ABSTRACT
@#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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
@#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.
ABSTRACT
PURPOSE: To investigate the function of the fellow eye in patients with unilateral nonarteritic anterior ischemic optic neuropathy (NAION). METHODS: From 2009 to March 2018, 18 patients with NAION who underwent bilateral visual field examinations and follow-up visits at least two times were enrolled in this study. Initial visual acuity, final visual acuity, degree of visual field defects, the cup-disc (C/D) ratio of the fellow eye, and the presence or absence of cardiovascular disease was retrospectively analyzed using medical records. RESULTS: The fellow eye mean best-corrected visual acuity was 0.03 ± 0.53 (logMAR) and the mean visual field defect was −4.68 ± 3.65 dB in 18 eyes of patients with unilateral NAION (p = 0.007 and p = 0.001, respectively). The C/D ratios were divided into two groups: > 0.3 and < 0.3. The visual field defect was improved significantly from −4.92 dB to −2.37 dB in the group with optic disc ratios < 0.3 (p = 0.013). When the changes in visual field defects were analyzed according to the presence or absence of cardiovascular disease, the visual field defects were improved from −5.65 dB to −4.49 dB in patients with cardiovascular disease, and improved from −3.69 dB to −1.46 dB in patients without cardiovascular disease (p = 0.025 and p = 0.021, respectively). CONCLUSIONS: In patients with unilateral NAION, reduced function in the fellow eye may appear temporarily, so a visual field examination should be performed in both eyes. The possibility of incipient NAION should be considered in patients with visual field abnormalities in the fellow eye.
Subject(s)
Humans , Cardiovascular Diseases , Follow-Up Studies , Medical Records , Optic Neuropathy, Ischemic , Retrospective Studies , Visual Acuity , Visual FieldsABSTRACT
@#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.
ABSTRACT
Purpose: The purpose of this study is to detect the optic nerve head (ONH) and peripapillary perfusion in eyes with acute nonarteritic anterior ischemic optic neuropathy (NAION) compared to the fellow normal eyes using optical coherence tomography angiography (OCTA) and to compare with nonischemic disc edema (papilledema). Methods: Retrospective analysis of patients with unilateral NAION who underwent OCTA was performed. All patients underwent comprehensive ocular examination including visual field testing. ONH was imaged using 6 mm � 6 mm scan by Topcon DRI Triton� OCT system. Vascularity loss was analyzed using ImageJ software in diseased eyes in comparison to normal fellow eyes and eyes with papilledema. Results: Twenty-one patients (15 males, 6 females) with unilateral NAION and 9 patients (18 eyes) with papilledema were included in the study. In eyes with NAION, two distinct patterns of loss of vasculature were noted � (a) diffuse loss of microvasculature cuff and vascular network around the optic disc in all the patients (100%) and (b) additional area of sectoral loss of vasculature extending from the disc in 12 of the 21 eyes (57.14%). All 18 eyes with papilledema showed loss of the microvasculature cuff; however, none showed the focal pattern of vascular defect. The mean area of the peripapillary vascular zone in eyes with NAION was significantly lesser than that in normals. Of the 12 eyes with NAION with focal loss of vasculature, 11 correlated with visual field defects (91.6%). Conclusion: Deficient peripapillary choroidal vasculature is present in NAION and has a different pattern than in nonischemic disc edema and can cause corresponding visual field deficits.
ABSTRACT
Anemia appears frequently in patients with alcoholic liver disease (ALD) but has never been linked to bilateral nonarteritic anterior ischemic optic neuropathy (NAION). A 65-year-old woman with a medical history of alcoholic cirrhosis was admitted for bilateral NAION. On admission, she was found to have a low arterial pressure and severe normocytic anemia (48 g/L). The anemia was related to chronic bleeding due to antral gastritis along with other factors associated with ALD. The applied treatment consisted of urgent transfusion followed by high doses of proton-pump inhibitors, iron and vitamin supplementation, and support in lifestyle measures. Her hemoglobin levels remained stable after 2 years but the patient still suffered from visual loss. This case highlights the link between anemia and bilateral NAION in ALD patients. The optic nerve head is prone to infarction in this context due to the vascularization characteristics of ALD. Hemoglobin levels should be monitored in ALD patients to avoid the severe complication of NAION.
Subject(s)
Aged , Female , Humans , Alcoholics , Anemia , Arterial Pressure , Gastritis , Hemorrhage , Infarction , Iron , Life Style , Liver Cirrhosis, Alcoholic , Liver Diseases, Alcoholic , Optic Disk , Optic Nerve Diseases , Optic Neuropathy, Ischemic , VitaminsABSTRACT
@#AIM: To observe the choroidal thickness in nonarteritic anterior ischemic optic neuropathy(NAION)measured by enhanced depth imaging optical coherence tomography(EDI-OCT)and evaluate its clinical significance. <p>METHODS: Totally 30 patients diagnosed with NAION were studied and 60 individuals with normal fundus were set as control. Choroidal thickness was measured by EDI-OCT. Choroidal thickness of the affected eye and contralateral eye in patient group and right eye of the control group were evaluated and recorded. <p>RESULTS: Differences in age, gender and refractive status between NAION group and control were not significant(<i>P</i>>0.05). Choroidal thickness near fovea and optic disc in affected eye and contralateral eye in patient group was thinner compared to these of control group(<i>P</i><0.01). No statistical differences were observed in the choroidal thickness between affected eye and contralateral eye(<i>P</i>>0.05). <p>CONCLUSION: In NAION patients, choroidal thickness of affected eyes and unaffected contralateral eyes were significantly thinner compared to these of control group. Diminish of the observed choroidal thickness in this study might be explained by small vessels occlusion in posterior ciliary artery, which would affect the blood supply of the choroid.
ABSTRACT
Nonarteritic anterior ischemic optic neuropathy (NAION)is a common optic neuropathy seriously affecting the visual function in the middle-aged and elderly population.However,its pathogenesis is not completely clear,and therefore its treating efficacy is dissatisfactory.The current study on NAION is focused on the establishment of suitable animal model and the pathogenesis.In recent years,the relatively ideal animal models(including rodent and primate) have been established by photodynamic methods,which make people have more in-depth understanding on the pathophysiologic mechanism of NAION and lay the basis for the research of therapies.The selection of experimental animals,various induction methods and existing problems in the creation of NAION animal model were reviewed and analyzed in this artical.
ABSTRACT
PURPOSE: Nonarteritic anterior ischemic optic neuropathy (NAION) is believed to result from inadequate blood supply to the posterior ciliary arteries. To date, NAION in a patient with acute angle-closure glaucoma (AACG) has been reported in only two studies in the English literature. Thus, the authors report a case of NAION following AACG in a Korean patient. CASE SUMMARY: A 59-year-old woman presented with a three-day history of acute ocular pain and decreased vision in her right eye; visual acuity was hand movement and the intraocular pressure (IOP) was 66 mm Hg in the right eye. Slit-lamp examination of the patient's right eye revealed diffuse corneal edema, shallow anterior chamber, and mid-dilated pupil. Gonioscopy revealed a grade 0 angle in the right eye, and a relative afferent pupillary defect was noted. Fundus photography showed disc hemorrhage and swelling of the optic disc. Fluorescein angiography demonstrated hyperfluorescence of the optic disc due to leakage. Visual evoked potential of the right eye at the initial visit showed a decreased amplitude of P100 compared with that of the left eye. A diagnosis of NAION following AACG was made. Laser iridotomy was successfully performed to the right eye. Two months later, IOP decreased from 66 to 21 mm Hg. However, visual acuity remained as hand movement and fundus examination revealed a pale optic disc. CONCLUSIONS: NAION following AACG may be attributed to an acute IOP rise with resultant perfusion pressure decrease in the vessels which supply the optic nerve. The result obtained from the patient in the present study indicates that evaluation for NAION should be considered in AACG cases.
Subject(s)
Female , Humans , Middle Aged , Anterior Chamber , Ciliary Arteries , Corneal Edema , Evoked Potentials, Visual , Eye , Fluorescein Angiography , Glaucoma, Angle-Closure , Gonioscopy , Hand , Hemorrhage , Intraocular Pressure , Optic Nerve , Optic Neuropathy, Ischemic , Patient Rights , Perfusion , Photography , Pupil , Pupil Disorders , Vision, Ocular , Visual AcuityABSTRACT
The purpose of this case report is to evaluate the visual outcome of an intravitreal triamcinolone acetonide injection (IVTA) as a treatment for a patient with acute nonarteritic anterior ischemic optic neuropathy (NAION). A 65-year-old male patient with severe visual loss due to acute NAION was treated with 4 mg/0.1mL IVTA. Fundus examination and measurements of the patient's best-corrected visual acuity and visual field were performed before and after the injection at 2 weeks, 1 month, 3 months, and 6 months. The best-corrected visual acuity changed from 0.05 before the injection to 0.16 at 2 weeks, 0.3 at 1 month, and 0.4 at 3 months and at the final visit. Optic disc swelling had markedly decreased at 1 week postoperatively and disappeared at 2 weeks after the injection. The clinical course of this patient suggests that an IVTA may be effective in increasing visual acuity following an acute NAION. A large randomized controlled trial is needed to assess the efficacy of IVTA as a treatment for NAION.