An acupuncture meta-analysis for optic atrophy Seven randomized,controlled trials

OBJECTIVE： To evaluate the efficacy and safety of acupuncture for optic atrophy. DATA SOURCES： A computer-based online search was conducted in Medline （1966-2008）, Embase （1986-2008）, the Cochrane Library （up to 2008）, Chinese Biomedical Literature Database （1975-2008）, China National Knowledge Infrastructure （1994-2008）, VIP Database （1989-2008）, Wanfang Database （1980-2008） and the National Research Register for ongoing trials. DATA SELECTION： Randomized, controlled trials addressing acupuncture treatment for patients with optic atrophy were included in this review. Inclusion criteria evaluated all forms of acupuncture therapy, such as filiform needle, electro-acupuncture, laser-acupuncture, acupressure, and auricular-acupuncture. Comparisons between acupuncture therapy and no treatment （blank） or placebo or Chinese medicine or Western medicine, as well as between acupuncture as an adjuvant and other treatments, were included. Exclusion criteria included studies comparing different forms of acupuncture therapy, different manipulations of acupuncture, and different acupuncture prescriptions, as well as non-randomized, controlled trials and animal studies. The domain-based evaluation criteria recommended by the guidelines in Chapter 8 of the Cochrane Handbook for Systematic Reviews of Interventions 5.0.1 was used to assess quality of the included studies. According to the type of outcome index, measurement data as assessed by weighted mean difference or standardized mean difference and 95% confidence interval; numeration data was estimated by relative risk and 95% confidence interval. Heterogeneity was analyzed by Meta-analysis using RevMan 5.0 software. MAIN OUTCOME MEASURES： Improved visual acuity and visual field was sought between treatment and control groups in the included articles. RESULTS： Seven randomized, controlled trials were included after screening and application of inclusion and exclusion criteria. However, the studies were of low methodological quality and lacked comparisons between acupuncture and no treatment or placebo. Applying visual acuity as the outcome index, meta-analysis indicated： the effect of medicine combined with acupuncture was superior to the medicine alone （relative risk = 1.41, 95% confidence interval 1.14-1.70, P 〈 0.01 ）, the efficacy of acupuncture was better than medicine alone （relative risk =1.42, 95% confidence interval 1.14-1.77, P 〈 0.01 ）. Using visual field as the other outcome index, meta-analysis revealed： effectiveness of acupuncture or acupuncture in combination with medicine was superior to medicine alone （relative risk = 1.47, 95% confidence interval 1.27-1.69, P 〈 0.01 ）. The 7 included articles were incorporated in a sensitivity analysis, and the overall effect showed a significant difference （relative risk = 1.35, 95% confidence interval 1.16-1.56, P 〈 0.01）. Acupuncture was not associated with any adverse events in any of the studies. CONCLUSION： Acupuncture therapy was determined to be superior to medicine in terms of improved visual acuity and visual field. However, well-designed, randomized, controlled trials with adequate controls and scientific rigor are urgently needed.

Bilateral Optical Nerve Atrophy Secondary to Lateral Occipital Lobe Infarction

Purpose:To report a phenomenon of optical nerve atrophy secondary to lateral occipital lobe infarction. Methods:Two successive patients with unilateral occipital lobe infarction who experienced bilateral optical nerve atrophy during the follow-up underwent cranial imaging, fundus photography, and campimetry. Results:Each patient was diagnosed with occipital lobe infarction by cranial MRI. During the follow-up, a bilateral optic atrophy was revealed,and campimetry showed a right homonymous hemianopia of both eyes with concomitant macular division. Conclusion:Bilateral optic atrophy was related to occipital lobe infarction, and a possible explanation for the atrophy was transneuronal degeneration caused by occipital lobe infarction.

HOW TO TREAT OPTIC ATROPHY WITH ACUPUNCTURE ?

Optic atrophy results mostly from affection by exopathic wind pathogen, insufficiency of Qi and Xue(blood) or hyperactivity of the liver-yang. We choose Qiuhou(EX-HN 7), Jingming(BL1 ), Taiyang(EX-HN 5 ) and Fengchi(GB 20) as the main acupoints and combine other auxiliary points according to different syndromes. For example, Hegu(LI 4) and Waiguan(TE 5 ) are supplemented for affection by exopathic wind pathogen, Qihai(CV 6), Zusanli(ST 36), Xuehai(SP 10) and Guang-ming(GB 37) for insufficiency of Qi and Xue, and Guanshu(BL 18), Baihui(GV 20), Taixi(KI 3),Sanyinjiao(SP 6) and Guangming(GB 37) for hyperactivity of the liveryang. When Qiuhou(EX-HN 7), Jingming(BL 1 ) and Fenchi(GB 20) punctured, the need1ing direction, angle and depth should be controlled very appropriate for achieving good therapeutic effect.

CLINICAL OBSERVATION ON TREATMENT OF 110 CASES OF OPTIC ATROPHY WITH ACUPUNCTURE

The author punctured Kuangshang (the medial one third of the supraorbitalmargin ), Jieli (midway between the occipital condyle and apex helix) and Yintang ((EX-HN3 ) asmain points to treat optic atrophy in 164 eyes of 110 patients. The results showed that 12 eyes (7.3% ) were cured, 71 eyes (43. 3 % ) remarkably effective, 39 eyes (23. 8 % ) improved and 42 eyes(25. 6 % ) ineffective, with the total effective rate 74. 4 %.

OBSERVATION ON THE THERAPEUTIC EFFECT OF ACUPUNCTURE ON OPTIC ATROPHY(48 CASES)

48 cases of optic atrophy were treated with acupuncture. Qiuhou (EX-HN 7), Jing-ming (BL 1), Ganshu (BL 18), Pishu (BL 20), Fengchi (GB 20), Cuanzhu (BL 2), Yiming (EX-HN 14), Guangming (GB 37), Taiyang (EX-HN 5), Yanglao (SI 6), Sibai (ST 2), Tongziliao(GB 1) were selected as main points, of which three to five points were punctured each time, but thefirst two were used necessarily. According to an overall differentiation of symptoms and signs auxiliarypoints were supplemented. The treatment was given once everyday with the manipulations of twirlingneedles plus slow or rapid insertion for reinforcing or reducing to make the needling sensation reach theeye regions. Twelve treatments made a course with an interval of 3 days between the two courses. Itwas shown that 15 cases were markedly effective (3l. 25 % ), 26 improved (54. 17% ), and 7 ineffec-tive (14. 58 % ). The total effective rate was 85.42%.

Quantitative analysis of optic disc changes in school-age children with ametropia based on artificial intelligence

AIM:To explore changes in the optic disc and peripapillary atrophy(PPA)in school-age children with ametropia using color fundus photography combined with artificial intelligence(AI)technology.METHODS:Based on the retrospective case-controlled study,226 eyes of 113 children aged aged 6–12y were enrolled from October 2021 to May 2022.According to the results of spherical equivalent(SE),the children were divided into four groups:low myopia group(66 eyes),moderate myopia group(60 eyes),high myopia group(50 eyes)and emmetropia control group(50 eyes).All subjects underwent un-aided visual acuity,dilated pupil optometry,best-corrected visual acuity(BCVA),intraocular pressure,ocular axis measurement and color fundus photography.RESULTS:The width of PPA,horizontal diameter ratio of PPA to the optic disc and area ratio of PPA to the optic disc were significantly different among the four groups(P<0.05).The width of the nasal and temporal neuroretinal rim,the roundness of the optic disc,the height of PPA,the vertical diameter ratio of PPA to the optic disc,and the average density of PPA in the high myopia group were significantly different compared with the other three groups(P<0.05).There were strong negative correlations between SE and area ratio of PPA to the optic disc(r=-0.812,P<0.001)and strong positive correlation between axial length(AL)and area ratio of PPA to the optic disc(r=0.736,P<0.001).CONCLUSION:In school-age children with high myopia,the nasal and temporal neuroretinal rims are narrowed and even lost,which have high sensitivity.The area ratio of the PPA to the optic disc could be used as an early predictor of myopia progression,which is of great significance for the development prevention and management of myopia.

38 CASES OF OPTIC ATROPHY TREATED BY NEEDLING QIUHOU POINT

Being a degenerative disease of the optic ner-ve,optic atrophy manifests marked loss of visualacuity,shrinking of visual field with pale opticfundus and narrowing of its vessels,resulting intotal and permanent blindness in severe cases.

OPTIC ATROPHY TREATED WITH ACUPUNCTURE

Trauma of the head is one of the commoncauses leading to optic atrophy.We have adapt-ed acupuncture to treat traumatic optic atrophywith rather satisfactory results.CLINICAL DATAIn this series,all 17 cases were male,diag-nosed as optic atrophy,with their ages rangingfrom 9 to 51 years.Before acupuncture treatment,

Clinical effect of acupuncture combined with Chinese medicine on optic atrophy caused by neuromyelitis optica

Objective:To explore the clinical effect of acupuncture combined with traditional Chinese medicine on optic nerve atrophy caused by neuromyelitis optic(NMO).Methods:the patients with optic atrophy caused by NMO with optic neuritis who visited the ophthalmology or neuro-ophthalmology clinic of our hospital from March 2016 to December 2019 were collected.The patients were treated with acupuncture and traditional Chinese medicine for 8 weeks before and after treatment.The best corrected visual acuity and dynamic visual field were tested before treatment,4 weeks and 8 weeks after treatment,respectively,to evaluate the effect of acupuncture combined with traditional Chinese medicine on the visual function of patients;Results:after 4 weeks of treatment,the visual acuity of 8 eyes improved more than 2 lines,the total effective rate was 91.67%.after 8 weeks of treatment,the visual acuity of 12 eyes improved more than 2 lines,the total effective rate was 100%;after 4 weeks of treatment,the mean defect(MD)and mean sensitivity(MS)of dynamic visual field were improved,but the difference was not statistically significant(MD:t=1.579,P=0.121;MS:t=-1.500,P=0.140);after 8 weeks of treatment,the MD was significantly decreased(t=2.65,P<0.05),and the MS was significantly improved and statistically significant(t=-2.58,P<0.05).Conclusion:the combination of acupuncture and Chinese medicine can significantly improve the visual function of patients with optic atrophy caused by NMO,improve the best corrected visual acuity and dynamic visual field sensitivity,and reduce the visual field defect.

Acupuncture Therapy for the Treatment of Optic Nerve Atrophy

Objective: Optical Nerve Atrophy is one of the most common causes of blindness worldwide. The condition is linked to several pathologies, which contribute to the damage of the optic nerve. The presence of a tumor on the optic nerve, improper formation of the optic nerve, glaucoma, hereditary and central nervous system diseases, and anterior ischemic optic neuropathy promote deterioration of the optic nerve. The purpose of this review is to examine the efficacy of acupuncture therapy for ONA. Method: Clinical trials (case control-trials), and randomized control trials (RCTs) were assessed to observe the efficacy of acupuncture as well as the safety of acupuncture, needling manipulation, and acupoints selection. The data collected in this research include scientific research papers from China National Knowledge Infrastructure (CNKI), PUBMED library, National Library of Medicine (NLM), EMBASE, Cochrane Library, Chinese Biomedical Literature Database, and other literature library date present. Ophthalmoscope, OCT, pupils test, ocular alignment, nystagmus, and visual acuity check were the diagnostic tools used for ONA in the included study. ONA treatment has been a challenge to ophthalmologists over the past decades. At present, western approaches have no fixed treatment mechanism for the condition. Early diagnosis, the use of magnifying lenses, and reduction of increased fluid around the spinal cord and brain are the multiple disciplinary approaches used in western medicine for ONA. On the other hand, Acupuncture, a branch of traditional Chinese medicine, which stimulates the body’s natural healing ability to promote physical and emotional well-being, has reported some significant treatment effects for ONA. Result: The overall result shows that Acupuncture greatly improved patients’ visual acuity, visual field, and visual function in the included study. Acupuncture acting alone showed significant superiority over other treatments for optical nerve atrophy. Acupuncture combined with medication could improve a patient’s condition more rapidly than medications alone. Conclusion: Optic nerve atrophy is a threatening condition to the vision, which is a leading cause of blindness worldwide. Acupuncture has improved the condition of patients with ONA more effectively than other treatment mechanisms in the included study. However, more clinical trials need to be carried out to substantiate stronger evidence of acupuncture for ONA.

一个遗传性听神经病伴视神经萎缩家系研究

目的 研究探讨一个听神经病伴视神经萎缩家系遗传性致病原因。方法 详细询问先证者病史及家族史、进行临床相关检查确诊听神经病伴视神经萎缩,绘制该家系遗传系谱。抽取先证者(Ⅲ-7)外周血行全外显子组测序,对检出的突变进行致病性判读,对先证者妻子(Ⅲ-8)、大女儿(Ⅳ-7)、二女儿(Ⅳ-9)和儿子(Ⅳ-10)进行Sanger测序验证突变位点,并结合临床表现和检查结果进行研究。结果 该家系遗传方式为常染色体显性遗传,先证者(Ⅲ-7)19岁时出现视力下降,30岁时出现双侧感音神经性聋,言语识别率下降,其所在5代20人大家系中10人(2人已故)有类似听力及视力下降症状。先证者(Ⅲ-7)、大女儿(Ⅳ-7)和儿子(Ⅳ-10)听力学检查:纯音测听示双侧感音神经性聋,ABR双耳未引出,40 Hz相关电位(AERP)双耳均未引出,OAE部分或全部频率可引出,镫骨肌声反射阈值未引出;Ⅲ-7、Ⅳ-10眼底检查有不同程度视乳头萎缩,OCT示双眼视盘神经纤维层厚度变薄、视觉诱发电位示P100波峰时延长,确诊为遗传性听神经病伴视神经萎缩。Ⅲ-7行全外显子检测发现3号染色体有一个致病位点OPA1基因c.1334G>A(p.Arg445His,NM_015560.2)突变,一代测序结果示Ⅳ-7和Ⅳ-10也有该突变,Ⅲ-8和Ⅳ-9该位点的基因型是野生纯合型,即未发生突变。结论 OPA1基因c.1334G>A(p.Arg445His,NM_015560.2)突变位点为该家系致病突变。

卵黄样黄斑营养不良合并垂体瘤1例

65岁男性,因“双眼视力下降3年”就诊。最佳矫正视力:右眼FC/20 cm,左眼0.2;双眼眼压正常,右眼12 mmHg,左眼13.1 mmHg。光学相干层析成像(OCT)提示双眼黄斑区卵黄样沉积物。OCT血管成像(OCTA)提示无新生血管。神经纤维层检查显示双眼神经纤维层变薄。眼底彩照结果显示右眼视盘上方盘沿缺失,伴屈膝样血管,视盘颜色苍白,双眼眼底杯盘比(C/D)为0.6。3年前视野检查示双颞侧偏盲。颅脑磁共振成像(MRI)结果显示存在颅内鞍区占位。初步诊断为垂体瘤。垂体瘤切除术后双眼视野有所改善,但视网膜下沉积物无明显好转。全外显子基因测序显示患者存在IMPG2基因复合杂合突变。最终诊断:垂体瘤,卵黄样黄斑营养不良5型。讨论体会:当我们遇到用“一元论”无法解释病情的时候,按照体征进行规范的排查有助于早诊早治。

视神经萎缩蛋白1与糖尿病心肌病相关性的研究进展

糖尿病心肌病(DCM)是指单纯由高血糖引起的心肌细胞或心脏微血管损伤及代谢障碍。有研究表明,DCM与线粒体融合异常密切相关。视神经萎缩蛋白1(Opa1)是线粒体融合的主要蛋白之一。在高血糖环境下,Opa1表达减少,造成线粒体融合障碍,进而引起心肌细胞能量代谢障碍、氧化应激、胰岛素抵抗与脂毒性增加、细胞凋亡等,最终导致DCM。上调Opa1的表达则能使DCM的症状得到改善。该文就Opa1与DCM的相关性的研究进展做一综述,为DCM的研究提供新思路。

视神经萎缩1型线粒体融合蛋白在心血管疾病中的研究进展

心血管疾病严重威胁着人类健康,现已成为人类死亡的主要原因。能量代谢异常对心血管疾病的发生和发展起着关键作用,人体内90%的能量来源于线粒体,因此线粒体功能的稳定对于维持细胞正常形态与功能至关重要。既往研究发现,位于线粒体内膜上的视神经萎缩1型(OPA1)对线粒体功能的维持至关重要,越来越多的研究也表明,OPA1在动脉粥样硬化、心肌缺血再灌注损伤、心力衰竭、糖尿病心肌病等心血管疾病中发挥重要作用。本综述将概述有关OPA1蛋白功能,功能障碍以及与心血管疾病相关的临床表型,重点关注治疗OPA1突变引起的相关心血管疾病的当前治疗选择和未来前景。

中药治疗视神经萎缩的研究进展

视神经萎缩(OA)不是一个独立性的疾病,它是由多因素引起的视网膜神经节细胞(RGCs)轴索变性萎缩,亦是多种眼病的终末阶段,在临床上属难治之症,多以中西医结合治疗。近年来,中医治疗OA取得一定疗效,中医认为OA与肝郁、瘀、湿、虚等因素相关,中药治疗OA有多种方法,如中药复方、中药单体、中成药、中药离子导入及熏蒸、针药结合等,这些方法有利于视神经修复和抑制RGCs损伤。未来对中医治疗OA进行深入研究,可为OA的治疗提供更多选择。

Characterization,expression dynamics,and potential function of OPA1 for regulation of mitochondrial morphology during spermiogenesis in Phascolosoma esculenta

Mitochondria undergo morphological changes during spermatogenesis in some animals.The mechanism and role of mitochondrial morphology regulation,however,remain somewhat unclear.In this study,we analyzed the molecular characteristics,expression dynamics and subcellular localization of optic atrophy protein 1(OPA1),a mitochondrial fusion and cristae maintenance-related protein,to reveal the possible regulatory mechanisms underlying mitochondrial morphology in Phascolosoma esculenta spermiogenesis.The full-length cDNA of the P.esculenta opa1 gene(Pe-opa1)is 3743 bp in length and encodes 975 amino acids.The Pe-OPA1 protein is highly conservative and includes a transmembrane domain,a GTPase domain,two helical bundle domains,and a lipid-interacting stalk.Gene and protein expression was higher in the coelomic fluid(a site of spermatid development)of male P.esculenta and increased first and then decreased from March to December.Moreover,their expression during the breeding stage was significantly higher than during the non-breeding stage,suggesting that Pe-OPA1 is involved in P.esculenta reproduction.The Pe-OPA1 protein was more abundant in components consisting of many spermatids than in components without,indicating that Pe-OPA1 mainly plays a role in the spermatid in coelomic fluid.Moreover,Pe-OPA1 was mainly detected in the spermatid mitochondria.Immunofluorescence experiments showed that the Pe-OPA1 are constitutively expressed and co-localized with mitochondria during spermiogenesis,suggesting its involvement in P.esculenta spermiogenesis.These results provide evidence for Pe-OPA1's involvement in the regulation of mitochondrial morphology during spermiogenesis.

Confocal laser endomicroscopy as a new diagnostic tool for poorly differentiated gastric adenocarcinoma

Gastric cancer(GC)is a multifactorial disease,where both environmental and genetic features can have an impact on its occurrence and development.GC represents one of the leading causes of cancer-related deaths worldwide.GC is most frequent in males and is believed to arise from a series of premalignant lesions.The detection of GC at an early stage is crucial because early GC,which is an invasive stomach cancer confined to the mucosal or submucosal lining,may be curable with a reported 5-year survival rate of more than 90%.Advanced GC usually has a poor prognosis despite current treatment standards.The diagnostic efficacy of conventional endoscopy(with light endoscopy)is currently limited.Confocal laser endomicroscopy is a novel imaging technique that allows real-time in vivo histological examination of mucosal surfaces during endoscopy.Confocal laser endomicroscopy may be of great importance in the surveillance of precancerous gastric lesions and in the diagnosis of GC.In this editorial we commented on the article about this topic published by Lou et al in the recent issue of the World Journal of Clinical Cases.

常染色体显性视神经萎缩1例

本文报道1例常染色体显性视神经萎缩病例,为该类疾病的临床诊断提供参考。患儿无明显诱因出现双眼视力差,结合辅助检查及基因检测后诊断为常染色体显性视神经萎缩。该病目前尚无有效的治疗方法,治疗的关键是提高患者的视觉质量,通常建议患者改变生活方式及定期随访复查。

复方血栓通胶囊治疗青光眼视神经萎缩患者的临床效果

目的分析青光眼视神经萎缩患者临床治疗中应用复方血栓通胶囊的临床优势。方法选取2022年1月—2023年1月在兖矿新里程总医院确诊为青光眼导致视神经萎缩的70例患者。以随机抽签法分为对照组与研究组,各35例。对照组接受常规方案治疗,研究组在常规药物治疗同时增加使用复方血栓通胶囊。对比2组的临床治疗效果。结果治疗40 d后,研究组视力水平、光敏度、缺损度高于对照组,总灰度值低于对照组(P<0.05);研究组舒张末期血流速度高及收缩期峰值流速指标高于对照组,阻力指数和搏动指数低于对照组(P<0.05);研究组治疗总有效率为96.00%,高于对照组的76.00%(P<0.05)。结论青光眼视神经萎缩选择常规西药治疗同时,加用复方血栓通胶囊,可促进患者视力水平及眼血流动力学指标得到确切改善,提高总体治疗有效性,应用价值高。

线粒体疾病相关视神经病变

线粒体疾病是主要累及全身多系统且临床表现各异的线粒体能量代谢耗竭疾病,其中眼部可单独受累,尤其是视神经病变可为其唯一表现,或是各种综合征的受累器官之一。临床最常见的线粒体相关视神经病变为Leber遗传性视神经病变和常染色体显性遗传性视神经萎缩。随着基因检测技术的发展,越来越多的线粒体基因突变类型及包括视神经萎缩的各种表型已被认识,例如MELAS脑病、Leigh综合征、Wolfram综合征、Charcot-Marie-Tooth病等。本文主要聚焦包括Leber遗传性视神经病变在内的各种线粒体疾病及其综合征的眼部表现,尤其是视神经病变,通过典型的临床特征及针对性的基因检测手段拓展神经眼科医师对视神经萎缩性疾病的认识,有利于对该类疾病的精准诊疗。