Outbreak of methanol-induced optic neuropathy in early COVID-19 era;effectiveness of erythropoietin and methylprednisolone therapy

BACKGROUND Methanol is a highly toxic,non-potable alcohol.Outbreaks of methanol toxicity occur due to its fraudulent addition to alcoholic beverages as a cheaper substitute for ethanol.Recently,alongside the coronavirus disease 2019(COVID-19)pandemic,rumors circulated on social media that consuming alcohol can prevent or cure the virus,leading to a COVID-19 and methanol-induced optic neuropathy(MON)syndemic.AIM To investigate the impact of erythropoietin(EPO)on the outcomes of patients diagnosed with MON.METHODS In this prospective study,105 patients presenting with acute bilateral visual loss secondary to methanol intoxication were enrolled from March to May 2020 at Farabi Eye Hospital.A comprehensive ocular examination was conducted for all participants.Recombinant human EPO and methylprednisolone were administered intravenously to all patients for three consecutive days.RESULTS The mean age of the participants was 39.9 years(±12.6).Ninety-four patients were male and eleven were female.The mean pre-treatment best corrected visual acuity(BCVA)improved from 2.0±0.86 to 1.39±0.69 logarithm of the minimum angle of resolution post-treatment(P<0.001),with significant improvement observed in all age categories and genders(P<0.001).Visual acuity improvement was also significant regardless of whether the patient presented before or after 72 h(P<0.001),and the post-treatment BCVA remained significant at all monthly follow-up visits(P<0.001).CONCLUSION EPO and methylprednisolone therapy have been shown to be effective in improving visual outcomes in patients with MON when administrated within the first month of exposure.Public awareness efforts are necessary to prevent further outbreaks of methanol toxicity in the current COVID-19 era.

Photoreceptor changes in Leber hereditary optic neuropathy with m.G11778A mutation

·AIM:To evaluate the functional and structural changes of photoreceptors in patients and asymptomatic carriers with Leber hereditary optic neuropathy(LHON)using fullfield electroretinography(FERG)and optical coherence tomography(OCT).·METHODS:Individuals diagnosed with LHON at the Renmin Hospital of Wuhan University and their family members were included in this cross-sectional observational study.The FERG a-wave amplitude of affected patients and asymptomatic carriers was analyzed.The thickness of the outer nuclear layer(ONL),inner and outer segment(IS/OS)and total photoreceptors in the macular fovea and parafovea were measured.·RESULTS:This study included 14 LHON patients(mean age:20.00±9.37y),12 asymptomatic carriers(mean age:39.83±6.48y),and 14 normal subjects(mean age:24.20±1.52y).The FERG results showed that the darkadapted 3.0 electroretinography and light-adapted 3.0 electroretinography a-wave amplitudes of patients and carriers were significantly decreased(P<0.001).The ONL and photoreceptors layers were slightly thicker in patients than in normal subjects(P<0.05),whereas they were thinner in carriers(P<0.05).There were no differences in IS/OS thickness among the groups(P>0.05).·CONCLUSION:Photoreceptors function is significantly impaired in LHON-affected patients and asymptomatic carriers.Meanwhile,photoreceptors morphology is slightly altered,mainly manifesting as a change in ONL thickness.

Non-arteritic anterior ischemic optic neuropathy combined with branch retinal vein obstruction:A case report

BACKGROUND Non-arteritic anterior ischemic optic neuropathy(NAION)is an independent disease characterized by edematous optic discs.In eyes with branch retinal vein occlusion(BRVO),the arteries and veins in the ethmoid plate of the optic disc are relatively crowded;however,a combination of the two is clinically uncommon.Herein,we reported a patient with NAION and concealed BRVO,for which the treatment and prognosis were not similar to those for NAION alone.CASE SUMMARY Herein,we report a case of NAION with concealed BRVO that did not improve with oral medication.A week later,we switched to intravenous drug administration to improve circulation,and the patient’s visual acuity and visual field recovered.Hormonal therapy was not administered throughout the study.This case suggested that:(1)Fundus fluorescein angiography(FFA)can help detect hidden BRVO along with the NAION diagnosis;(2)intravenous infusion of drugs to improve circulation has positive effects in treating such patients;and(3)NAION with concealed BRVO may not require systemic hormonal therapy,in contrast with the known treatment for simple NAION.CONCLUSION NAION may be associated with hidden BRVO,which can only be observed on FFA;intravenous therapy has proven effectiveness.

Impact of Selected Processing Methods of High-Level Cyanide in Cassava on Optic Neuropathy in Wistar Albino Rats—An Experimental Study

Background: Cassava tuber crop is a staple food rich in carbohydrates and utilized in various forms by millions of Nigerians. The storage root of the cassava contains linamarin, a cyanogenic glycoside that is easily hydrolyzed to release cyanide salt compounds which is toxic to the nervous system especially the optic nerve, sometimes leading to optic neuropathy and visual impairment. Aim: The aim of this study is to find out the impact of selected processing methods of high-level cyanide in cassava on optic neuropathy in Wistar albino rats. Methodology: Twenty-four Wistar albino rats were fed with different concentration and duration of predetermined high-cyanide content cassava root cultivar which was processed using different processing methods adopted by various communities in Rivers State, Nigeria (for human consumption). A control group of 3 Wistar albino rats was fed with normal “Growth Mesh” meals. The pre and post weights of the animals and the fundoscopic optic nerve status of the rats were evaluated after 30 and 60 days. SPSS Version 25 was employed for descriptive and inferential statistical analyses. A p-value of ≤0.05 was considered statistically significant. Results: The Cassava species available in Rivers State have high cyanide content (2336.79 mg CN-/kg dry weight of cassava). There was statistically significant reduction in the cyanide content (p = 0.000) depending on the various common processing methods (into garri for human consumption): 24 hours, 48 hours, fermentation;with and without red palm oil additive. The individual weights as well as the mean weight of the 24 rats in the experimental group increased gradually from the first week to the 9th week with a slight weight reduction on the third and fourth weeks which was not statistically significant (p = 0.092). However, there was a steady increase in the weights of the animals in the control group throughout the 9 weeks. Varying degrees of optic neuropathy occurred, worse with the rats that had 24-hour fermented cassava twice daily for 60 days. The intra and inter group differences in the optic disc changes was statistically significant (p = 0.000). Conclusion: Longer duration of processing cassava roots into garri for human consumption reduces its cyanide content and minimizes the adverse impact on the optic nerve.

Stem Cell Ophthalmology Treatment Study (SCOTS)： bone marrow-derived stem cells in the treatment of Leber＇s hereditary optic neuropathy

The Stem Cell Ophthalmology Treatment Study(SCOTS) is currently the largest-scale stem cell ophthalmology trial registered at Clinical Trials.gov(identifier: NCT01920867). SCOTS utilizes autologous bone marrow-derived stem cells(BMSCs) to treat optic nerve and retinal diseases. Treatment approaches include a combination of retrobulbar, subtenon, intravitreal, intra-optic nerve, subretinal, and intravenous injection of autologous BMSCs according to the nature of the disease, the degree of visual loss, and any risk factors related to the treatments. Patients with Leber's hereditary optic neuropathy had visual acuity gains on the Early Treatment Diabetic Retinopathy Study(ETDRS) of up to 35 letters and Snellen acuity improvements from hand motion to 20/200 and from counting fingers to 20/100. Visual field improvements were noted. Macular and optic nerve head nerve fiber layer typically thickened. No serious complications were seen. The increases in visual acuity obtained in our study were encouraging and suggest that the use of autologous BMSCs as provided in SCOTS for ophthalmologic mitochondrial diseases including Leber's hereditary optic neuropathy may be a viable treatment option.

Clinical characteristics of progressive nonarteritic anterior ischemic optic neuropathy

AIM:To study whether patients with progressive nonarteritic anterior ischemic optic neuropathy(NAION)present earlier than patients with stable NAION and to describe their clinical characteristics and visual outcome.METHODS:This was a retrospective chart review.All patients with NAION seen during the acute stage from January 2012 to December 2018 were reviewed.Patients were included if they had documented disc edema and follow up of at least 3 mo.Patients with progressive NAION were identified if they worsened in 2 out of 3 parameters:visual acuity≥3 Snellen lines;Color vision≥4 Ishihara plates;the visual field defect involved a new quadrant.The clinical characteristics,time from symptom onset to presentation,systemic risk factors and visual outcome were compared to patients with stable NAION.RESULTS:Totally 122 NAION cases met the inclusion criteria.Mean age was 58.1 y(range 22-74),70%were men.Twenty cases(16.4%)had progressive NAION.Patients with progressive NAION did not differ from stable NAION in their demographics,systemic risk factors or in their initial visual deficit.At last follow up,median visual acuity was 1.0 log MAR(IQR 0.64-1.55)in patients with progressive NAION,vs 0.18(IQR 0.1-0.63)in stable NAION(P<0.001).Median color vision testing was 0 plates correct(IQR 0-2.5%)vs 92%plates correct(IQR 50%-100%)in the stable NAION group(P<0.001).Patients with progressive NAION differed in the time from symptom onset to presentation(median 2 d vs 5 d,P=0.011).CONCLUSION:We find no identifiable risk factors associated with progressive NAION.Progressors arrive earlier for ophthalmological evaluation.

Optical coherence tomography angiography of optic disc perfusion in non-arteritic anterior ischemic optic neuropathy

AIM: To compare the optic disc blood flow of non-arteritic ischemic optic neuropathy(NAION) eyes with normal eyes. METHODS: The optic disc blood flow densities of diagnosed non-acute phase NAION eyes(21 eyes, 14 individuals) and normal eyes(19 eyes, 12 individuals) were detected via Optovue optical coherence tomography angiography(OCTA). The optic disc blood flow was measured via Image J software. Correlations between optic disc perfusion and visual function variables were assessed by linear regression analysis.RESULTS: The average percentage of the optic disc nonperfusion areas in the non-acute phase NAION patients(17.84%±6.18%) was increased, when compared to the normal control eyes(8.61%±1.65%), and the difference was statistically significant(P<0.01). Moreover, there was a proportional correlation between the visual field mean defect(MD) and the optic disc non-perfusion area percentage, and the relationship was statistically significant(t=3.65, P<0.01, R^2=0.4118). In addition, the critical correlation between the best corrected visual acuity(BCVA) and the optic disc non-perfusion area percentage was statistically significant(t=4.32, P<0.01, R^2=0.4957).CONCLUSION: The optic disc non-perfusion area percentages detected via OCTA in NAION eyes were significantly increased when compared with the normal eyes. Both the BCVA and MD were correlated with the optic disc flow detected, revealing that OCTA may be valuable in the diagnosis and estimation of NAION.

Newly onset indirect traumatic optic neuropathy-surgical treatment first versus steroid treatment first

AIM: To investigate the efficacy and safety of the treatment of endoscopic trans-ethmosphenoid optic canal decompression(ETOCD) with combination of steroid in patients with newly onset indirect traumatic optic neuropathy(ITON) and compare the outcome between immediate ETOCD treatment and ETOCD with preoperative steroid treatment. METHODS: Patients presented as newly onset ITON(suffered trauma within 3 d) at a tertiary medical center between Mar 1 st, 2016 and Mar 1 st, 2018 were enrolled in this study. All patients were equally and randomly divided into 2 groups. Cases in group A were performed ETOCD immediately after admition while cases in group B were prescribed by methylprednisolone(20 mg/kg · d) for 3 d before ETOCD. Methylprednisolone(20 mg/kg · d) was used after surgery for 6 d in group A and 3 d in group B. Follow-up was up to 3 mo in all cases. Visual acuity(VA) before and after treatment between the two groups were taken into comparison. RESULTS: Complete postoperative data were acquired from 34 patients in group A and from 32 patients in group B. Group A had significantly higher effective rate in VA than group B(χ~2 =4.905, P=0.027).CONCLUSION: For patients with newly onset ITON, combination treatment of ETOCD with high-dose steroid is an effective and safe way. Immediate surgery will lead to better prognosis for these cases.

Macular thickness as a predictor of loss of visual sensitivity in ethambutol-induced optic neuropathy

Ethambutol is a common cause of drug-related optic neuropathy.Prediction of the onset of ethambutol-induced optic neuropathy and consequent drug withdrawal may be an effective method to stop visual loss.Previous studies have shown that structural injury to the optic nerve occurred earlier than the damage to visual function.Therefore,we decided to detect structural biomarkers marking visual field loss in early stage ethambutol-induced optic neuropathy.The thickness of peripapillary retinal nerve fiber layer,macular thickness and visual sensitivity loss would be observed in 11 ethambutol-induced optic neuropathy patients(22 eyes) using optical coherence tomography.Twenty-four healthy age-and sex-matched participants(48 eyes) were used as controls.Results demonstrated that the temporal peripapillary retinal nerve fiber layer thickness and average macular thickness were thinner in patients with ethambutol-induced optic neuropathy compared with healthy controls.The average macular thickness was strongly positively correlated with central visual sensitivity loss(r2=0.878,P=0.000).These findings suggest that optical coherence tomography can be used to efficiently screen patients.Macular thickness loss could be a potential factor for predicting the onset of ethambutol-induced optic neuropathy.

Complete mitochondrial DNA sequence analysis in two southern Chinese pedigrees with Leber hereditary optic neuropathy revealed secondary mutations along with the primary mutation

AIM: To investigate mitochondrial factors associated with Leber hereditary optic neuropathy (LHON) through complete sequencing and analysis of the mitochondrial genome of Chinese patients with this disease.· METHODS: Two unrelated southern Chinese families with LHON and 10 matched healthy controls were recruited, and their entire mitochondrial DNA (mtDNA) was amplified and sequenced with the universal M13 primer. Then DNA sequence analysis and variation identification were perfomed by DNAssist and Chromas 2 software and compared with authoritative databases such as Mitomap.RESULTS: Mutational analysis of mtDNA in these two Chinese pedigrees revealed one common LHON-associated mutation, G11778A (Arg→His), in the MT-ND4 gene. In addition, there were two secondary mutations in Pedigree 1: C3497T (Ala→Val), and C3571T (Leu→Phe) in the MT-ND1 gene, which have not been reported; and two secondary mutations occurred in Pedigree 2: A10398G (Thr→Ala) in the MT-ND3 gene, and T14502C (Ile→Val) in the MT-ND6 gene. Three polymorphisms, A73G, G94A and A263G in the mtDNA control region, were also found.· CONCLUSION: Our study confirmed that the known MT-ND4* G11778A mutation is the most significant cause of LHON. The C3497T and C3571T mutations in Pedigree 1 were also both at hot-spots of MT-ND1; they may affect the respiratory chain in coordination with the primary mutation G11778A. In Pedigree 2, the two secondary mutations A10398G of MT-ND3 and T14502C of MT-ND6 may influence mitochondrial respiratory complex I, leading to the mitochondrial respiratory chain dysfunction which results in optic atrophy together with G11778A. Therefore, not only the common primary LHON mutation is responsible for the visual atrophy, but other secondary mtDNA mutations should also be considered when giving genetic counseling.

A Meta-analysis of the association between different genotypes(G11778A, T14484C and G3460A ) of Leber hereditary optic neuropathy and visual prognosis

AIM:To analyze the influences of different genotypes(G11778A,T14484 C and G3460A) of Leber hereditary optic neuropathy(LHON) on visual prognosis. METHODS: After a systematic literature search,all relevant studies evaluating the association between the three primary mutations of LHON and visual prognosis were included.All statistical tests were calculated with Revman 5.2 and STATA 12.0. RESULTS: Ten independent studies were included finally.A significant association between the three primary mutations and prognostic vision over 0.3 were found in G11778 A versus T14484 C [odds ratio(OR) =0.10,95% confidence interval(CI) =0.05-0.17,P <0.001],G11778 A versus G3460A(OR=0.18,95%CI=0.09-0.37,P <0.001) and T14484 C versus G3460A(OR =2.45,95% CI =1.10-5.48,P <0.05).In addition,obtained by pairwise comparison,the vision during onset,age of onset and sex ratio of these three kinds of patients,have no statistical significance(P >0.05).CONCLUSION: From pairwise comparison,we conclude that these three different genotypes of LHON are related to patients' visual prognosis.The T14484 C patients might have a best prognostic vision,G3460 A second,and G11778 A worst.And there is little relation between the three different genotypes and patients' vision,age of onset and sex ratio.

Protective effects of Rutin against methanol induced acute toxic optic neuropathy：an experimental study

AIM:To determine the effects of Rutin on methanol induced optic neuropathy and compare the results with the effects of ethanol.METHODS:Totally 30 rats were divided into 5 groups,with 6 rats in each group as follows:healthy controls(C),methotrexate(MTX),methotrexate+methanol(MTM),methotrexate+methanol+ethanol(MTME) and methotrexate+ methanol+Rutin(MTMR).In all rabbits except those of the control group,MTX,diluted in sterile serum physiologic,0.3 mg/kg per oral was applied for 7 d by the aid of a tube.After this procedure to the rats of MTM,MTME and MTMR groups,20% methanol with a dose of 3 g/kg per oral was given by the aid of a tube.In MTME group,4 h after the application of methanol,20% ethanol was applied by the same way with a dose of 0.5 g/kg.On the other hand,in MTMR group 4 h after the application of methanol,Rutin,which was dissolved in distilled water,was applied by the same way with a dose of 50 mg/kg.RESULTS:There were statistically significant differences in tissue 8-hydroxy-2 deoxyguanine(8-OHdG),interleukin-1β(IL-1β),tumor necrosis factor-alpha(TNF-α),malondialdehyde(MDA),myeloperoxidase(MPO).glutathione peroxidase(t GSH) and superoxide dismutase(SOD) levels between groups(P<0.001).In MTMR group tissue 8-OHdG,IL-1β,MDA,and MPO levels were similar with the healthy controls but significantly different than the other groups.In histopathological evaluations,in MTX group there was moderate focal destruction,hemorrhage and decrease innumber of astrocytes and oligodendrocytes;in MTM group there was severe destruction and edema with decrease in number of astrocytes and oligodendrocytes;in MTME group there was mild hemorrhage,mild edema,mildly dilated blood vessels with congestion while in MTMR group,optic nerve tissue was resembling the healthy controls.CONCLUSION:Rutin may prevent methanol-induced optic neuropathy via anti-inflammatory effects and decreasing the oxidative stress.New treatment options are warranted in this disease to avoid loss of vision in patients.

The transcorneal electrical stimulation as a novel therapeutic strategy against retinal and optic neuropathy: a review of experimental and clinical trials

Transcorneal electrical stimulation(TES) is a novel therapeutic approach to activate the retina and related downstream structures. TES has multiple advantages over traditional treatments, such as being minimally invasive and readily applicable in a routine manner.Series of animal experiments have shown that TES protects the retinal neuron from traumatic or genetic induced degeneration. These laboratory evidences support its utilization in ophthalmological therapies against various retinal and optical diseases including retinitis pigmentosa(RP), traumatic optic neuropathy,anterior ischemic optic neuropathy(AION), and retinal artery occlusions(RAOs). Several pioneering explorations sought to clarify the functional mechanism underlying the neuroprotective effects of TES. It seems that the neuroprotective effects should not be attributed to a solitary pathway, on the contrary, multiple mechanisms might contribute collectively to maintain cellular homeostasis and promote cell survival in the retina. More precise evaluations via functional and morphological techniques would determine the exact mechanism underlying the remarkable neuroprotective effect of TES. Further studies to determine the optimal parameters and the long-term stability of TES are crucial to justify the clinical significance and to establish TES as a popularized therapeutic modality against retinal and optic neuropathy.

Central retinal artery occlusion and traumatic optic neuropathy following blunt ocular trauma

Dear Editor,We are writing to present a case report of central retinal artery occlusion(CRAO)and traumatic optic neuropathy(TON)with immediate visual loss caused by blunt facial trauma with a soccer ball.CRAO is an ophthalmic emergency with an estimated incidence of 10 in 1 million~[1].There are few reported cases of retinal artery occlusion(RAO)

Establishing an experimental model of photodynamic induced anterior ischemic optic neuropathy

BACKGROUND: Scholars have supposed to establish animal models of optic neuropathy by pressing and partially amputating optic nerve, increasing intraocular pressure and injecting vasoconstrictor, etc., but the models are greatly different from anterior ischemia optic neuropathy. Therefore, a more ideal method is needed to establish animal model of anterior ischemic optic neuropathy (AION).OBJECTIVE: To establish AION models in rats, observe the functional changes of fundus, fundus fluorescein angiography (FFA), optical coherence tomography (OCT), flash visual evoked potential (F-VEP), and histopathologically confirm its reliability.DESIGN: A randomized control trial.SETTINGS: Department of Ophthalmology, Xi’an Fourth Hospital; Xi’an Institute of Ocular Fundus Diseases.MATERIALS: The experiments were carried out in the research room of Xi’an Institute of Ocular Fundus Diseases from February 2005 to May 2006. Thirty healthy male SD rats of 4-5 weeks old, weighing 140-160 g, were provided by the animal experimental center of the Fourth Military Medical University of Chinese PLA [SCXK(Military)2002-005], and those without eye disease examined by slit lamp and direct ophthalmoscope after mydriasis were enrolled. The conditions for feeding mice without special pathogen were strictly followed. The rats were randomly divided into blank control group (n =5), laser group (n =5), hematoporphyrin derivative (HPD) group and AION group (n =15), each group was numbered randomly. For each rat, the right eye was taken as the experimental eye, and the left one as the control one.METHODS: In the AION group, the rats were injected with HPD (10 mg/kg) via caudal vein, and then the optic discs were exposed to krypton red (647 nm, 80 mV) for 120 s, and the rats were in avoidance of light for 2 weeks postoperatively. Rats in the laser group were only exposed to krypton red (647 nm, 80 mV) for 120 s, and in avoidance of light for 2 weeks postoperatively; Those in the HPD group were only injected with HPD (10 mg/kg) via caudal vein; Those in the blank control group were untouched. ① Visual electrophysiological test: The F-VEP was used to evaluate the function of visual nerve. ② FFA: After mydriasis and anesthesia as describe above, the fluorescein sodium parenteral solution (1 mL/kg) was injected via caudal vein and finished within about 3 s, the time of FFA was recorded from the beginning of injection, the video sight aimed at the optic disc and the surrounding area. ③ After mydriasis and anesthesia as describe above, the rats were examined with OCT. ④ Histological observation: After hematoxylin and eosin (HE) staining, the optic disc and surrounding blood vessels of retina were observed under light microscope at high power field. MAIN OUTCOME MEASURES: The results of fundus, FFA, visual electrophysiological test and OCT detection within 90 days after model establishment were observed. RESULTS: Of the 30 rats, 1 died after anesthesia in the laser group and 2 died in the AION group respectively, and finally 27 rats were involved in the analysis of results. ① Changes in fundus: In the AION group, there was edema in upper optic disc and unclear boundary at 1 day after establishment, edema still could be observed at 6 days, and upper optic disc atrophied and appeared as pale at 90 days. ② FFA results: In the AION group, early "low fluorescence", middle and late "high fluorescence" were observed in upper optic disc 1 day after model establishment, and there was "low fluorescence" at 6 days, and the low fluorescence could be observed all the time at 23 days. ③ Visual electrophysiological changes: In the AION group as compared with the control eyes, the experimental ones had prolonged F-VEP P100 latency [(71.65±8.81), (57.58±8.38) ms, t =3.148, P =0.012], and decreased wave amplitude [(4.77±1.90), (10.06±3.66) μV, t =4.082, P =0.003], and these changes lasted to 35 days after model establishment. ④ OCT results: In the AION group, the reflection surface of part nerve fiber layer was higher than the retina plane, the surface was rough and the thickness was increased at 6 days after model establishment. ⑤ Histopathological results: At 1 day after model establishment, part optic discs had highly edema, edema of nerve fibers, and loose tissue, also accompanied by the displacement of surrounding retina; At 23 days, the optic disc and surrounding nerve fiber layers became thinner, and the numbers of ganglion nuclei in the retina tissue sections were obviously decreased. These changes were not observed in the laser group, HPD group and blank control group. CONCLUSION: The changes of fundus, FFA, OCT, visual electrophysiology and histopathology confirmed that the krypton red laser irradiation (647 nm) at 2 hours after HPD was injected via caudal vein can establish more ideal animal models of AION.

The Mitochondrial DNA Mutation at Position 11778 in Chinese Families with Leber's Hereditary Optic Neuropathy

We amplified the 340 bp of mitochondrial DMA (mtDNA) by PCR including the recognized sequence of restriction enzyme of SfaN I . After amplification and digestion of SfaN I , two bands of 190 bp and 150 bp appeared in the mtDNA of four normal individuals but only one band of 340 bp appeared in the mtDNA with the mutation of G to A at the site of the nucleotide 11778 because such mutation destroyed the recognized sequence of SfaN I . We studied the mtDNAs of the patients with Leber's hereditary optic neur...

Analysis of optic disc damage by optical coherence tomography in terms of therapy in non-arteritic anterior ischemic optic neuropathy

This study aimed to assess the relationship between the rate of nerve fiber loss in non-arteritic anterior ischemic optic neuropathy(NAION) and time delay before therapy.Total 24 patients received the same treatment within or after 2wk(early and late groups).There were significantly lower level of destruction of nerve fibers(P=0.0014) and significantly better visual field sensitivity(P=0.039) in early group.The results indicate that therapy should be started within 2wk.The degree of ischemic damage due to NAION correlates well with retinal nerve fiber layer thickness and the ischemia-induced decrease in visual field sensitivity.

Foveal pit morphological changes in asymptomatic carriers of the G11778A mutation with Leber’s hereditary optic neuropathy

AIM:To investigate the foveal pit morphology changes in unaffected carriers and affected Leber’s hereditary optic neuropathy(LHON)patients with the G11778 A mutation from one family.METHODS:This study was a prospective cross-sectional study.Both eyes from 16 family members(age from 9 to 47 y)with the G11778 A mutation were analyzed and compared with 1 eye from 20 normal control subjects.Eleven family members with the G11778 A mutation but without optic neuropathy were classified as unaffected carriers(n=22 eyes).Five family members(n=10 eyes)expressed the LHON phenotype and were classified as affected patients.Retinal images of all the subjects were taken by optical coherence tomography(OCT),and an automatic algorithm was used to segment the retina to eight layers.Horizontal and vertical OCT images centered on the fovea were used to measure intra-retinal layer thicknesses and foveal morphometry.RESULTS:Thicker foveal thickness,thinner foveal pit depth,and flatter foveal slopes were observed in unaffected carriers and affected LHON patients(all P<0.001).Further,the slopes of all four sectors in the LHON were flatter than those in the unaffected carriers(all P<0.001).Compared with the control group,affected LHON patients had a thinner retinal nerve fiber layer(RNFL),ganglion cell layer and inner plexiform layer(GCL+IPL),and total retina(all P<0.01).The retinal nerve fiber layer(RNFL)of affected patients was 38.0%thinner than that of controls while the GCL+IPL was 40.1%thinner.CONCLUSION:The foveal pit morphology shows changes in both unaffected carriers and affects patients.RNFL and GCL+IPL are thinner in affected LHON patients but not in unaffected carriers.

Macular ganglion cell complex injury in different stages of anterior ischemic optic neuropathy

BACKGROUND Anterior ischemic optic neuropathy(AION)is a group of ophthalmic diseases in which the optic nerve is injured causing blindness.However,the pathogenesis,clinical manifestations,and clinical treatments of AION are yet elusive.Only a few related experimental or clinical reports are available on the disease.In this study,spectral domain optical coherence tomography(SD-OCT)was used to examine the morphology of thickness swelling and atrophic changes of macular ganglion cell complex(mGCC)in the different stages of AION that were then compared with the visual fields.Thus,the clinical value of mGCC examination was alleged to be similar to that of the visual field.AIM To explore the mGCC injury at different stages in AION and the clinical significance.METHODS Cases with AION were analyzed in a retrospective study.SD-OCT was used to analyze the correlation between mGCC and peripapillary retinal nerve fiber layer thicknesses at different stages of AION and the changes in the corresponding stages of visual fields.RESULTS A total of 21 cases(28 eyes)presented AION.The onset time of AION was defined as early stage(within 3 wk of onset),middle stage(from 3 wk to 2 mo),and late stage(disease span>2 mo).In the early stage,the mGCC thickness of SD-OCT was within the normal high limit,and the perioptic nerve fibers thickness was more than the normal.The changes in the visual field in early stage were not consistent with the swelling changes in mGCC and peri-disc nerve fibers.In addition,atrophy and thinning appeared in mGCC,and the perioptic nerve fibers were swollen.However,the thickness was lower in the middle period than that in the early stage.The change in visual field was consistent with that of mGCC in this period.In the late stage,mGCC shrank and thinned,and the thickness of the nerve fibers around the optic disc in the corresponding region shrank and thinned.CONCLUSION The changes in mGCC thickness in patients with AION showed early,middle,and late stages of development by SD-OCT.Although the early stage visual field changes of AION were not consistent with the swelling changes of mGCC,the horizontal delimitation or annular atrophy of mGCC was consistent with that in the middle and late stage of the disease.The atrophy of peripheral nerve fibers was later than that of the mGCC atrophy.

Prognostic factors of trans-ethmosphenoid optic canal decompression for indirect traumatic optic neuropathy

● AIM: To investigate a possible correlation between visual acuity(VA) prognosis and the presence at baseline of various orbital and ocular signs in patients affected by indirect traumatic optic neuropathy(ITON).● METHODS: From July 1 st, 2012 to July 1 st, 2015, 224 adults diagnosed with ITON who underwent endoscopic transethmosphenoid optic canal decompression(ETOCD) were reviewed. Visual outcome before and after treatment were taken into comparison.● RESULTS: Accompanied older in age, longer time to medical treatment and existence of optic canal fracture(OCF) were the independent predictors for poor postoperative VA and lower improvement degree of visual acuity(IDVA), while worse preoperative VA was predictive factor for poor postoperative VA only. Mean value of IDVA in patients with OCF was 0.19±0.30. Mean value of IDVA in patients without OCF was 0.29±0.35. IDVA in cases without OCF was significant higher than those with OCF(t=2.272, P<0.05).● CONCLUSION: Patients suffered from ITON without OCF before ETOCD have better surgical outcome than those with OCF. Older in age, longer time to medical treatment and existence of OCF are independent factors for poor VA prognosis and lower IDVA. Preoperative VA is independent factor for VA prognosis only.