Neuroimaging in atypical normal tension glaucoma:debating routine implementation in the absence of classic neurological findings

●AIM:To assess the necessity of neuroimaging in patients with neurological or atypical findings of normal tension glaucoma(NTG)who do not exhibit typical glaucoma manifestations.●METHODS:A retrospective analysis was conducted on 90 atypical NTG patients who underwent cranial magnetic resonance imaging(MRI)due to atypical symptoms.The demographic characteristics,clinical parameters,and radiological findings were recorded.●RESULTS:Among the patients,66.7%had abnormal radiology results,with the most common findings being gliosis(34.4%),sequelae of cerebrovascular events and vascular malformations(14.4%),and benign intracranial mass lesions(11%).Non-glaucomatous visual field defects were more frequently observed in patients with abnormal neuroimaging results.However,there were no significant differences in intraocular pressure,optic disc parameters,retinal nerve fiber layer thickness,and visual field indices between patients with normal and abnormal radiological results.The mean age of the patients was 58.74y.Interestingly,there was a significant age difference,with the abnormal radiology group having a higher median age(P=0.021).●CONCLUSION:The study highlights the importance of cranial imaging in older NTG patients to detect underlying pathologies and prevent misdiagnosis.It suggests that neuroimaging may be warranted in NTG patients with atypical visual field defects incompatible with glaucoma.However,routine neuroimaging in all NTG patients without classic neurological signs may not be necessary.

Anti-inflammatory effect of miR-125a-5p on experimental optic neuritis by promoting the differentiation of Treg cells

Methylprednisolone pulse treatment is currently used fo r optic neuritis.It can speed visual recovery,but does not improve the ultimate visual outcomes.Recent studies have repo rted that miR-125 a-5 p has immunomodulatory effects on autoimmune diseases.However,it remains unclear whether miR-125 a-5 p has effects on optic neuritis.In this study,we used adeno-associated virus to overexpress or silence miR-125 a-5 p in mice.We found that silencing miR-125 a-5 p increased the latency of visual evoked potential and aggravated inflammation of the optic nerve.Ove rexpression of miR-125 a-5 p suppressed inflammation of the optic nerve,protected retinal ganglion cells,and increased the percentage of Treg cells.Our findings show that miR-125 a-5 p exhibits anti-inflammatory effects through promoting the diffe rentiation of Treg cells.

Optic radiation injury in patients with aneurismal subarachnoid hemorrhage: a preliminary diffusion tensor imaging report

Visual field defect is one of the various clinical manifestations in patients with subarachnoid hemorrhage（SAH）. Little is known about the pathogenic mechanism of visual field defect in SAH. In the current study,we investigated the diffusion tensor imaging （DTI） finding of the optic radiation in patients with SAH followingrupture of a cerebral artery aneurysm. We recruited 21 patients with aneurismal SAH （12 males, 9 females, mean age, 52.67 years; range, 41–68 years） who showed no definite lesion along the visual pathway.Twenty-one age-and sex-matched normal control subjects were also recruited. DTI data were acquired at an average of 5.9 weeks （range： 3–12 weeks） after onset and reconstruction of the optic radiation was performed using DTI-Studio software. The fractional anisotropy value, apparent diffusion coefficient value,and fiber number of the optic radiation were measured. The fractional anisotropy value of the optic radiation was significantly decreased, and the apparent diffusion coefficient value was significantly increased, in patients with aneurismal SAH than in normal control subjects. However, there was no significant difference in the fiber number of the optic radiation between patients with aneurismal SAH and normal control subjects. The decrement of fractional anisotropy value and increment of apparent diffusion coefficient value of the optic radiation in patients with aneurismal SAH suggest optic radiation injury. Therefore, we recommend a thorough evaluation for optic radiation injury in patient with aneurismal SAH.

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.

Structure-function relationship comparison between retinal nerve fibre layer and Bruch's membrane opening-minimum rim width in glaucoma

AIM：To evaluate and compare structural optical coherence tomography（OCT）-based parameters,such as Bruch’s membrane opening-minimum rim width（BMO-MRW）,and retinal nerve fiber layer（RNFL）thickness in glaucoma patients with visual field（VF）defects,and to correlate both to mean deviation（MD）values of obtained standard achromatic perimetry（SAP）examinations.METHODS：Patients with glaucoma and glaucomatous VF defects were enrolled in this prospective study and compared to age-matched healthy individuals.All study participants underwent a full ophthalmic examination and VF testing with SAP.Peripapillary RNFL thickness and BMO-MRW were acquired with SD-OCT.Correlation analyses between obtained global functional and global as well as sectorial structural parameters were calculated.RESULTS：A consecutive series of 30 glaucomatous right eyes of 30 patients were included and compared to 36healthy right eyes of 36 individuals in the control group.Global MD of values correlated significantly with global RNFL（Pearson corr.coeff：0.632,P=0.001）and global BMO-MRW（Pearson corr.coeff：0.746,P〈0.001）values in the glaucoma group.Global MD and sectorial RNFL or BMO-MRW values correlated less significantly.In the control group,MD values did not correlate with RNFL or BMO-MRW measurements.A subgroup analysis of myopic patients（〉4 diopters）within the glaucoma group（n=6）revealed a tendency for higher correlations between MD and BMO-MRW than MD and RNFL measurements.CONCLUSION：In a clinical setting,RNFL thickness and BMO-MRW correlate similarly with global VF sensitivity in glaucoma patients with BMO-MRW showing higher correlations in myopic glaucoma patients.

Functional PET Scan in Four Patients with Higher Order Neglect-Like Cognitive Dysfunction Associated to Chiasm Related Pathology

Cognitive disturbances with neglect-like features have been reported occasionally in patients with chiasmal disorders, so far however with no obvious substrate by conventional brain imaging. Thus, there were no right hemisphere lesions that could explain the lateralised visual inattention as observed in particular during monocular visual acuity testing. On this background, we further examined four adult patients who consented to functional 18F-fluoro-deoxyglucose (FDG) positron emission tomography (PET) scan. In three there were no significant findings. The fourth patient, a 26-year-old male with cognitive defects after surgery for craniopharyngioma, will be discussed in more detail. His PET scan demonstrated a widespread reduction of regional metabolic activity in left hemisphere primary visual cortex and higher order visual areas, despite absence of explanatory pathological signal changes on MRI. As present in only one out of four patients, however, the findings do not allow specific pathogenetic mechanisms to be suggested, nor generally to substantiate involvement of higher cerebral circuits. Obviously, even developed imaging has its limits, and in the very theory the visual dysfunctions observed might still depend on higher brain centres’ faulty adaptation to loss of pre-geniculate visual information.

Epidemiological Review of Macular Hole in Ekiti, Southwestern Nigeria

Background: Macular hole is a known cause of central visual defect with varying etiologies in different parts of the world. It was considered an untreatable condition until 1991 when varying treatment techniques began to emerge with resultant restoration of central vision. This study was carried out to evaluate the prevalence and pattern of Macular hole in a tertiary eye centre in Nigeria. Method: This is a prospective hospital-based study over a 5 year period spanning from November 2013 to October 2018. All patients with macular hole seen within this period were included in the study. Relevant data were recorded with a structured questionnaire and analysed with SPSS version 20. Results: There were 46 eyes of 42 patients which constituted about 0.5% of all new patients seen over the study period. Male to female ratio was 1:1.3 with age ranged between 15 and 91years (mean = 61.8 ± 16.5 years). The majority of the patients (95.7%) had Idiopathic macular hole. Half of the patients (54.8%) had visual acuity less than 3/60 in the affected eye at the time of presentation. The majority (95.7%) of the patients did not accept the recommended surgical treatment option because of financial incapacitation. Conclusion: Macular hole is a disease of marked visual consequence. Available treatment option is still not within the reach of the majority because of the high cost.

Posner-Schlossman syndrome:a 10-year review of clinical experience

Background:To describe our 10-year experience with Posner-Schlossman syndrome(PSS)in terms of morbidity and prognosis.Methods:We investigated 72 cases(74 eyes;both eyes of 2 cases)of PSS between July 2005 and July 2015.Data were collected on intraocular pressure(IOP),keratic precipitates(KP),anterior chamber,pupil,optic nerve disc and visual field,as well as general characteristics.Each case was examined every 3 to 7 days during attacks and every 2 to 6 months between attacks.Results:The mean age of the 72 patients(41 men)was 40±6 years(range,16-64 years).The mean disease duration was 4.3 years(range,1-7 years)and mean follow-up 4.9 years(range,1-8 years).Medical treatment was efficacious for 62 patients(62 eyes,83.78%).Ten patients exhibited progressive cupping and visual field loss(12 eyes,16.22%),all had normal IOP and no recurrence of PSS after trabeculectomy with anti-metabolite treatment.Conclusions:Although the prognosis of most PSS is usually benign,the IOP and optic nerve disc must be monitored.Visual-field damage can occur with long-term disease and frequent attacks.

Optical coherence tomography in ischemic optic neuropathy

Ischemic optic neuropathies are among the most common causes of sudden vision loss,especially in patients over age 50.The cause and prognosis of these disorders,and in particular non-arteritic anterior ischemic optic neuropathy,is poorly understood,and treatments remain poor in terms of restoring or preserving vision.Optical coherence tomography(OCT)and OCT angiography have allowed us to identify early and late structural changes in the optic nerve head and retina that may assist in predicting visual outcomes and may lead to greater understanding of pathogenesis and thus the development of effective medical interventions.

Bilateral papilledema in a child with osteogenesis imperfecta

Background:To present a female child patient with osteogenesis imperfecta who had bilateral papilledema.Case presentation:A twelve-year-old girl with osteogenesis imperfecta was referred to our clinic.Bilateral best corrected visual acuity of the patient was 5/10(corrected with+3.50 for right eye,+5.00 for left eye)with a standard Snellen scale at a distance of a 6 m.Anterior chamber,iris and lens examination of both of her eyes were unremarkable.In her fundus examination,bilateral stage 2 papilledema and the wrinkles in papillomacular area were noticed.Optical coherence tomography images revealed the macular pucker and thickening in the retinal nerve fibre layers of both eyes.Computed tomography images revealed that there were ossifications in the optic chiasma and occlusion in all periorbital sinus areas.Conclusion:Osteogenesis imperfecta is a rare,autosomal dominant connective tissue disorder characterised by bone fractures,deafness and blue sclera.We would like to draw attention to the clinical course of our patient with computed tomography,optical coherence tomography and visual field findings.