Impaired systemic vascular endothelial function in patients with non-arteritic anterior ischaemic optic neuropathy.

PURPOSE: The purpose of this study was to evaluate systemic endothelial function in elderly hypertension patients with non-arteritic anterior ischaemic optic neuropathy (NAION) by using a noninvasive physiological method: endothelium-dependent, flow-mediated vasodilation (FMD). METHODS: Forty-two systemic hypertension patients with NAION (NAION group), 64 age- and sex-matched patients with systemic hypertension and no other ocular disease (hypertension group), and 100 age- and sex-matched healthy volunteers (normal group) were enrolled. FMD was evaluated using a high-resolution ultrasonography. Traditional cardiovascular risk factors and vascular parameters were measured. RESULTS: Systolic blood pressure and diastolic blood pressure were significantly higher in patients with NAION compared with the control groups (p < 0.001). The FMD decreased significantly in the NAION group (6.02 ± 1.87 %) compared to in the hypertension group (7.86 ± 2.94 %, p < 0.001) and the normal group (8.99 ± 2.44 %, p < 0.001). By multivariable logistic regression analysis, FMD was significantly associated with NAION (OR, 1.79; 95%CI, 1.67-2.01). CONCLUSIONS: NAION may be associated with systemic vascular endothelial dysfunction. FMD might be useful in the treatment monitoring of NAION.

Factors influencing improvement of visual field after trans-sphenoidal resection of pituitary macroadenomas: a retrospective cohort study.

AIM: To investigate the influencing factors of visual field improvement after trans-sphenoidal resection of pituitary macroadenomas. METHODS: This retrospective cohort study included 201 patients (366 eyes) with visual field defect induced by pituitary macroadenomas. All of them were treated with trans-sphenoidal surgery. Ophthalmologic evaluation, best-corrected visual acuity (BCVA), and visual field examination were performed before and 3mo after surgery. BCVA, visual field defect index mean deviation (MD), duration of symptoms, age, sex, and volume of tumors were compared. Expression of vascular endothelial growth factor (VEGF) and Ki-67 of tumor tissue were detected by immunohistochemical technique. RESULTS: The mean age of patients was 44.23±1.29y. Ninety-three patients were female and 108 were male. The mean tumor volume was 14.36±6.23 cm(3). The mean duration of preoperative symptoms was 11.50±0.88mo. Mean preoperative MD was -17.50±0.82 dB. Mean Preoperative visual acuity was 0.64±0.04. Postoperative visual field improved in 270 (73.77%) eyes, unchanged in 96 (26.23%) eyes. Multivariate logistic regression displayed that the factors independently influencing visual field improvement were young age (OR=1.71, 95%CI: 1.325-2.387, P=0.013), low preoperative MD absolute value (OR=1.277, 95%CI: 1.205-1.355, P<0.001), small volume of tumor (OR=1.458, 95%CI: 1.060-4.289, P<0.001), low expression of VEGF in tumor tissue (OR=1.554, 95%CI: 1.089-2.457, P=0.022), and low expression of Ki-67 in tumor tissue (OR=1.552, 95%CI: 1.161-2.847, P=0.026). CONCLUSION: After pituitary macroadenomas trans-sphenoidal resection, the independent influencing factors of the visual fields recovery were low preoperative MD absolute value, young age, small volume of tumor, and expression levels of VEGF/ Ki-67.

Effect of enhanced extracorporeal counterpulsation in patients with non-arteritic anterior ischaemic optic neuropathy.

PURPOSE: The purpose is to study the effect of Enhanced Extracorporeal Counterpulsation (EECP) in patients with non-arteritic anterior ischaemic optic neuropathy (NAION). METHODS: EECP is a noninvasive, mechanical, and circulatory support therapy. Sixteen patients with unilateral NAION were treated with EECP (twelve 1-h daily treatment sessions for each patient). Color Doppler imaging (CDI) was applied to measure the mean flow velocity (MFV), peak-systolic velocity (PSV), end-diastolic velocity (EDV) of the ophthalmic artery (OA) and central retinal artery (CRA). Intraocular pressure (IOP) was measured by Goldmann applanation tonometry. Measurements were collected before and immediately after the first and the last sessions of EECP in both eyes, and they were compared with the baseline measurement before EECP. The measurements were also compared between the NAION eyes and the normal fellow eyes. Visual acuity (VA) and visual field (VF) were assessed before EECP and after the last EECP. RESULTS: EECP progressively increased blood flow velocities of the OA and CRA and progressively decreased IOP in both eyes (P < 0.05). After the first session of EECP, there was a 16 ± 5.3% increase in EDV and a 13.9 ± 9.5% increase in MFV of the OA, and a 17.1 ± 2.5% increase in PSV, a 21.2 ± 9.3% increase, in EDV and a 16.5 ± 3.3% increase in MFV of the CRA in NAION eyes. After the last EECP treatment, there was a 16.8 ± 6.7% increase in EDV and a 14.0 ± 5.1% increase in MFV of the OA, and a 17.7 ± 12.3 % increase in PSV, a 23.1 ± 6.3% increase in DSV, and a 21.1 ± 8.4% increase in MFV of the CRA in NAION eyes (P < 0.05). The change of the PSV, EDV, and MFV in the CRA were more significant in NAION eyes than that of their fellow eyes (P < 0.05). VA was improved and VF mean deviation was decreased in NAION eyes after the last EECP treatment (P = 0.003 and 0.049, respectively), and VA improvement was correlated positively with the blood flow parameter. CONCLUSIONS: EECP could be a clinically effective and safe treatment for NAION.

Retrobulbar and common carotid artery haemodynamics and carotid wall thickness in patients with non-arteritic anterior ischaemic optic neuropathy.

PURPOSE: To evaluate retrobulbar and common carotid artery (CCA) haemodynamics and CCA wall thickness in the patients with acute unilateral non-arteritic anterior ischaemic optic neuropathy (NAION) by colour Doppler imaging (CDI). METHODS: Twenty-two patients with acute unilateral NAION and 28 age- and sex-matched controls were included in this prospective study. By CDI, the peak-systolic velocity (PSV) and end-diastolic velocity (EDV) of the ophthalmic artery (OA) and central retinal artery (CRA) in both eyes were measured or calculated. Intima-media thickness (IMT) and blood flow velocity were measured in both CCAs. Measurements on the affected side of the patients were compared to the contralateral healthy side and the controls. RESULTS: Compared to the controls, the blood flow velocities in the CRA were significantly decreased (p < 0.05), and IMT of CCA was greater (p < 0.001) on the affected side, while the blood flow velocities in the OA and CCA showed no statistically significant difference. The blood flow velocities in the CRA tended to be reduced bilaterally in the patients with NAION, and the difference of PSV and EDV was insignificant between the affected eyes and fellow eyes (p = 0.69, 0.86 respectively). No marked differences between the controls and the unaffected sides were detected, neither for the blood flow velocities in CRA, OA, CCA nor for the IMT of CCA. CONCLUSION: Decreased blood velocities of CRA and increased carotid wall thickness were found on the affected side of acute NAION compared to healthy controls. These findings might be potentially useful in the treatment monitoring of NAION.

A retrospective study: form-deprivation myopia in unilateral congenital ptosis.

BACKGROUND: The aim of this retrospective study was to investigate the relationship between unilateral congenital ptosis in patients older than eight years and their refractive state and spherical equivalent refraction (SER). METHODS: The study involved a review of the clinical records of 85 patients admitted to the First Affiliated Hospital, Sun Yat-sen University between 1998 and 2010 with unilateral congenital ptosis. The average age was 16.83 years (nine to 27 years). The patients were classified into mild (27 cases), moderate (37 cases) or severe (21 cases) ptosis according to the degree of the droopy eyelid covering the cornea. The fellow eyes served as controls. RESULTS: In 85 eyes with unilateral ptosis, the frequency of myopia (SER of -0.50 D or more myopia) was significantly higher than in the fellow eye (47 versus 32, p = 0.031). The frequency of myopia in eyes with severe unilateral ptosis was significantly higher than in the fellow eyes (16 versus 7, p = 0.012), whereas there were no significant differences in patients with mild (15/27 versus 13/27, p = 0.79) or moderate (16/37 versus 12/37, p = 0.47) unilateral ptosis. Similarly, the SER was significantly more myopic in eyes with severe ptosis compared with the fellow eye (-1.37 D versus -0.85 D, p = 0.01), whereas no significant differences were found in patients with mild or moderate unilateral ptosis. CONCLUSIONS: The results showed a higher frequency of myopia and more myopic SER in eyes with severe unilateral ptosis compared with the fellow eye. The myopia found in eyes with unilateral ptosis might be caused by a mechanism similar to that resulting in myopia among animals subjected to form deprivation. It is important to pay attention to possible refractive error in patients with unilateral ptosis. Surgical correction of unilateral ptosis at an early age is recommended.

Rehabilitation of vision disorder and improved quality of life in patients with primary open angle glaucoma.

BACKGROUND: Primary open angle glaucoma (POAG) is a common cause of irreversible blindness. The variable etiology of POAG poses significant challenges for treatment and rehabilitation. We analyzed a large POAG patient cohort during treatment to reveal possible causes of vision disorder, assess vision-related quality of life (VRQL), and to evaluate the efficacy of rehabilitative treatments. METHODS: We analyzed the visional disturbances in 500 POAG patients (890 eyes) by regular ophthalmic examination and visual field examination using Humphrey 30° perimetry. Appropriate rehabilitative treatments for POAG were prescribed based on results of clinical examination and included correction of ametropia, health education, counseling, and the fitting of typoscopes. VRQL was assessed before and after treatment by a VRQL self-assessment questionnaire. RESULTS: Scores on the VRQL self-assessment were significantly lower compared to healthy controls. The primary cause of the vision disturbances was ametropia (97.99%), and 51.61% of the ametropia eyes had not received appropriate correction. The secondary causes of visual impairment were glaucomatous neurodegeneration (26.29%), complicated cataract, or other accompanying eye diseases. The causes of the clinical low vision (44 patients) were glaucomatous neurodegeneration (32 eyes), fundus diseases (23 eyes), keratopathy (11 eyes), and other eye diseases (10 eyes). The VRQL scores of patients improved significantly after rehabilitation and the correction of ametropia (P < 0.01). Twenty-five patients with low vision were provided with typoscopes, and 21 (84%) experienced significant functional recovery, while the remaining low vision patients could see letter lines two or more levels lower (smaller) on visual charts in a near vision test. CONCLUSIONS: Vision disorders in POAG patients are common and severe. Appropriate rehabilitation, especially the correction of ametropia, can significantly improve VRQL as revealed by the self-assessment of POAG patients.

[Ophthalmic manifestations of Wilson's disease].

OBJECTIVE: To investigate the ophthalmic manifestations of Wilson's disease (WD). METHODS: In this nonrandomized retrospective case series, fifty-two WD patients were investigated retrospectively, based on the family history, clinical signs and the laboratory test Patients were divided into 4 groups: asymptomatic group, only with hepatic disorders, only with neurological disorders and with both hepatic and neurological disorders group. RESULTS: Thirty two males and twenty females were studied. The ratio of male to female was 1.6:1.0. The mean age was (20 +/- 1) years, ranged from 4 to 53 years. The majority (78.8%) of patients belonged to younger age groups (10-30 years). The family history showed members with WD in 14 patients (26.9%), probable WD in 3 patients (5.8%). Out of 52 patients, 2 asymptomatic patients (3.8%) were detected by family screening, 12 patients (23.1%) only had hepatic disease, 11 patients (21.2%) only had neurological disorders and 27 patients (51.9%) had both hepatic and neurological disorders. Among 45 patients (86.5%) with Kayser-Fleischer (K-F) ring, 1 patient was asymptomatic, 7 patients had hepatic disease, 11 had neurological disorders and 26 had both hepatic and neurological disorders. One patient (1.9%) was presented with sunflower cataract. Fifty one patients (98.1%) had low serum ceruloplasmin levels and high urinary copper excretion. CONCLUSIONS: K-F ring is a common and characteristic manifestation of WD. This is often found in patients with neurological disorders.

First case of Arthrographis kalrae ethmoid sinusitis and ophthalmitis in the People's Republic of China.

We present here the first case in the People's Republic of China of human disease caused by the fungus Arthrographis kalrae. The male patient had fungal panophthalmitis and invasive sinusitis involving the maxillary and ethmoid sinuses. He was an apparently healthy man before receiving trauma to his left eye. He complained of pain and loss of visual acuity in the injured eye, which displayed redness and edema and eventually discharged pus. His symptoms became more severe after he was treated with steroids and several antibacterial agents. A computed tomography scan of the left eye revealed that the maxillary and ethmoid sinuses were involved. A smear of purulent material from the left eye orbit revealed fungal elements, and cultures of the material grew a fungus. The isolate was identified as A. kalrae based on gross and microscopic morphologies, biochemical assays, and DNA sequence analysis. The patient received amphotericin B intravenously, itraconazole orally, and atomized allitridum by nebulizing allitridum therapy. The patient's wound healed following surgical intervention, but the patient lost the use of his left eye. This case should remind ophthalmologists and other clinicians to consider the possibility of infections being fungal when antibacterial agents have no effect and the patient's condition worsens.

Bilateral central retinal vein occlusions combined with artery occlusions in a patient with acquired immune deficiency syndrome.

PURPOSE: This is the first report of a bilateral nonischemic central retinal vein occlusions combined with artery occlusions in a patient with acquired immune deficiency syndrome (AIDS). METHODS: Case report. RESULTS: A 22-year-old Chinese (male) with a positive human immunodeficiency virus (HIV) infection developed bilateral nonischemic central retinal vein occlusions combined with artery occlusions and severe vision loss. The manifestations of the fundus and fluorescein angiography were similar in both eyes. CONCLUSION: This case report provides the evidences that central retinal vein and artery occlusions are probably part of the spectrum of AIDS vascular diseases.