Relationship between visual function and retinal structure in non-arteritic anterior ischemic optic neuropathy of different courses / 眼科新进展

Objective To observe the changes in visual function and retinal structure in patients with non-arteritic anterior ischemic optic neuropathy(NAION)at different stages and analyze the correlation between visual function and structural indicators.Methods A retrospective study was conducted on 33 patients(33 eyes)with NAION presented within 3 weeks of onset.Changes in visual function[best corrected visual acuity(BCVA),visual field mean deviation(MD),pattern standard deviation(PSD),and visual field index(VFI)]and retinal structure[peripapillary retinal nerve fi-ber layer(pRNFL)]thickness,macular ganglion cell complex(mGCC)thickness and loss volume,and radial peripapillary capillary(RPC)density)were analyzed from 4 to 12 weeks of onset and over 12 weeks of onset.The change features of and correlation between visual function indicators and structural indicators were analyzed.Results The BCVA of NAION eyes exhibited significant improvement with disease progression(P=0.021),with a statistically significant difference be-tween onset＞12 weeks and onset≤3 weeks(P=0.020)and no statistically significant difference between onset≤3 weeks and onset from 4 to 12 weeks or between onset from 4 to 12 weeks and onset＞12 weeks(P=0.158 and 0.100).There were no significant differences in MD,PSD and VFI across different stages of NAION(P=0.419,0.767 and 0.134).The pRNFL thickness(average,superior,and inferior),RPC density(average,superior,and inferior),and mGCC thick-ness(average,superior,and inferior)significantly decreased with disease progression(all P＜0.001),while focal loss volume(FLV)and global loss volume(GLV)of mGCC significantly increased with disease progression(both P＜0.001).The differences in these indicators above among each stage were statistically significant(all P＜0.05).Correlation analysis revealed that the BCVA demonstrated positive correlations with mGCC thickness(average and inferior)and RPC density(average and inferior)(all P＜0.05).Conversely,it exhibited negative correlations with FLV and GLV(both P＜0.05).There were no correlations between BCVA and pRNFL thickness(average,superior,and inferior),superior mGCC thick-ness,and superior RPC density(all P＞0.05).MD and VFI showed positive correlations with mGCC thickness(average and inferior)and RPC density(average,superior,and inferior)(all P≤0.001)and negative correlations with GLV(both P＜0.001),but no correlations with pRNFL thickness(average,superior,and inferior),superior mGCC thickness,and FLV(all P＞0.05).PSD showed no correlations with pRNFL thickness(average,superior,and inferior),mGCC thickness(average,superior,and inferior),FLV,GLV,and RPC density(average,superior,and inferior)(allP＞0.05).Conclu-sion The changes in visual acuity and visual field with the progression of NAION are associated with changes in mGCC thickness and RPC density,but not correlated with changes in pRNFL thickness.This suggests that visual function and reti-nal structural changes do not occur synchronously.

Correlation between remnant cholesterol and anterior ischemic optic neuropathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the correlation between remnant cholesterol(RC)and anterior ischemic optic neuropathy(AION).METHODS: A total of 80 cases of AION patients hospitalized in the department of ophthalmology of Linyi People's Hospital from January 2020 to December 2023 were selected as the observation group, and 80 cases of those who had completed health checkups in Linyi People's Hospital during the same period(without ischemic optic neuropathy and other fundus vasculopathies)were selected as the control group. The general data and biochemical indexes of the two groups were compared to evaluate the correlation between RC and AION.RESULTS: Compared with the control group, the levels of RC, fasting blood glucose(FBG), triglyceride(TG), total cholesterol(TC), and low-density lipoprotein cholesterol(LDL-C)in patients with AION were significantly higher than those in the control group(all P<0.01). Spearman correlation analysis showed that RC was positively correlated with TG, TC, and LDL-C(all P<0.01). Logistic regression analysis showed that RC and FBG were risk factors for the development of AION. The analysis of receiver operating characteristic(ROC)curves showed that the level of RC had a better predictive value for the development of AION compared with FBG.CONCLUSION: RC is associated with the development of AION and is a risk factor for the development of AION. Clinical standardization of the management of people with high RC values can reduce the risk of the development of AION, which is of clinical significance.

Research progress of dysthyroid optic neuropathy / 国际眼科杂志(Guoji Yanke Zazhi)

Dysthyroid optic neuropathy is an important secondary pathological condition of thyroid-associated ophthalmopathy, characterized clinically by several clinical manifestations, including reduced visual acuity, impairment of color vision, relative afferent pupillary defect, and optic disk edema or atrophy. Ophthalmological auxiliary examination shows abnormal vision field and visual evoked potential, etc., and imagining examination shows orbital apex crowding, which can assist diagnosis. The pathogenesis of this disease is still unclear. With previous studies proposing that it was related to optic nerve compression, stretch, and ischemia. Treatment methods include high-dose intravenous glucocorticoid, orbital decompression, orbital radiation therapy, and biological agent. This article systematically reviews the research progress on the epidemiological characteristics, pathogenesis, diagnosis, and treatment of this disease, with a view to providing useful reference for future in-depth clinical practice and scientific research.

Partial regression of peripapillary myelinated nerve fibers after non-arteritic anterior ischemic optic neuropathy / Regressão parcial das fibras nervosas peripapilares mielinizadas após neuropatia óptica isquêmica anterior não arterítica

ABSTRACT A 71-year-old woman presented a non-arteritic anterior ischemic optic neuropathy in an optic nerve with previously registered superonasal peripapillary myelinated nerve fibers. Her past medical history was significant for controlled systemic hypertension, hyperlipidemia, and diabetes mellitus. The physiologic cup was absent in both optic discs. Non-arteritic anterior ischemic optic neuropathy mainly affected the temporal and inferior sectors of the peripapillary retinal nerve fiber layer, as could be demonstrated by retinal nerve fiber layer optical coherence tomography and optic disc optical coherence tomography angiography. Unlike other published reports, just a slight regression of the myelinated nerve fibers was observed after 1 year of follow-up. This occurred because ischemia mainly affected the temporal and inferior peripapillary sectors, whereas myelinated nerve fibers were superonasal to the optic disc.

RESUMO Uma mulher de 71 anos de idade apresentou neuropatia óptica isquêmica anterior não arterítica no nervo óptico com fibras nervosas peripapilares mielinizadas previamente registradas. Seu histórico médico foi significativo para hipertensão arterial sistêmica controlada, hiperlipidemia e diabetes mellitus. Em ambos os discos ópticos, a tacícula fisiológica esteve ausente. A neuropatia óptica isquêmica anterior não arterítica afetou principalmente os setores temporal e inferior da camada de fibras nervosas da retina peripapilar, como demonstrado pela tomografia de coerência óptica da camada de fibras nervosas da retina e pela angiotomografia de coerência óptica do disco óptico. Ao contrário de outros relatórios publicados, apenas uma ligeira regressão das fibras nervosas mielinizadas foi observada após um ano de acompanhamento. Isto pode ser explicado pelo fato da isquemia ter afetado principalmente os setores temporal e inferior peripapilares, enquanto as fibras nervosas de mielina eram nasal superior ao disco óptico.

The relationship between intraocular pressure and random blood glucose levels with open angle glaucoma

Background: Primary open-angle glaucoma (POAG) is a multifactorial chronic optic neuropathy, characterized by progressive loss of retinal ganglion cells (RGC), leading to structural damage to the optic nerve head (ONH), retinal nerve fibre layer (RNFL), with visual field defects. This study was carried out at the department of optometry GSVM Medical College, Kanpur, UP from December 2015 to September 2017. Objectives were determination of the relationship between intraocular pressure and blood glucose levels in patients with primary open-angle glaucoma. Methods: A total of 74 subjects, 28 males and 46 females were used for the study. The Accu-Chek glucometer was used to measure the random blood glucose level and the intraocular pressure was measured using the Perkins applanation tonometer. Results: The mean intraocular pressure was 16.57±3.97 while the mean random blood glucose level was 168.43±108.48. Analysis of the SPSS version 23 data using the Pearson product-moment correlation coefficient at a significance level of 0.05 and a 95% confidence interval revealed no correlation between IOP and random blood glucose (p and gt; 0.05). People with primary open-angle glaucoma are advised to have their blood sugar levels monitored frequently. Conclusions: This study showed that there was no significant correlation between intraocular pressure and random blood glucose levels in patients with primary open-angle glaucoma. This would suggest that diabetics should be monitored regularly for intraocular pressure to detect an early onset of glaucoma.

Clinical profile and visual outcome in patients with traumatic optic neuropathy

Purpose: To analyze the visual outcome in patients with traumatic optic neuropathy (TON) with respect to different treatment modalities, to study the correlation of initial visual loss with the final visual outcome, and to find out the predictor of final visual outcome in patients with indirect TON. Methods: A retrospective analysis of 36 eyes with TON was done. Data on clinical profile, including demographics, mode of trauma, best corrected visual acuity (BCVA), pupillary reflex examination, and anterior and posterior segment examination, was collected. Presence and location of orbital and cranial fractures were identified from computed tomography scan. Visual outcomes following steroid therapy, optic nerve (ON) decompression, and in untreated patients were analyzed. Pre? and post?treatment BCVA were divided into three groups based on logarithm of the minimum angle of resolution (logMAR) as follows: group A: 3, group B: 2.9–1.3, and group C<1.3. BCVA values at follow?up visits were taken as the primary outcome measure. Association between various risk factors and final visual outcome in patients with indirect TON was also analyzed. Results: Out of 34 patients whose 36 eyes were studied, three (8.8%) patients were females and 31 (91.2%) patients were males. Most common mode of trauma was road traffic accident (RTA; 91.2%), which was followed by fall (8.8%) and assault (2.9%). Pre? and post?treatment BCVA values of 36 eyes were compared, and improvement in BCVA after treatment was found to be statistically significant. Also, 28.6% of patients with presenting BCVA of no light perception showed improvement compared to 94.1% and 100% in groups B and C, respectively. Orbital wall fractures were seen in 80.5% (n = 29) of the patients, with lateral wall fracture being the most common (58.3%) followed by medial wall (33.3%), roof (27.7%), floor (27.7%), and optic strut (5%). Conclusion: Baseline BCVA had significant association with final vision improvement. Lateral wall fracture was the most common fracture associated with indirect TON. Patients treated with high?dose corticosteroids, irrespective of the time of presentation, had a better visual outcome

Comparison of glaucomatous from non-glaucomatous optic neuropathy using Bruch’s membrane opening minimum rim width optical coherence tomography measurements

Purpose: To compare glaucomatous from non?glaucomatous optic atrophy using optical coherence tomography (OCT) based on the measurement values of Bruch’s membrane opening minimum rim width (BMO?MRW), which is a difficult task otherwise due to their varied course of disease progression, treatment protocols, and systemic association to visual impairment. Methods: This study was conducted in 40 eyes, comprising 20 eyes with non?glaucomatous optic neuropathy (NGON) and 20 eyes with glaucomatous optic neuropathy (GON). All patients underwent a complete ophthalmic examination followed by an OCT optic disc scan to calculate the measurement of BMO?MRW. Results: The 5?fold cross?validated area under the curve for GON versus NGON from logistic regression models was 0.95 (95% confidence interval [CI]: 0.86–1.00) using BMO?MRW values from all sectors. The results revealed that the measurements were significantly lesser in GON than in NGON patients. Conclusion: Hence, OCT?based BMO?MRW values could be used as an additional test to compare glaucomatous with non?glaucomatous optic neuropathy patients, especially in cases of high clinical suspicion.

Características epidemiológicas y clínicas de pacientes con glaucoma crónico simple / Epidemiologic and clinic characteristics of patients with chronic simple glaucoma i: en

Introducción: El glaucoma es una de las enfermedades oculares de mayor prevalencia a escala mundial y se caracteriza por presión intraocular elevada, cambios en la papila y alteraciones en el campo visual. Objetivo: Caracterizar a pacientes con glaucoma crónico simple según variables epidemiológicas y clínicas. Método: Se realizó un estudio observacional, descriptivo y transversal de 96 pacientes con glaucoma primario de ángulo abierto, quienes fueron atendidos en la consulta de oftalmología del Policlínico Docente Alberto Fernández Montes de Oca del municipio de San Luis, en la provincia de Santiago de Cuba, desde enero hasta julio del 2019. Resultados: En la serie prevalecieron el sexo masculino, el grupo etario de 60 a 69 años y los pacientes de piel negra, además de la hipertensión arterial y ocular como factores de riesgo asociados. Por otra parte, la mayoría de los afectados presentaron agudeza visual entre 1,0-0,6, cifras de presión intraocular entre 16-21 mmHg y excavación papilar entre 0,6-0,7, con daños importantes en el campo visual. Conclusiones: Las características epidemiológicas y clínicas de los pacientes con glaucoma primario de ángulo abierto resultaron útiles para establecer el pronóstico y trazar pautas terapéuticas efectivas, a fin de evitar la fase avanzada de la enfermedad y los daños irreversibles que se producen en el nervio óptico.

Introduction: Glaucoma is one of the most prevalent eye diseases worldwide and is characterized by high intraocular pressure, changes in the papilla and visual field alterations. Objective: To characterize patients with chronic simple glaucoma according to epidemiologic and clinical variables. Methods: An observational, descriptive and cross-sectional study of 96 patients with primary open-angle glaucoma was carried out, who were assisted in the Ophthalmology Service of Alberto Fernández Montes de Oca Teaching Polyclinic of San Luis municipality, in Santiago de Cuba province, from January to July, 2019. Results: In the series there was a prevalence of the male sex, the 60 to 69 age group, and dark-skinned patients, besides hypertension and ocular hypertension as associated risk factors. On the other hand, most of those affected presented visual acuteness between 1.0-0.6, intraocular pressure figures between 16-21 mmHg and papillary excavation between 0.6-0.7, with important damage in the visual field. Conclusions: The epidemiologic and clinical characteristics of patients with primary open-angle glaucoma were useful to establish the prognosis and trace effective therapeutic guidelines, in order to avoid the advanced phase of the disease and the irreversible damage that occurs in the optic nerve.

A Rare Case of Posterior Ischemic Optic Neuropathy after Appendicectomy

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.

Changes in visual acuity using low vision devices in patients with Leber hereditary optic neuropathy: A retrospective study

Purpose: This study was conducted to estimate the visual acuity improvement in patients with Leber hereditary optic neuropathy (LHON) with the help of low vision devices (LVDs) and to analyze the types of distant and near LVDs prescribed to the patients with LHON. Methods: A retrospective case review of 74 subjects with LHON who were referred to a low vision care clinic at a tertiary eye center from 2016 to 2019 were recruited. The reason for referral was assessed from the patients’ electronic medical records (EMR). Demographic data of the patients, visual acuity status, type of LVD prescribed, and visual acuity improvement with LVD were documented. Results: Out of 74 patients, 91.9% (n = 68) were male, and the median age of patients was 21 (16) years. A 4× monocular telescope was prescribed for 2.7% of patients (n = 2) and SEETV binocular telescope for 1.4% (n = 1) was advised for distance. The most commonly prescribed near LVD was the 6× cutaway stand magnifier for 22 patients (29.7%). Four patients (5.4%) were prescribed with Notex, the most commonly prescribed non?optical LVD. Niki CCTV (12.2%, n=9) was the most commonly prescribed assistive device. The subjects were divided into three groups based on age: group I consisted of those <18 years of age, group II 18–40 years, and group III >40 years for the interpretation of visual improvement. There was a statistically significant improvement (group I: P < 0.001, group II: P < 0.0001, group III: P < 0.003) in near vision with help of LVDs in all three groups. Conclusion: The use of LVDs and rehabilitation can help patients with LHON to lead a better life and will be more beneficial

Erythropoietin as a treatment option for indirect traumatic optic neuropathy: A pilot study

Purpose: Our study aims to evaluate the effectiveness of intravenous erythropoietin (EPO) in patients with indirect traumatic optic neuropathy (TON), assess the side effects, and compare the visual function results among three groups of patients who had received different treatment options – EPO, steroids, and observation. Methods: Patients with indirect TON presenting to the neuro?ophthalmology clinic from August 2019 to March 2020, were assigned to three groups, with six patients in each group. In group 1, patients were recruited prospectively and received recombinant human erythropoietin, whereas, in groups 2 and 3, patients were recruited retrospectively and received intravenous methylprednisolone followed by oral steroids and multivitamins, respectively. Groups 1 and 2 included patients presenting within 2 weeks of trauma, whereas group 3 included those presenting beyond that. Best?corrected visual acuity, pupillary reaction, color vision, and visual fields following treatment were measured. Results: Initial visual acuity in the EPO group ranged from 20/80 to no perception of light (No PL). The mean initial BCVA (1.82 logMAR, standard deviation [SD] = 0.847) improved to 1.32, SD = 0.93 logMAR after treatment recorded at the third month (P = 0.0375), with no significant adverse effects. The initial BCVA of group 2 ranged from 20/120 to No PL. The mean initial BCVA (1.95, SD = 0.77 logMAR) improved to 1.45 logMAR, SD = 0.97 after treatment (P = 0.0435) but three patients had side effects of steroids. Initial visual acuity in Group 3 ranged from 20/40 to no PL. The mean initial BCVA (1.09 logMAR, SD = 1.10) worsened to 1.19 logMAR, SD = 1.06 after treatment after treatment (P = 0.0193). The improvement in BCVA when compared between the three groups was not significant. Conclusion: Both erythropoietin and steroids are effective in the management of traumatic optic neuropathy. However, erythropoietin shows lesser or no side effects when compared to steroids

Therapeutic landscape for inherited ocular diseases: Current and emerging therapies

Inherited ocular diseases comprise a heterogeneous group of rare and complex diseases, including inherited retinal diseases (IRDs) and inherited optic neuropathies. Recent success in adeno-associated virus-based gene therapy, voretigene neparvovec (Luxturna®) for RPE65-related IRDs, has heralded rapid evolution in gene therapy platform technologies and strategies, from gene augmentation to RNA editing, as well as gene agnostic approaches such as optogenetics. This review discusses the fundamentals underlying the mode of inheritance, natural history studies and clinical trial outcomes, as well as current and emerging therapies covering gene therapy strategies, cell-based therapies and bionic vision.

Panscleritis After Blunt Ocular Trauma in A Child with Epididymitis / 中国医学科学杂志(英文版)

We reported an 8-year-old boy with panscleritis in left eye and right epididymitis after falling on the ground. Etiologic diagnosis played a key role in this case. Systemic examinations ruled out systemic autoimmune diseases, tumors, and infections as the cause of scleritis and suggested that the disease was caused by a local delayed-type hypersensitivity (DTH) induced by ocular trauma and was non-infectious. Still, the right epididymitis was infectious. Both conditions were treated successfully using steroids and antibiotics, respectively. Thus, early etiologic diagnosis and reasonable treatment are crucial to prevent visual loss.

Research progress of tumor immunotherapy-associated optic nerve adverse events, prevention and treatment / 中华眼底病杂志

Tumor immunotherapy includes immune checkpoint inhibitor (ICI), tumor vaccines, and adoptive cell therapy. Immunotherapy, as the main systemic treatment for advanced malignant tumors, kills tumor cells by activating the immune system and prolongs the survival of patients. However, excessive immune responses can cause immune-related adverse events (irAE), causing damage to systemic tissues. ICI are the main tumor immunotherapy drugs that cause optic nerve irAE. The most common optic nerve irAE are optic neuritis, only a few patients appeared arteritic anterior ischemic optic neuropathy. Sudden painless loss of bilateral vision is the most common clinical manifestation. In severe cases, the vision decrease to no light perception. Early diagnosis and early adequate glucocorticoid treatment can improve the symptoms. Therefore, neuro-ophthalmologists and oncologists should know the clinical characteristics of optic nerve irAE, in order to diagnose and treat early and improve the prognosis.

Correlation between macular mean sensitivity and ganglionic plexiform layer in non-arteriotic anterior ischemic optic neuropathy / 中华眼底病杂志

Objective:To observe and analyze the changes and correlation of macular mean sensitivity (MS) and the thickness of ganglionic plexiform layer (GCIPL) in patients with non-arteriotic anterior ischemic optic neuropathy (NAION).Methods:A cross-sectional clinical study. From March to August 2023, 37 patients with 38 eyes of NAION (NAION group) diagnosed by ophthalmic examination in the First Affiliated Hospital of Zhengzhou University were included in the study. In the NAION group, 29 patients with contralateral healthy eyes were selected as the contralateral healthy eye group. A total of 31 eyes of 16 healthy subjects matching gender and age were selected as the normal control group. NAION group was divided into acute stage group (disease course ≤3 weeks), subacute stage group (disease course 4-12 weeks) and chronic stage group (disease course>12 weeks), with 16, 10 and 12 eyes, respectively. Best corrected visual acuity (BCVA), optical coherence tomography (OCT), perimetry, and microperimetry were performed. BCVA statistics are converted to logarithm of the minimum angle of resolution (logMAR). The macular region was scanned by Cirrus HD-OCT macular volume 512×128 scanning program. The mean (GCIPLav), minimum (GCIPLmin), and the GCIPL thickness at supranasal, superior, subnasal, supratemporal, inferior, and inferotemporal quadrants were detected. The Humphrey 24-2 automated visual field test was utilized to measure the mean defect (MD) of the visual field. MP-3 microperimetry was used to measure MS (total MS) in the 10° macular region and MS in the supranasal, superior, subnasal, supratemporal, inferior, and inferotemporal quadrants. MS> 21 dB was defined as normal. One-way analysis of variance was used to compare among groups. t test was used to compare GCIPL thickness between MS≤21 dB and> 21 dB regions. Spearman correlation analysis was used to analyze the correlation between GCIPL thickness and MS in corresponding areas. Results:There were statistically significant differences in logMAR BCVA and MS in the NAION group, contralateral healthy eye group, and normal control group ( F=13.595, 83.741; P<0.05). GCIPL thickness in the MS≤21 dB region was significantly lower than that in the> 21 dB region in the NAION group ( t=2.634, P=0.009). The thickness of GCIPL in the inferotemporal quadrant decreased in the NAION group compared with the contralateral healthy eye group and normal control group, but the difference was not statistically significant ( P=0.092, 0.192). The thickness differences of GCIPLav and GCIPLmin and GCIPL in other quadrants were statistically significant ( P<0.05). Compared with the contralateral healthy eye group and normal control group, the thickness of GCIPLmin, superior and supratemporal of GCIPL in the acute stage group were significantly decreased ( P<0.05). The thickness of GCIPLav, GCIPLmin, GCIPL in upranasal, superior and supratemporal quadrants were significantly decreased in the subacute stage group ( P<0.05). The thickness of GCIPLav, GCIPLmin and GCIPL in all quadrants were significantly decreased in the chronic stage group ( P<0.05). Correlation analysis showed that total MS were significantly correlated with logMAR BCVA ( r=0.779, -0.596, P<0.001) in NAION group. The inferior GCIPL thickness was significantly correlated with MS in the corresponding region ( r=0.410, P=0.046), while no correlation was found in the other quadrants ( r=0.220, 0.148, -0.131, 0.296, 0.321; P>0.05) in NAION group. GCIPL thickness in acute and subacute groups was significantly correlated with MS ( r=0.329, 0.400; P=0.007, 0.028). There was no correlation in the chronic phase group ( r=0.238, P=0.103). Conclusions:GCIPL atrophy and thinning and MS decrease in the macular area of NAION. The thickness of GCIPL in the MS decreasing region is significantly lower than that in the MS normal region. GCIPL atrophy and thinning in acute and subacute stages are correlated with MS.

Clinical characteristics and analysis of 49 misdiagnosed nonarteritic anterior ischemic optic neuropathy patients / 中华眼底病杂志

Objective:To observed and analyze the clinical features of patients with nonarteritic anterior ischemic optic neuropathy (NAION) causes of misdiagnosis.Methods:A retrospective case study. From November 2014 to July 2022, 49 NAION patients with 49 eyes diagnosed in Department of Ophthalmology, The First People’s Hospital of Lanzhou were included in the study. All patients were misdiagnosed with other eye diseases at first diagnosis. All eyes were examined by best corrected visual acuity (BCVA), relative afferent pupil defect (RAPD), orbital magnetic resonance imaging (MRI), visual field, optical coherence tomography (OCT), and graphic visual evoked potential (P-VEP). Fluorescein fundus angiography (FFA) was performed in 32 eyes. Clinical and MRI, visual field, P-VEP、FFA features of the patients were retrospectively analyzed.Results:There were 31 males and 18 females among the 49 patients. All cases were monocular. Age was (59.3±7.8) years. All of them complained of painless visual acuity loss or occlusion sensation in one eye. There were 12 (24.5%, 12/49) and 37 (75.6%, 37/49) cases with disease duration >2 months and ≤2 months, respectively. In 49 eyes, misdiagnosed as optic neuritis, normal tension glaucoma (NTG) or suspected glaucoma, optic disc vasculitis, cataract, diabetic retinopathy, traumatic optic neuropathy and toxic optic neuropathy were 28 (57.1%, 28/49), 11 (22.4%, 11/49), 5 (10.2%, 5/49), 2 (4.1%, 2/49), 1 (2.0%, 1/49), 1 (2.0%, 1/49), 1 (2.0%, 1/49) eyes. 24 (49.0%, 24/49), 16 (32.7%, 16/49) and 9 (18.4%, 9/49) eyes had BCVA<0.1, 0.1-0.5 and> 0.5, respectively. RAPD was positive in 45 eyes (91.8%, 45/49). There were 37 (75.6%, 37/49) and 12 (24.5%, 12/49) eyes with and without optic disc edema, respectively. Bleeding was observed on and around the optic disc in 15 eyes (30.6%, 15/49). MRI examination showed no obvious abnormality in the optic nerve segments of all affected eyes. OCT showed an increase in retinal nerve fiber layer thickness (307.1±62.1) μm in 37 patients with optic disc edema. The visual field examination showed that 24 eyes (49.0%, 24/49) had typical lower visual field defect connected with the physiological blind spot and circumvented the central fixation point, 6 eyes (12.2%, 6/49) had limited visual field defect connected with the physiological blind spot, and 19 eyes (38.8%, 19/49) had diffuse visual field defect. By P-VEP examination, the amplitude of P100 wave decreased moderately to severely in all affected eyes. There were 24 eyes (49.0%, 24/49) with mild peak delay and 11 eyes (22.4%, 11/49) with moderate peak delay. In 32 eyes examined by FFA, the arteries had early peridisk limitation or diffuse delayed filling, and mid-course fluorescein leakage in the corresponding area.Conclusions:The main symptoms of NAION patients are painless visual acuity loss in one eye or occlusion of vision. The main clinical features of NAION patients are visual field defect, retinal nerve fiber layer thickening and visual electrophysiological abnormalities. NAION patients with acute or subacute visual loss accompanied by optic disc edema and/or bleeding are often misdiagnosed as optic neuritis, optic neurovasculitis and other types of optic neuropathy. NAION patients with a disease course of >2 months are easily misdiagnosed as NTG.

Visual analysis of the research status of ischemic optic neuropathy in China in the past 20 years / 中华眼底病杂志

Objective:To gain an in-depth understanding of the research status, hotspots, and future development trends in the field of ischemic optic neuropathy (ION).Methods:Using "ischemic optic neuropathy" as the subject heading or keyword to search for relevant literature in Chinese and English databases from January 1, 2000, to December 31, 2022. The bibliometrics method and software were applied to construct the visualization map of authors, institutions, keyword co-occurrence, outburst words, and keyword clustering.Results:A total of 1 203 ION-related articles were included, 1 106 Chinese literature and 97 English literature were included; the number of published articles in this field has fluctuated and increased in the past 20 years, mainly Chinese literature and English literature have shown a low growth trend. Chinese literature involved a total of 2 171 authors, and English literature involved 368 Chinese authors. A core team represented by Wang Runsheng, Wei Shihui, Zhong Yong, and Wei Qiping was formed among the high-yielding authors. Chinese literature involved a total of 799 research institutions, and English literature covered 119 Chinese institutions. The Xian No.1 Hospital and Beijing Tongren Hospital Affiliated to Capital Medical University respectively ranked first in the number of Chinese and English literature published in this field; 121 and 23 high-frequency keywords in Chinese and English were identified. In addition to "ischemic optic neuropathy" , compound anisodine, visual field, vision, treatment, risk factors, pathogenesis, optic nerve and rAION also appeared more frequently. The Chinese literature obtained 13 emergent words, and the English literature keywords formed 11 clusters. From the perspective of research type, the Chinese and English literature in this field mainly focued on the clinical efficacy observation of nonarteriotic Anterior ischemic optic neuropathy (NAION).Conclusions:In the past 20 years, clinical studies of ION in China have mainly focused on the treatment of NAION, risk factors, and the application of auxiliary examinations in disease diagnosis. The combination of drugs in treatment, the application of optical coherence tomography angiography, and the research on pathogenesis is still a future research trend in this field.

Screening and diagnostic system construction for optic neuritis and non-arteritic anterior ischemic optic neuropathy based on color fundus images using deep learning / 中华眼底病杂志

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.

Clinical and imaging features of infiltrative optic neuropathy secondary to extraocular malignant tumors / 中华眼底病杂志

Objective:To observe the clinical and imaging features of infiltrative optic neuropathy (ION) secondary to extraocular malignant tumors.Methods:A retrospective case study. From January 2017 to October 2022, 26 eyes of 20 patients with ION secondary to extraocular malignancies and 32 eyes of 16 patients with early papilloedema (EP) secondary to intracranial metastatic carcinoma were included in the study. All eyes underwent best corrected visual acuity (BCVA), fundus color photography, orbital and/or craniocerebral magnetic resonance imaging (MRI). A total of 54 eyes were examined by visual field examination, among which ION and EP were 22 and 32 eyes, respectively. Clinical and imaging features of the affected eye were retrospectively analyzed.Results:Among 26 eyes of 20 ION patients, there were 13 males and 7 females, with the mean age of (52.8±16.9) years. There were 10 patients of hematologic malignancy, 7 patients of periorbital malignancy, 2 patients of lung cancer, 1 patient of gastric cancer, 1 patient of breast cancer and 1 patient of prostate cancer. Two patients of nasal lymphoma were recorded as hematologic malignancies and periorbital malignancies. Sixteen patients had a history of systemic or periorbital malignancy, among which 4 patients reported that they had been "clinically cured". Optic neuritis was diagnosed in 15 patients. Among the 16 patients with EP, 5 were males and 11 were females, with the mean age of (47.9±12.3) years. The primary malignant tumors were lung cancer, breast cancer, leukemia, gastric cancer, ovarian cancer, colon cancer and rectal cancer in 7, 2, 2, 2, 1, 1, 1, respectively. In 26 eyes of ION, 20 eyes complained of blurred vision or peripheral vision occlusion and progressive aggravation; no obvious visual symptoms in 6 eyes. BCVA was light sensing to 1.0 with a median of 0.3, including light sensing and light sensing in 4 eyes. Optic disc edema was observed in 19 eyes; no obvious abnormality in 7 eyes. Visual field examination showed that in 22 eyes, normal or mild enlargement of blind spot in 3 eyes, arcuate scotoma in 4 eyes, annular scotoma in 6 eyes, tubular visual field or concentric contraction of visual field in 6 eyes, and diffuse depression in 3 eyes. MRI showed optic nerve enlargement with sheath enhancement in all ION eyes. Among 32 eyes of EP, 28 eyes showed recurrent transient amaurosis, and the other 4 eyes showed horizontal diplopia. BCVA ranged from 0.8 to 1.5, with a median of 1.0. All EP patients showed different degrees of optic disc hyperemia and edema by fundus examination. The visual field examination showed normal or mild enlargement of the physiological blind spot. MRI showed thickening of the optic nerve and widening of the intrathecal space, but no obvious enhancement of the optic nerve and its intrathecal membrane, and obviously enhanced space-occupying lesions in the brain parenchyma, accompanied by compression and edema of the surrounding brain tissue and midline displacement.Conclusions:ION secondary to extrocular malignant tumors mainly manifested as mild visual symptoms and obvious optic disc edema. MRI showed thickened optic nerve and strengthened sheath, and no obvious abnormality in optic nerve parenchyma.

Analysis of retinal sublayer thickness in Leber hereditary optic neuropathy and G11778A mutation carriers / 中华眼底病杂志

Objective:To analyze the thickness of peripapillary retinal nerve fiber layer (pRNFL) and photoreceptor (PR) sublayer in Leber hereditary optic neuropathy (LHON) and G11778A mutation carriers. Methods:A cross sectional study. From September 2020 to October 2021, 68 LHON patients (136 eyes) (patient group) and 40 G11778A mutation carriers (80 eyes) of LHON patients' families (carrier group) were included in the study. All patients were found to have G11778A mutation by Genetic testing. Forty healthy volunteers with 80 eyes matched to the age and gender of the patient group were recruited as a normal control group. All eyes were examined by optical coherence tomography (OCT). The pRNFL thickness was automatically measured by the built-in software of the OCT device. The total retinal thickness (MT) and the thickness of the outer bundle layer (OPL), outer nuclear layer (ONL), external limiting membrane to retinal pigment epithelium (ELM-RPE) in macular OCT images were measured by Image J software. Linear mixed model was used to analyze and compare the thickness of pRNFL, macular fovea and four layers above the nasal and temporal paracentral retina in patients, carriers and normal controls. The correlation between pRNFL and macular retinal sublayer thickness and the course of disease was also analyzed. Results:The thickness of the upper and lower pRNFL, temporal pRNFL and average pRNFL of the patients were smaller than those of the carriers and the normal control group ( P<0.01), and the nasal pRNFL thickness of the patients was smaller than that of the carriers ( P<0.01). Fovea: compared with the normal control group, the thickness of MT and ONT in the patient group was decreased, ONL thickness decreased in carrier group, with the significant different ( P<0.05). Parafovea: compared with normal control group, the thickness of MT and temporal ONL decreased and temporal OPL increased in the patients group, with the significant different ( P<0.05). In the carrier group, the thickness of MT and temporal, nasal ONL decreased, and the thickness of nasal OPL increased, with the significant different ( P<0.05). Compared with the carrier group, the MT thickness of the patient group was decreased, and the nasal ONL and nasal ELM-RPE thickness were increased, with the significant different ( P<0.05). Correlation analysis results showed that the thinning of pRNFL in the superior, nasal, temporal and average ( r=-0.22, -0.21, -0.25, -0.22), and the thickening of ELM-RPE in foveo-temporal ( r=0.19) were correlated with the course of disease ( P<0.05). Conclusions:The pRNFL of LHON patients with G11778A mutation becomes thinner and is related to the course of the disease. There were significant differences in the thickness of MT and PR sublayers between patients and carriers compared to the normal control group.