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Objective:To evaluate the efficacy and safety of oral anisodine hydrobromide tablets in the treatment of nonarteritic anterior ischemic optic neuropathy (NAION).Methods:A multicenter nonrandomized controlled trial was conducted.A total of 282 acute NAION patients (282 eyes) were recruited from 16 hospitals in China from July 2020 to May 2021.Patients were divided into two groups according to treatment methods, which were control group (124 cases, 124 eyes) receiving regular treatment including citicoline sodium plus Ginkgo biloba leaf liquid extract or Ginkgo biloba leaf extract tablets plus mecobalamin, and experimental group (158 cases, 158 eyes) receiving treatment in control group plus oral anisodine hydrobromide tablets 1 mg, twice daily for 2 to 3 months.Best corrected visual acuity (BCVA), visual field index (VFI), peripapillary retinal nerve fiber layer (pRNFL) and radial peripapillary capillary vessel density (RPC) were assessed at 1, 2, 3, and 6 months after enrollment using the standard decimal visual acuity chart, 750i Humphery visual field analyzer, Cirrus HD-OCT 4000/Cirrus HD-OCT 5000, RTVue-XR optical coherence tomography respectively.The primary outcomes were BCVA and VFI, and the secondary outcomes were pRNFL, RPC, and the side effects during the follow-up.The study adhered to the Declaration of Helsinki.All patients were fully informed about the treatment and purpose of this study and voluntarily signed the informed consent form.The study protocol was approved by Chinese PLA General Hospital (No.S2020-021-01). Results:In all, 242 patients (242 eyes) completed the follow-up of BCVA, and 98 patients (98 eyes) completed the VFI follow-up.In terms of visual function, BCVA and VFI improved significantly over time in the two groups, and BCVA and VFI were better in experimental group than in control group at various follow-up time points (all at P<0.05). In terms of structure, pRNFL gradually decreased in both groups with the extension of treatment, and pRNFL was significanthy thinner in experimental group than in control group at various follow-up time points (all at P<0.05). There was no significant difference in RPC between the two groups at the last follow-up ( P>0.05). There were two cases with side effects and one case was discontinued due to side effects 25 days after enrollment. Conclusions:Oral anisodine hydrobromide can improve visual acuity and visual field in NAION and accelerate the regression of optic disc edema, with good safety.
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Objective:To quantitatively analyze the protein expression changes of the optic nerve in an SD rat model of non-arteritic anterior ischemic optic neuropathy (NAION), and to make bioinformatics analysis of the differential proteins.Methods:Ten 8-week-old SPF male SD rats with a body mass of 200-250 g were selected.The NAION model was established using the method of rose bengal and laser photodynamics.Four from the 8 rats with successful model were selected as the NAION model group.Another 4 body weight- and age-matched healthy SD rats without eye diseases were taken as the normal control group.The optic nerve was dissected on the 7th day after modeling.The samples were prepared by the enzyme digestion method, and the proteins were identified and quantitatively detected by isobaric tag for relative and absolute quantification labeling combined with liquid chromatography-tandem mass spectrometry.The proteins with expression fold greater than 1.5 times and significant differences between the two groups ( P<0.05) were defined as differentially expressed proteins and analyzed by bioinformatics.The use and care of animals complied with Regulations for the Administration of Affair Concerning Experimental Animals by the State Science and Technology Commission of China.The study protocol was approved by an Animal Ethical and Welfare Committee of Tianjin Medical University Eye Hospital (No.TJYY2021041029). Results:Three days after modeling, the optic disc of rats was swollen and fluorescein leakage in the optic disc was detected in fluorescein fundus angiography images in the NAION model group, which indicated the model was established successfully.A total of 1 291 quantifiable proteins including 80 differentially expressed proteins were identified.Compared with the normal control group, there were 5 up-regulated proteins and 75 down-regulated proteins.The expression levels of collagen alpha-1(V) chain (Col5A1), cAMP-dependent protein kinase catalytic subunit beta (Prkacb) and disks large homolog 1(Dlg1) were increased, and the expression levels of neurofilament medium polypeptide (Nefm), microtubule-associated protein 1B (Map1b), Ras-related protein Ral-A (Rala), serine/threonine-protein kinase N2 (Pkn2) and platelet-activating factor acetylhydrolase IB subunit beta (Pafah1b1) were decreased.Differentially expressed proteins were mainly involved in the biological processes, including regulation of the cytoskeleton, cellular response to hypoxia, axon production and extension, regulation of synapse, regulation of neuron apoptosis and axo-dendritic transport, etc.KEGG pathway enrichment analysis showed that differentially expressed proteins were mainly involved in metabolic pathways, synaptic vesicle circulation and platelet activation.Conclusions:The expression of proteins related to signal pathways such as nerve growth, energy metabolism, axo-dendritic transport and apoptosis is involved in the apoptosis of neurons in NAION.
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Objective:To evaluate the efficacy and safety of compound anisodine (CA) injection for anterior ischemic optic neuropathy (AION).Methods:Studies, which were randomized controlled trials (RCT) of CA with routine treatment for AION from PubMed, The Cochrane Library, Web of Science, CNKI, Wanfang database, Chinese science and technology journals full-text database and CD-ROM database of Chinese Biology Medical disc published from January 1978 to June 2021 were searched.Included studies were screened by two researchers independently based on inclusion and exclusion criteria.After data collection and quality assessment, a meta-analysis of included studies was performed with Revman 5.3 software.Results:Thirteen RCT were included, involving 1 636 eyes, with 829 eyes in treatment group and 807 eyes in control group without CA treatment.It was found that the total effective rate of treatment group was higher than that of control group ( OR=3.25, 95% CI: 2.47-4.28, P<0.01), and the best corrected visual acuity of AION patients after CA treatment was significantly better than that of control group when articles with high heterogeneity were excluded (MD=0.14, 95% CI: 0.11-0.17, P<0.01) or not (MD=0.14, 95% CI: 0.12-0.16, P<0.01).The mean defect of visual field was significantly smaller and the mean sensitivity of visual field was higher in treatment group than control group (MD=-2.58, 95% CI: -3.98--1.19, P<0.01; MD=3.49, 95% CI: 3.07-3.91, P<0.01). Conclusions:CA shows good efficacy in the treatment of AION.It can improve visual acuity and mean sensitivity of visual field, decrease mean defect of visual field.
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Objective:To observe the morphological characteristics of internal carotid artery (ICA) siphon and ophthalmic artery (OA) in patients with non-arteritic anterior ischemic optic neuropathy (NAION) based on CT angiography (CTA) three-dimensional reconstruction of ICA siphon and OA models.Methods:A retrospective cohort study. From January 2017 to January 2019, 26 patients with 31 eyes (NAION group) who were diagnosed with NAION by ophthalmic examination at Beijing Friendship Hospital, Capital Medical Universitywere included in the study. Among them, there were 11 males with 13 eyes, and 15 females with 18 eyes; the age was 67.52±6.30 years old. Nineteen eyes of 19 non-affected contralateral eyes were selected as the contralateral eye group. Among them, there were 9 males with 9 eyes and 10 females with 10 eyes; the age was 65.95±5.66 years old. Twenty-six eyes of 26 age- and sex-matched subjects with normal fundus examination during the same period were selected as the normal control group. All subjects underwent best corrected visual acuity (BCVA), intraocular pressure, fundus photography and CTA examination. The data obtained from CT scans were reconstructed by 3D model, and the anatomical morphology of ICA siphon was divided into U-shape, V-shape, C-shape and S-shape; the diameter of ICA siphon portion and the diameter at the beginning of OA were measured. One-way analysis of variance was used to compare the diameter of the OA at the beginning of the OA and the diameter of the ICA siphon between the three groups of eyes.Results:The diameters at the beginning of OA in the NAION group, the contralateral eye group, and the normal control group were 1.17±0.20, 1.34±0.17, and 1.39±0.15 mm, respectively, and the differences among the three groups were statistically significant ( F=12.325, P<0.05); there was no significant difference between the contralateral eye group and the normal control group ( P=0.310). In the NAION group, the anatomical morphology of the ICA siphon was U-shaped and V-shaped in 20 (64.52%) and 8 (25.81%) eyes respectively, and S and C-shaped in 3 eyes (9.67%); in the contralateral eye group, in the control group, the ICA siphon shape of the eyes examined was U-shaped and V-shaped, and S-shaped and C-shaped were rare. The diameters of the ICA siphons in the NAION group, the contralateral eye group, and the normal control group were 3.50±0.69, 3.22±0.59, and 3.55±0.54 mm, respectively. There was no significant difference between the three groups ( F=1.860, P=0.163). Conclusion:U-shaped and V-shaped ICA siphons are more common in NAION-affected eyes; the diameter of the starting point of OA is significantly reduced.
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Objective:To evaluate the occurrence of nocturnal hypotension (NHP) in nonarteritic anterior ischemic optic neuropathy (NAION).Methods:A evidence-based medicine study. Chinese and English as search terms for NAION and NHP was used to search literature in PubMed of National Library of Medicine, Embase, Web of science, Cochrane Library, Clinical Trials, Wanfang, and China National Knowledge Infrastructure and China Biology Medicine disc. Incomplete or irrelevant literature and review literature were excluded. The literature was meta-analyzed using Review Manager 5.4 and STATA 15.0. The 95% confidence interval ( CI) were selected as the estimated value of effect size, the occurrence of NHP in NAION was calculated, and sensitivity analysis and publication bias analysis were also performed to assess the robustness of pooled outcomes. Results:According to the search strategy, 159 articles were initially retrieved, and 8 articles were finally included for meta-analysis, three prospective studies and five retrospective studies. The occurrence of NHP in NAION was 43% (95% CI, 0.36-0.50). Sensitivity analyses confirmed that the evidence was robust. Subgroup analyses showed that the occurrence of NHP in NAION nearly the same in White patients (47%, 95% CI 0.39-0.55) and Chinese patients (41%, 95% CI 0.32-0.51). The occurrence of NHP in NAION was higher in using night mean artery pressure (45%, 95% CI 0.31-0.60) as the diagnostic criteria than using night systolic blood pressure & night diastolic blood pressure (40%, 95% CI 0.32-0.50). Conclusions:The occurrence of NHP in NAION was 43%; the occurrence was similar in patients of different ethnicities. The diagnosis rate could be improved by using nMAP < 70 mm Hg (1 mm Hg=0.133 kPa) as a diagnostic criterion for NHP. Careful intervention should be taken for the blood pressure of patients with NAION and NHP.
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Objective:To investigate the application of critical flicker fusion frequency (CFF) in non-arteritic anterior ischemic optic neuropathy (NAION).Methods:A cross-sectional study. From January 2021 to September 2021, a total of 58 NAION patients (105 eyes) (NAION group) and 33 cases (63 eyes) in the healthy control (HC) group were included from Department of Ophthalmology of First Medical Center, PLA General Hospital. Patients underwent best-corrected visual acuity (BCVA), optical coherence tomography (OCT), visual field, CFF and flash visual evoked potential (F-VEP) examinations. BCVA examination was performed using a Snellen decimal visual acuity chart and was converted to logarithm of the minimum angle of resolution visual acuity. In the affected eyes group, there were 56 cases (72 eyes), 31 cases (43 eyes) male and 25 cases (29 eyes) female, with an average age of 49.28±11.42 years old. And the affected eyes were divided into 4 groups: <1, 1-<3, 3-<6 and >6 months according to the time interval from onset to CFF examination, which were 20(27.8%), 26 (36.1%), 17 (23.6%) and 9 (12.5%) eyes, respectively. According to the BCVA ≥0.5, 0.1-0.5, <0.1 in CFF examination, the affected eyes were divided into a mild, moderate, and severe degree, 33 (45.8%), 32(44.4%) and 7 (9.8%) eyes, respectively. Sixty-three eyes of 33 cases were in the HC group. There were 17 cases(31 eyes) males and 16 cases (32 eyes) females, with an average age of 35.18±10.96 years. Hand-held CFF detector type 2 (Japan, NEITZ company) was used for the CFF examination. The thickness of peripheral retinal nerve fiber layer (pRNFL), macular inner limiting membrane retinal pigment epithelium (mILM-RPE), F-VEP peak time and peak value and mean visual field defect (MD) values were recorded within 1 week of CFF examination. The CFF value of the above subgroups was analyzed in order using one-way ANOVA. Pearson correlation analysis was used for the correlation between CFF and F-VEP peak time, peak value, BCVA and MD. The correlations between BCVA, visual field, F-VEP, and CFF were analyzed.Results:The trichromatic values of red, green and yellow in NAION affected eyes were 22.56±10.30, 24.10±11.51, 24.81±11.41 Hz, respectively, which was significantly reduced compared with the HC group ( t=-10.53,-11.11,-11.36; P<0.05). There was no significant difference in CFF-red, green, and yellow values at different time points after the onset of the disease ( F=2.075, 1.893, 2.073; P>0.05). Compared CFF-red, green, and yellow values in NAION-affected eyes with different degrees, the difference was statistically significant ( F=31.579, 27.332, 32.055; P<0.05). The results of correlation analysis showed that the peak time of F-VEP ( r=-0.362, -0.379,-0.357; P<0.05), BCVA ( r=-0.705,-0.695,-0.714; P<0.05), and which was negatively correlated with CFF three color. MD and CFF were positively correlated ( r=0.486, 0.435, 0.450; P<0.05). Conclusion:The CFF value of the affected eye is decreased significantly in NAION-affected eyes, and CFF is more sensitive than F-VEP in reflecting visual impairment, and has a good correlation with visual function and latency of F-VEP.
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Objective:To observe the changes in blood flow density of radial retinal peripapillary capillary (RPC) around the optic disc in patients with non-arteritic anterior ischemic optic neuropathy (NAION) at different stages of the continuous course of the disease.Methods:A prospective cohort study. From January to December 2020, 29 cases of 29 eyes of NAION patients diagnosed in the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine were included in the study. Among them, there were 18 males with 18 eyes and 11 females with 11 eyes. The average age was 53.62±6.67 years old. The affected eye underwent routine eye examination and visual field, optic cohenrence tomography angiography (OCTA) examination. Visual field inspection was performed to obtain the average visual mean defect (MD) value. OCTA was used to measure the thickness of the peripapillary retinal nerve flayer (pRNFL) around the optic disc, the whole en face image vessel density (wiVD), intro disc vessel density (diVD), RPC blood flow density around the optic disc, and macular ganglion cell complex (GCC). The course of disease ≤3 weeks was defined as the acute phase; 4-12 weeks was defined as the subacute phase; >12 weeks was defined as the chronic phase. The changes of visual field MD, optic disc RPC blood flow density, pRNFL thickness and macular GCC thickness were observed in the acute, subacute and chronic phases (12-24, >24 weeks). A completely randomized design of variance analysis was used to compare the differences in visual field MD, RPC blood flow density, GCC, and pRNFL thickness in different courses. Pearson correlation analysis was used to analyze the correlation between pRNFL thickness, macular GCC thickness, visual field MD changes and RPC blood flow density around the optic disc sex.Results:The wiVD of the eyes in the acute phase, subacute phase, and chronic phase (12-24 weeks, >24 weeks) were (44.96±2.76)%, (41.50±3.49)%, (39.08±5.43)%, (38.56±6.48)%. There was a statistically significant difference in wiVD of eyes with different disease courses ( F=8.939, P<0.001). The average difference of wiVD between 12-24 weeks and >24 weeks in the chronic phase was -0.984, and the difference was not statistically significant ( P>0.05). There was no statistically significant difference in diVD of patients with different courses of disease ( F=1.079, P=0.365). The blood flow density of RPC around the optic disc of the affected eye, except for the lower part, the blood flow density of the nasal side, the temporal side, and the upper quadrant, decreased significantly with the progression of the disease, and the difference was statistically significant ( F=8.816, 6.069, 8.943; P<0.05). In the chronic phase, the average difference of blood flow density between the nasal, temporal, and upper sides of the eyes between 12-24 weeks and more than 24 weeks in the chronic phase was -0.984, -0.230, -0.198, and the difference was not statistically significant ( P>0.05). There was no statistically significant difference in the visual field MD of patients with different courses of disease ( F=0.277, P=0.842); the overall pRNFL thickness and average macular GCC thickness were compared with statistical significance ( F=47.122, 14.954; P<0.001, <0.001), all became significantly thinner with the progression of the disease. The results of Pearson correlation analysis showed that the blood flow density of the entire optic disc wiVD, the blood flow density of RPC in the temporal quadrant around the optic disc and the visual field MD ( r=-0.225, -0.268; P<0.05), and the average thickness of GCC ( r=0.480, 0.436; P<0.01) were all related. Conclusion:The blood flow density of RPC in the entire optic disc and around the optic disc (except the lower quadrant) of NAION eyes gradually decrease with the progression of the disease, and stabilize after 12 weeks of the disease.
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Objective:To observe the clinical efficacy of oral glucocorticoids in the treatment of acute non-arteritic anterior ischemic optic neuropathy (NAION).Methods:A prospective clinical study. From December 2017 to June 2020, 40 eyes of 40 patients with acute NAION who were diagnosed in Department of Ophthalmology of Tengzhou Central People's Hospital were included in the study. All the affected eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examination of optic disc; 35 eyes (BCVA≥0.1) underwent visual field examination at the same time. The BCVA examination was carried out using the international standard decimal visual acuity chart, which was converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. The static visual field inspection was performed with Humphrey automatic perimeter to obtain the average mean deviation (MD) value. The thickness of peripapillary retinal nerve fire layer (pRNFL) around the optic disc of the affected eye was measured with an OCT instrument. According to the wishes of patients, they were divided into hormone treatment group and control group. All were given vitamin B1 and methylcobalamin orally; the hormone treatment group was given oral prednisone acetate treatment, 60 mg/d (regardless of body weight); after 2 weeks, the dose was reduced by 5 mg every 5 days, and the dose was reduced to 40 mg and maintained until optic disc edema subsides; thereafter, the dose was quickly reduced until the drug was stopped. Three and 6 months after treatment, the same equipment and methods were used for related examinations before treatment to observe the thickness changes of BCVA, MD, and pRNFL. The thickness of BCVA, MD, and pRNFL between the two groups was compared by Mann-Whitney U test. The thickness of BCVA, MD, and pRNFL before and after treatment within the group was compared by rank analysis of variance. Results:Among 40 eyes of 40 cases, 21 eyes were in the hormone treatment group, and 19 eyes were in the control group. There were differences in age, sex composition, course of disease, associated systemic risk factors, BCVA, MD, and pRNFL thickness between the two groups. There was no statistical significance ( P>0.05). At 3 and 6 months after treatment, the average logMAR BCVA of the eyes of the hormone treatment group and the control group were 0.26±0.32, 0.26±0.34, 0.28±0.30, 0.25±0.32, respectively. The visual field MD were -15.52±6.87, -15.55±6.04 dB and -14.82±7.48, -15.18±6.40 dB; pRNFL thickness was 70.38±10.22, 73.79±11.82 μm and 65.67±10.07, 69.26±10.85 μm. LogMAR BCVA ( Z=-0.014, -0.315; P=1.000, 0.768), visual field MD ( Z=-0.041, -0.068; P=0.979, 0.957), pRNFL thickness ( Z= -0.965, -1.112; P=0.347, 0.270), the difference was not statistically significant. Conclusion:Compared with the control group, oral glucocorticoid treatment of acute NAION fail to improve the visual function and morphological prognosis during the 6-month follow-up period.
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Objective To evaluate the efficacy of modified Xuefu-Zhuyu decoction in the treatment of nonarteritic anterior ischemic optic neuropathy (NAION).Methods A total of 87 patients with NAION who met the inclusion criteria were divided into control group (43 cases) and study group (44 cases) by the random number table method.The control group was given the routine treatment combined with compound anisodine injection,while the study group was treated with routine treatment combined with modified Xuefu-Zhuyu decoction.Both groups were treated for 28 days.The standard logarithmic visual acuity chart was used to detect and record the best corrected visual acuity.The Visual field photosensitivity and visual field defect was recorded by visual field program(Oc-topus-101).The systolic peak blood flow velocity (PSV),end diastolic velocity (EDV),resistance index (RI) of the posterior ciliary short artery were measured by color Doppler ultrasound.The clinical effect was evaluated.Results The total effective rate was 97.7％ (43/44) in the study group and 76.7％ (33/43) in the control group.There were significant differences between the two groups (x2=8.669,P=0.003).After treatment,the best corrected visual acuity (0.85 ± 0.21 vs.0.72 ± 0.32,t=2.245),visual field photosensitivity (18.71 ± 4.79 φ/db vs.16.32 ± 5.22 φ/db,t=2.226) in the study group was significantly higher than those in the control group (P＜0.05);the visual field defect (6.06 ± 1.52 φ/db vs.8.13 ± 2.43 φ/db,t=4.775) in the study group was significantly lower than that of the control group (P＜0.05);the PSV (10.03 ± 1.79 cm/s vs.8.85 ± 1.88 cm/s,t=2.999),EDV (3.06 ± 0.37 crn/s vs.2.67 ± 0.31 cm/s,t=5.323) in the study group was significantly higher than those of the control group (P＜0.05),RI (0.61 ± 0.08 vs.0.69 ± 0.09,t=4.385) in the study group was significantly lower than that of control group (P＜0.05).Conclusions The modified Xuefu-Zhuyu decoction combined with conventional medicine can effectively improve the hemodynamics and visual function of posterior ciliary short artery in NAION patients and improve the clinical efficacy.
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Objective To investigate the neuroprotective effect of Benztropine on retinal ganglion cells (RGCs) death and optic nerve injury in rats model of non-arteritis anterior ischemic optic neuropathy (rNAION).Methods A total of 25 Sprague-Dawley rats were randomly divided into Benztropine treatment group (n=13)and PBS control group (n=12).The right eye was set as the experimental eye.rNAION model was established by using rose Bengal combined with laser photodynamic method.The rats in the Benztropine treatment group were received intraperitoneal injection with Benztropine 10 mg/kg (0.2 ml) daily for 3 weeks,while the rats in the PBS control group were received intraperitoneal injection with an equal volume of PBS.At 1,3 and 7 days after modeling,the retinal and optic disc conditions of the rats were observed by direct ophthalmoscopy.Retrograde labeling,fluorescence microscopy and transmission electron microscopy were used to observe the survival of RGCs and the damage of the optic nerve myelin and axon at 4 weeks after modeling.The RGCs density and survival rate of the two groups were compared by One-Way Anova.Results At 1 and 3 days after modeling,the optic disc edema was observed in the rats of rNAION model group.At 7 days after modeling,the optic disc edema decreased and the boundary was blurred compared with 3 days after modeling.After 4 weeks,the RGCs density in the PBS group was 308± 194/mm2 and the survival rate was 13.7％.The density of RGCs in the Benztropine group was 1173+868/mm2 and the survival rate was 47.6％.The differences of RGCs density and survival rate were significant between the two groups (F=7.552,8.184;P=0.015,0.012).Myelin disintegration,axon degeneration,onion-like body and gliosis were observed in the optic nerve sections of rNIAON in the PBS group,while the damage ofaxon and myelin structure in the Benztropine group was significantly less than that in the PBS group.Conclusions Benztropine group showed higher RGC survival rate,less damage ofaxon and myelin structure on rNAION model.This study explored the potential neuroprotective effect of Benztropine.
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Objective To determine the correlation between obstructive sleep apnea syndrome (OSAS)and nonarteritic ischemic optic neuropathy (NAION).Methods It was a perspective study.A total of 41 consecutive patients with NAION (NAION group) and 41 age-and sex-matched physical examination subjects (control group) in Xi'an No.3 Hospital from December 2016 to December 2018 were enrolled in this study.The apnea hypopnea index (AHI,the number of sleep apneas per hour) was monitored using a polysomnography for patients in NAION group and control group.At the same time,the blood oxygen saturation was continuously recorded.The OSAS can be diagnosed if the AHI value was ≥ 5.OSAS severity was graded as mild:5≤AHI＜ 15;moderate:15≤AHI＜30;severe:AHI ≥30.The grading of OSAS severity between two groups was compared by Fisher's exact test.The AHI and minimum blood oxygen saturation were compared between NAION group and control group using the Mann-Whitney U test.Spearman correlation analysis was performed on the correlation between OSAS and NAION.Results Among the patients in the NAION group,31 patients (75.61％) were diagnosed with OSAS.Among them,6 patients (14.63％) were mild,9 patients (21.95％) were moderate,and 16 patients (39.03％) were severe.In the control group,19 patients (46.34％) were diagnosed with OSAS.Among them,10 patients (24.39％) were mild,5 patients (12.20％) were moderate,and 4 patients (9.75％) were severe.The difference of OSAS patients of mild,moderate and severe between two groups were statistically significant (Z=0.235,0.245,0.312;P=0.012,0.014,0.032).The average AHI of patients in the NAION group was 20.25 ± 7.74,and the mean minimum oxygen saturation at night was (87.38± 5.53)％.The average AHI of the control group was 18.67 ± 11.67,and the mean minimum oxygen saturation at night was (85.06+4.25)％.The differences of the mean AHI and mean minimum oxygen saturation between two groups were statistically significant (Z=1.124,2.317,P=0.003,0.020).There was a positive correlation between OSAS and NAION (Spearman correlation coefficient=0.229,P=0.030).Conclusion There is a positive correlation between OSAS and NAION.
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Objective To observe the blood perfusion changes ofperipapillary and macular vessels in patients with nonarteritic anterior ischaemic optic neuropathy (NAION).Methods Retrospective cohort study.Thirty-six eyes (19 affected eyes and 17 fellow eyes) of 19 patients with NAION diagnosed in People's Hospital of Wuhan University from November 2017 to January 2019 were included in this study.There were 1 0 males and 9 females,with the mean age of 55.05 ± 7.11 years.Forty eyes of 20 normal subjects matched with NAION patients were included as controls.BCVA,fundus color photography,SD-OCT and OCT angiography were performed in normal controls and repeated in NAION affected eyes at 1-2 weeks,1-2 months,3-5 months intervals.OCT quantitative measurements:average retinal nerve fiber layer thickness (aRNFL) of the disc and its superior values (sRNFL) and the inferior values (iRNFL),average ganglion cell complex thickness (aGCC) in macular region and its superior values (sGCC) and the inferior values (iGCC).OCTA quantitative measurements:average radial peripapillary capillary density (aRPC) and its superior values (sRPC) and the inferior values (iRPC),average vascular density of superficial retina (aSVD) in macular region and its superior values (sSVD) and the inferior values (iSVD),average vascular density of deep layer retina (aDVD),areas of foveal avascular zone (FAZ).The differences of OCT and OCTA quantitative measurements between NAION eyes and the fellow eyes and normal controls were comparatively analyzed.Independent sample t test,paired sample t test or nonparametric rank sum test were performed for comparison among three groups.Pearson or Spearman correlation analysis were used to analyze the correlation between RNFL and RPC,GCC and SVD,RNFL and GCC,RPC and SVD.Results At baseline,the aRNFL,aRPC and aDVD of NAION patients were significantly higher than those of normal controls.Compared with the fellow eyes,the aRNFL increased significantly and the aRPC decreased significantly in NAION affected eyes.The overall differences of aRNFL,aRPC,aGCC and aSVD at four intervals within NAION affected eyes were statistically significant (P＜0.05).The average sRNFL,sRPC,sGCC and sSVD at 1-2 months interval were significantly lower than the average iRNFL,iRPC,iGCC and iSVD (P＜0.05).Correlation analysis:at 1-2 months interval,aGCC was positively correlated with aSVD (r=0.482,P=0.037);at 3-5 months interval,aRNFL was positively correlated with aRPC (r=0.631,P=0.037).Conclusion There is a sectorial reduction of vascular density of peripapillary RPC and macular SVD with the disease progression of NAION.
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Diffusion Magnetic Resonance Imaging , Diffusion , Optic Nerve Diseases , Optic Nerve , Optic NeuritisABSTRACT
Objective To investigate the hemodynamics of ocular vessels of the bilateral eyes in patients with unilateral non-arteritic anterior ischemic optic neuropathy(NAION) . Methods Clinical data of 28 patients with unilateral NAION were collected . The peak systolic velocity ( PSV ) ,end diastolic velocity (EDV) ,resistance index (RI) of ophthalmic artery (OA) ,central retinal artery (CRA) ,nasal short posterior ciliary arteries ( NPCA ) and temporal posterior ciliary arteries ( TPCA ) were comparatively analyzed by color Doppler ultrasonography . Results The hemodynamic parameters of OA in NAION were not significantly different from those in the contralateral eyes ( P ＞ 0 .05 ).PSV of CRA was lower in NAION than that in contralateral eyes ,as well as EDV ( P ＜ 0 .05 ) ,while the RI of CRA was not significantly different between two groups ( P ＞0 .05).PSV of NPCA in NAION was lower than that in the contralateral eyes ( P ＜ 0 .05) ,while EDV and RI of NPCA were not quite different from those in contralateral eyes ( P ＞0 .05).The hemodynamic parameters of TPCA in NAION were not significantly different from those in the contralateral eyes ( P ＞0 .05).Conclusions Color Doppler ultrasonography can non-invasively detect and monitor the hemodynamic changes of ocular vessels in NAION ,which will be of great help in illuminating the pathogenesis of NAION and providing groundbreaking evidence for the diagnosis and prognosis of NAION .
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Non-arterial Inflammatory ischemic optic neuropathy(NAION)is a common ocular disease in middle and old ages.Symptoms of optic nerve dysfunction in NAION are caused by cerebral ischemia,which leads to optic atrophy.Recent studies have focused on the early interventions targeting NAION′s risk factors to protect the optic nerve and retinal ganglion cells.This article reviews recent progress in studies on the etiology and risk factors of NAION and potential therapies that may help to preserve optic nerve function in NAION.
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Objective To observe the expression of triggering receptor expressed on myeloid cells (TREM),Caspase-3 and interleukin (IL)-6 in optic nerve tissue of ischemic optic neuropathy (ION).Methods Twenty Sprague-Dawley rats were randomly divided into control group and model group,10 rats in each group.The permanent ligation of bilateral internal carotid arteries (BICA) was performed for 14 days to establish subacute ION model as model group.The control group were separated BICA without ligation.The expressions of TREM-1,TREM-2,Caspase-3 and IL-6 in rat retina were detected by reverse transcription PCR and Western blot,respectively.Results Compared with the control group,the expressions of TREM-1,Caspase-3,IL-6mRNA (t=6.058,7.86,6.055) and protein (t=9.671,9.524,14.501) in the optic nerve tissue of the model group were increased,while the expression ofTREM-2 mRNA and protein (t=9.283) was decreased,and the difference was statistically significant (P＜0.05).Conclusion In ischemic optic nerve tissue,TREM-1 mRNA and protein were significantly expressed,the expressions of TREM-2 mRNA and protein decreased significantly.
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Non-arteritic ischemic optic neuropathy (NAION) is a neurological disease due to poor perfusion in optic disk. It causes severe visual function impairment, characterized by loss of vision and visual field defect. Optical coherence tomography (OCT) is vital for detecting anterior laminar depth, peripapillary nerve fiber layer thickness, ganglion cell complex thickness and peripapillary choroid thickness change in eyes with NAION at different course of the disease. In addition, OCT features are in accordance with visual function impairment. OCT angiography (OCTA) reveals retinal and choroidal vasculature networks in optic and macular area. OCTA revealed vasculature perfusion decline in eyes with NAION, even if their visual sensitivity and visual evoked potential were normal. Studying OCT and OCTA features is vital for exploring the pathogenesis and prognosis of NAION.
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Background Anterior ischemic optic neuropathy (AION) is a common eye disease,and early diagnosis is very important for reserving useful vision.Frequency-domain optical coherence tomography (FD-OCT) can display retinal microstructure in vivo and quantify the thickness of macular ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL).Previous study on assessing retinal ganglion cell loss is assessed by measuring the RNFL thickness,while recent researches showed that GCC thickness measurement can reveal the retinal structure change in AION patients.However,there is few comparative studies on the diagnostic efficiency of RNFL thickness versus GCC thickness for AION.Objective This study was to evaluate and analyze the diagnostic value of GCC thickness and RNFL thickness measured by FD-OCT in patients with AION.Methods Fifteen eyes of 15 patients with AION and 14 normal eyes of 14 normal persons were enrolled in Eye Hospital of Tianjin Medical University from December 2013 to July 2014.Macular GCC thickness and disc RNFL thickness were measured by FD-OCT,and macular GCC thickness included superior,inferior and average GCC thickness around 6 mm×6 mm of macula,and focal loss volume (FLV) and global loss volume (GLV) were calculated.The disc RNFL thickness included superior,inferior and mean RNFL thickness around disc.The measuring outcomes between AION group and normal control group were compared.The diagnostic efficiency of GCC thickness and RNFL thickness was evaluated by the area under the receiver operating characteristic (ROC) curve.Results Compared with normal control group,the GCC thickness at superior,inferior and average GCC thickness at macula were thinner,with significant differences between them (t=-3.402,P=0.002;t =2.690,P=0.012;t=2.913,P=0.007).The FLV and GLV values were (8.39±4.54) μm3and (19.57±10.66) μm3 in the AION group,which were significantly lower than (0.64±0.48) μm3 and (1.14±0.91) μm3 in the normal control group (t=5.036,6.732;both at P＜0.01).The disc RNFL thicknesses of superior,inferior and average RNFL were thinner in the AION group than those in the normal control group,with significant differences between them (t=2.815,P=0.009;t =2.392,P=0.024;t =2.863,P=0.008).The AUC of FLV and GLV for AION were both 1.000,and that of superior GCC thickness,inferior GCC thickness and average GCC thickness at macula was 0.871,0.819 and 0.795,respectively.The AUC of average RNFL thickness and disc superior,inferior RNFL thicknesses for AION were 0.814,0.809 and 0.762,respectively.Conclusions The diagnosis ability of GCC and RNFL thickness for AION is comparable.FLV and GLV appear to have the strongest efficiency in the evaluation of GCL in AION patients.Macular GCC measurement may provide a good alternative or a complementary practice to RNFL scans for the diagnosis of AION.
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ABSTRACT Herein, we report a case of nonarteritic anterior ischemic optic neuropathy (NAION) following uneventful pars plana vitrectomy for macular hole treatment. A 56-year-old previously healthy woman presented with a full-thickness macular hole in right eye (OD) and small cup-to-disc ratios in both eyes. Five days after surgery, she noticed sudden painless loss of vision in OD and was found to have an afferent pupillary defect and intraocular pressure of 29 mmHg. Fundus examination showed right optic disc edema and the resolution of a macular hole with an inferior altitudinal visual field defect. Erythrocyte sedimentation rate, C-reactive protein levels, and general physical examination findings were normal. She was treated with hypotensive eyedrops and oral prednisone, resulting in mild visual improvement and a pale optic disc. A combination of face-down position and increased intraocular pressure due to a small optic disc cup were considered as potential mechanisms underlying NAION in the present case. Vitreoretinal surgeons should be aware of NAION as a potentially serious complication and be able to recognize associated risk factors and clinical findings.
RESUMO Nosso objetivo é descrever a ocorrência de neuropatia óptica isquêmica anterior não-arterítica (NOIA-NA) após vitrectomia posterior para tratamento do buraco macular. Uma mulher de 56 anos de idade previamente hígida apresentou buraco macular de espessura total no olho direito (OD) e uma relação escavação disco pequena em ambos os olhos. No quinto dia de pós-operatório ela notou uma perda visual súbita e indolor OD associado a presença de um defeito pupilar aferente relativo e pressão intraocular de 29 mmHg neste mesmo olho. A avaliação do fundo de olho revelou a presença de edema de disco óptico e buraco macular fechado OD associado a presença de defeito de campo visual altitudinal inferior. A velocidade de hemossedimentação e a dosagem da proteína C reativa foram normais, assim como o exame físico geral. A paciente foi tratada com colírios hipotensores e prednisona oral e evoluiu com discreta melhora visual e palidez de disco óptico. Acreditamos que a combinação de posição de cabeça virada para baixo associado a um aumento da pressão intraocular em um paciente com relação escavação disco pequena são os possíveis mecanismos para a ocorrência de NOIA-NA neste presente caso. Os cirurgiões de retina e vítreo devem estar atentos a esta possível grave complicação e reconhecer os seus fatores de risco relacionados assim como sua apresentação clinica.
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Humans , Female , Middle Aged , Retinal Perforations/surgery , Vitrectomy/adverse effects , Vitrectomy/methods , Optic Neuropathy, Ischemic/etiology , Optic Neuropathy, Ischemic/pathology , Postoperative Complications/etiology , Visual Acuity , Visual Fields , Treatment Outcome , Optic Neuropathy, Ischemic/drug therapy , Optic Neuropathy, Ischemic/diagnostic imaging , Tomography, Optical Coherence , Fundus Oculi , Intraocular PressureABSTRACT
The development of optical coherence tomography (OCT) has changed the clinical management of ophthalmic diseases by furthering the understanding of pathogenesis, as well as improving the monitoring of their progression and assisting in quantifying the response to treatment modalities in ophthalmic diseases. Initially, the two-dimensional configuration of the optic nerve head (ONH) and the thickness of the retinal nerve fiber layer (RNFL) were the main OCT structural parameters used in clinical management of optic nerve diseases. Now, with higher resolution power and faster acquisition times, the details of ONH and the retina including the macular area can be measured using spectral domain OCT (SD-OCT) with high reproducibility and increased diagnostic ability. OCT can provide structural information to improve the understanding and management of optic nerve diseases. In this review, we will briefly summarize the clinical applications of SD-OCT in glaucoma and nonarteritic anterior ischemic optic neuropathy, which are two representative optic nerve diseases.