal injection of anti-vascular endothelial growth factor, triamcinolone acetonide, and erythropoietin in NAION was reviewed.
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@#AIM: To observe the improvement of ocular hemodynamics before and after intraocular pressure(IOP)intervention in patients with non-arteritic anterior ischemic optic neuropathy(NAION).<p>METHODS: Retrospective case series. Totally 92 patients(92 eyes)with NAION were admitted to the Department of Ophthalmology, Xi'an Fourth Hospital from July 2012 to September 2018. Forty-six patients received only basic treatment without IOP lowering treatment as the conventional treatment group. The other 46 patients were treated with brinzolamide eye drops combined with brimonidine eye drops to lower IOP on the basis of conventional treatment, as the IOP intervention group. Before and after treatment, the blood flow rate of the ophthalmic artery and central retinal artery were measured by color Doppler ultrasound. The IOP, best corrected visual acuity(BCVA), mean visual field defect(MD), retinal nerve fiber layer thickness(RNFLT), ophthalmic artery and central retinal artery peak systolic blood velocity(PSV), end-diastolic blood velocity(EDV), pulse index(PI)and resistance index(RI)were compared.<p>RESULTS: Before treatment, there were no significant differences in IOP, BCVA(LogMAR), MD, RNFLT, PSV, EDV, PI and RI between the two groups(<i>P</i>>0.05). After 14d of treatment, IOP, BCVA(LogMAR), MD and RNFLT of the two groups were significantly improved compared with those before treatment(<i>P</i><0.05), and the improvement effect of IOP intervention group was better, and the difference between the two groups was statistically significant(<i>P</i><0.05). The PSV, EDV, PI of ophthalmic artery and central retinal artery in the two groups were increased compared with those before treatment, and RI was decreased compared with before treatment; and the changes of PSV, EDV, RI, PI of ophthalmic artery and PSV, EDV, RI of central retinal artery in the IOP intervention group were more significant than those in the conventional treatment group(<i>P</i><0.05). <p>CONCLUSION: IOP intervention can significantly improve the ocular hemodynamic indexes and improve the visual acuity of patients with NAION.
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@#Nonarteritic anterior ischemic optic neuropathy(NAION)is caused by ischemia of the short posterior ciliary artery that supplies the lamina area of the optic disc. It usually occurs in over 50-year-old people. It is acute optic neuropathy and featured with acute, monocular, and painless vision loss, which frequently results in severe permanent vision damage and visual field defects. This disease is attracting increased attention of clinical researchers. This paper overviews the current molecular pathology of NAION from these aspects, including pathogenesis, pathological changes, relevant protein molecules and susceptibility genes in previous studies. This paper lays a theoretical foundation for future research on the pathological mechanism and the treatment of NAION.
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@#Visual loss after non-ocular surgery(VLNOS)includes postoperative visual loss and perioperative visual loss after non-ocular surgery. The former accident consists of the blindness during a surgery or after a surgery, and the latter accident shows the acute visual loss in perioperative period. VLNOS can be appeared in a prone spinal surgery, cardiopulmonary bypass surgery, head and neck surgery, and facial micro-plastic injection treatment, which is a rare, extremely serious complication. VLNOS is divided into predictable and unpredictable condition. Doctors of related subjects have pay attention to VLNOS, and begin to study the possible reasons, and take positive precautions.
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@#High-quality clinical evidence, derived from well-designed and implemented clinical trials, serves to advance clinical care and to allow physicians to provide the most effective treatments to their patients. The field of ophthalmology, including the subspecialty of neuro-ophthalmology, abounds with such high-quality clinical trials that provide Level 1 clinical evidence. This review article summarizes the research design, key findings, and clinical relevance of select monumental clinical studies in neuro-ophthalmology with the primary goal of providing the readers with the rationale for current standard of care of various neuro-ophthalmic diseases. This includes the Optic Neuritis Treatment Trial, Ischemic Optic Neuropathy Decompression Trial, Idiopathic Intracranial Hypertension Treatment Trial, Rescue of Hereditary Optic Disease Outpatient Study, and Controlled High-Risk Avonex® Multiple Sclerosis Study
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Optic Neuritis , Optic Neuropathy, Ischemic , Intracranial HypertensionABSTRACT
Some recent advances in neuro-ophthalmology including clinical trials,diagnostic testing and newly elucidated disease entitites were summarized in present paper,such as neuromyelitis optica spectrum disorder.The review goes into great detail regarding recent clinical trials in neuro-ophthalmology.These trials have investigated the management of idiopathic intracranial hypertension as well as treatment of Leber hereditary optic neuropathy and optic nerve glioma.The potential gene therapy for Leber hereditary optic neuropathy seems very promising and may have a significant clinical impact within the next few years.This review also includes an extensive discussion about the application of optical coherence tomography (OCT) and OCT-angiography (OCTA) in neuro-ophthalmology.OCT has important clinical relevance not only for the diagnosis and management of optic neuropathies,such as optic neuritis,ischemic optic neuropathy and chiasmal compression,but also for retro-chiasmal injury.In terms of OCTA,recent studies have demonstrated increased vessel density in acute stage of ischemic optic neuropathy (NAION) and optic neuritis,but decreased vessel density in severe papilloedema and late stage of optic atrophy of any cause.These serve as the potential foundation for future clinical applications.Ophthalmologists should pay more attentions to these recent progress in neuro-ophthalmology.
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Objective:To study the pathogenesis and the risk factors of eye injury after non-ocular surgery in the patients underwent general anesthesia, and to provide the reference for its prevention, diagnosis and treatment.Methods:The clinical materials of two patients with eye injury after non-ocular surgery underwent general anesthesia were analyzed and the related literatures were reviewed.Results:A young woman patient underwent laparoscopic hysterectomy with general anesthesia while positioned Trendelenburg, the eyes were being closed naturally without protection, and corneal abrasion of both eyes occurred after operation.The lesion had completely resolved with no sequelae after treatment.An old man underwent cervical posterior laminoplasty with general anesthesia in prone position developed ischemic optic neuropathy (ION) after operation.The vision of the patients partly recovered after symptomatic treatment.Conclusion:Corneal abrasion is the most frequent ophthalmologic complication during general anesthesia, most of the patients have good prognosis.Postoperative visual loss (POVL) is the most severe ophthalmologic complication without effective treatment available, the delicate reasons and mechanisms are not totally clear, prevention outweighs treatment.
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@#AIM: To study the effect and mechanism of salvia ligustrazine on non-arteriti anterior ischemic optic neuropathy.<p>METHODS: A total of 60 cases of non-arteriti anterior ischemic optic neuropathy were randomly divided into two groups. The control group(<i>n</i>=30 cases)was treated with oral prednisone acetate tablets and injection of compound anisodine. The experimental group(<i>n</i>=30 cases)was the same to the control group and added intravenous salvia ligustrazine, the period of treatment was 14d. The levels of IL-1β and TNF-α were detected by ELISA, and the protein expression levels of Bcl-2 and Caspase-3 were detected by Western blot. <p>RESULTS: The best corrected visual acuity was improved in both groups. The plasma levels of IL-1β and TNF-α were significantly lowed in the experimental group than the control group, and the difference between the two groups was statistically significant(<i>P</i><0.05). The protein expression of Bcl-2 and Caspase-3 in the two groups were different from those before treatment(<i>P</i><0.05), and the difference between the two groups was statistically significant(<i>P</i><0.05). <p>CONCLUSION: Salvia ligustrazine promotes the recovery of visual function by reducing the level of inflammation and inhibiting cell apoptosis in body.
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@#AIM: To investigate the effect of cardiovascular risk factors on the occurrence of nonarteritic anterior ischemic optic neuropathy(NAION)and visual functions of the patients.<p>METHODS: Sixty-eight patients diagnosed as initial ipsilateral NAION(68 eyes)in NAION group and another 68 patients(68 eyes)matched in age, gender and systemic diseases in Control group were selected from June 2014 to June 2016 were enrolled in this study and evaluated for their levels of homocysteine(Hcy), blood lipids, folic acid and vitamin B12, as well as carotid Doppler ultrasonography. The visual functions were also examined in patients with NAION.<p>RESULTS: The levels of Hcy(24.8±13.9μmol/L), total plasma cholesterol(4.5±1.0mmol/L), triglyceride(2.0±0.9 mmol/L)and low-density lipoprotein(2.9±0.8mmol/L)in NAION patients were significantly higher(<i>P</i><0.05)than those in Control group(11.1±8.2μmol/L, 3.8±0.7mmol/L, 1.5±0.5mmol/L and 2.3±0.5mmol/L)while the level of vitamin B12 decreased significantly(315.6 ±214.5pg/mL, <i>P</i><0.05)in NAION group in comparison with those(467.9±198.2pg/mL)in Control group. However, no significant differences in the artery resistance and inner diameter of the internal carotid were detected between the two groups. The mean deviation(MD)of the visual field was 16.6±7.5dB in NAION group. The levels of Hcy, vitamin B12, folic acid and blood lipid and the presence of systemic diseases were not the risk factors for the visual field damage in NAION patients. MD value was associated with the amplitude and peak latency of P100 waves.<p>CONCLUSION: Hyperhomocysteinemia, hyperlipidemia and low vitamin B12 are the risk factors of in NAION patients. These risk factors, however, are not related to the extent of visual field damage. To some extent, the amplitude and peak latency of visual evoked potentials can reflect the extent of visual field damage.
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@#AIM: To investigate the relationship between serum homocysteine(Hcy)and anterior ischemic optic neuropathy(AION)in patients with type 2 diabetes mellitus.<p>METHODS: One hundred patients with type 2 diabetes mellitus who treated in Hebei Eye Hospital from January 2016 to April 2019 were divided into two groups: group A(<i>n</i>=53)without AION, group B(<i>n</i>=47)with AION. Thirty-eight healthy volunteers were used as control group(group C). The serum levels of Hcy, triglyceride cholesterol(TG), low density lipoprotein cholesterol(LDL-C), creatinine(Cr), gycosylated hemoglobin(HbA1c), blood pressure, best corrected visual acuity were detected. To analyze the correlation between serum Hcy level and the clinical indicators in AION in patients with type 2 diabetes mellitus.<p>RESULTS: The level of Hcy in group B was significantly higher than that in group A and group C \〖(13.87±5.02)μmol/L ratio(11.83±3.49)μmol/L, and(11.06±3.62)μmol/L, all <i>P</i><0.05\〗.The group B HHcy incidence(36.2%)was significantly higher than that in group A(11.3%)and group C(10.5%).The level of Hcy was positively correlated with HbA1c(<i>r</i>=0.517, <i>P</i>=0.001)and negatively correlated with BCVA(<i>r</i>=-0.353, <i>P</i>=0.026)after adjustment for age, TG, LDL-C, Cr, systolic blood pressure, diastolic blood pressure and course of diabetes mellitus.<p>CONCLUSION: The level of Hcy in serum may be involved in the pathogenesis of AION in type 2 diabetic patients. Hcy may be a potential target for preventing and treating AION in type 2 diabetic patients.
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OBJECTIVE: To observe the effect of acupuncture of intraorbital and extraorbital acupoints on apoptosis and expression of Bax, Bcl-2 and Caspase-3 proteins of retinal ganglion tissue in rabbits with nonarteritis anterior ischemic optic neuropathy (NAION), so as to reveal its mechanism underlying improvement of NAION. METHODS: Female New Zealand rabbits were randomly divided into four groups: model, intraocular needling (ION), extraocular needling (EON), ION＋EON groups (n＝5 per group), and the 5 healthy eyes of those rabbits in the model group were selected to be used as the control group. The NAION model of the right eye was established by photodynamic stroke method. For ION group, acupoints "Jingming" (BL1), "Chengqi" (ST1) and "Qiuhou" (EX-HN7) were needled, and for EON group, "Cuanzhu" (BL2), "Yuyao" (EX-HN4) and "Qiaoming" (EX) were needled with filiform needles, followed by retaining the needles for 30 min. For ION＋EON group, the 6 acupoints were needled simutaneously. The treatment was conducted once daily for 3 days. The apoptosis of retinal ganglion tissue was detected by using TUNEL fluorescence labeling, and the expression of Bax, Bcl-2 and active Caspase-3 in the retinal ganglion were detected by immunohistochemistry. RESULTS: Following modeling and compared with the control group, the number of the apoptotic cells, and the expression levels of Bax and Caspase-3 proteins, as well as the ratio of Bax/Bcl-2 were significantly increased in the model group (P0.05). CONCLUSION: Acupuncture of intraorbital and extraorbital acupoints can reduce apoptosis of retinal ganglion in NAION rabbits via inhibiting the activation of Caspase-3 protein and ratio of Bax/Bcl-2, and up-regulating the expression of Bcl-2 protein.
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Objective: To study the pathogenesis and the risk factors of eye injury after non-ocular surgery in the patients underwent general anesthesia∗ and to provide the reference for its prevention, diagnosis and treatment. Methods: The clinical materials of two patients with eye injury after non-ocular surgery underwent general anesthesia were analyzed and the related literatures were reviewed. Results: A young woman patient underwent laparoscopic hysterectomy with general anesthesia while positioned Trendelenburg, the eyes were being closed naturally without protection, and corneal abrasion of both eyes occurred after operation. The lesion had completely resolved with no sequelae after treatment. An old man underwent cervical posterior laminoplasty with general anesthesia in prone position developed ischemic optic neuropathy (ION) after operation. The vision of the patients partly recovered after symptomatic treatment. Conclusion: Corneal abrasion is the most frequent ophthalmologic complication during general anesthesia, most of the patients have good prognosis. Postoperative visual loss (POVL) is the most severe ophthalmologic complication without effective treatment available, the delicate reasons and mechanisms are not totally clear, prevention outweighs treatment.