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.

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,R2=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,R2=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.

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.

Optical coherence tomography evaluation of retinal nerve fiber layer thickness in non-arteritic anterior ischemic optic neuropathy and primary open angle glaucoma:a systematic review and Meta-analysis

AIM:To assess the differences in average and sectoral peripapillary retinal nerve fiber layer(p RNFL)thickness using spectral domain optical coherence tomography(SD-OCT)in patients with non-arteritic anterior ischemic neuropathy(NAION)compared with those with primary open angle glaucoma(POAG).METHODS:A comprehensive literature search of the Pub Med,Cochrane Library,and Embase databases were performed prior to October,2021.Studies that compared the p RNFL thickness in NAION eyes with that in POAG eyes with matched mean deviation of the visual fields were included.The weighted mean difference(WMD)with 95%confidence interval(CI)was used to pool continuous outcomes.RESULTS:Ten cross-sectional studies(11 datasets)comprising a total of 625 eyes(278 NAION eyes,347 POAG eyes)were included in the qualitative and quantitative analyses.The pooled results demonstrated that the superior p RNFL was significantly thinner in NAION eyes than in POAG eyes(WMD=-6.40,95%CI:-12.22 to-0.58,P=0.031),whereas the inferior p RNFL was significant thinner in POAG eyes than in NAION eyes(WMD=11.10,95%CI:7.06 to 15.14,P≤0.001).No difference was noted concerning the average,nasal,and temporal p RNFL thickness(average:WMD=1.45,95%CI:-0.75 to 3.66,P=0.196;nasal:WMD=-2.12,95%CI:-4.43 to 0.19,P=0.072;temporal:WMD=-1.24,95%CI:-3.96 to 1.47,P=0.370).CONCLUSION:SD-OCT based evaluation of inferior and superior p RNFL thickness can be potentially utilized to differentiate NAION from POAG,and help to understand the different pathophysiological mechanisms between these two diseases.Further longitudinal studies and studies using eight-quadrant or clock-hour classification method are required to validate the obtained findings.

Risk factors of non-arteritic anterior ischaemic optic neuropathy and central retinal artery occlusion

AIM:To investigate the difference in risk factors between non-arteritic anterior ischaemic optic neuropathy(NAION)and central retinal artery occlusion(CRAO)and develop a predictive diagnostic nomogram.METHODS:The study included 37 patients with monocular NAION,20 with monocular CRAO,and 24 with hypertension.Gender,age,and systemic diseases were recorded.Blood routine,lipids,hemorheology,carotid and brachial artery doppler ultrasound,and echocardiography were collected.The optic disc area,cup area,and cup-to-disc ratio(C/D)of the unaffected eye in the NAION and CRAO group and the right eye in the hypertension group were measured.RESULTS:The carotid artery intimal medial thickness(C-IMT)of the affected side of the CRAO group was thicker(P=0.039)and its flow-mediated dilation(FMD)was lower(P=0.049)than the NAION group.Compared with hypertension patients,NAION patients had higher whole blood reduced viscosity low-shear(WBRV-L)and erythrocyte aggregation index(EAI;P=0.045,0.037),and CRAO patients had higher index of rigidity of erythrocyte(IR)and erythrocyte deformation index(EDI;P=0.004,0.001).The optic cup and the C/D of the NAION group were smaller than the other two groups(P<0.0001).The diagnostic prediction model showed high diagnostic specificity(83.7%)and sensitivity(85.6%),which was highly related to hypertension,the C-IMT of the affected side,FMD,platelet(PLT),EAI,and C/D.CONCLUSION:CRAO patients show thicker C-IMT and worse endothelial function than NAION.NAION and CRAO may be related to abnormal hemorheology.A small cup and small C/D may be involved in NAION.The diagnostic nomogram can be used to preliminarily identify NAION and CRAO.

Characterization of retinal microvasculature in acute non-arteritic anterior ischemic optic neuropathy using the retinal functional imager: a prospective case series

Background:Non-arteritic anterior ischemic optic neuropathy(NAION)is the most common cause of acute optic neuropathy in patients over 50 years of age,and many affected individuals are left with permanent visual deficits.Despite the frequency of NAION and its often devastating effects on vision,no effective treatment has been established.Further understanding of the acute vascular effects in NAION,using advanced ophthalmic imaging techniques like the retinal function imager,may shed light on potential treatment targets.Methods:Five patients with acute NAION underwent retinal functional imaging within 2 weeks of the onset of their visual symptoms,and at 1 month and 3 months after onset.Average arteriolar and venular blood flow velocities were calculated for each eye at each time point.The Wilcoxon rank sum test was used to compare blood flow velocity results with a normative database.Results:The average arteriolar blood flow velocity in the normative group was 3.8 mm/s,and the average venular blood flow velocity was 3.0 mm/s,versus 4.1 mm/s and 2.7 mm/s,respectively,in the NAION-affected group at presentation.Average arteriolar blood flow increased slightly to 4.2 mm/s one month after the acute NAION event,then decreased to 3.8 mm/s three months after the event.Average venular blood flow velocity was 2.8 mm/s 1 month after the NAION event and 2.7 mm/s 3 months after the event.Differences in blood flow velocity between the NAION-affected and control groups were not statistically significant at any time point;however,there was a trend toward increasing blood flow velocity initially after an NAION,with a decrease over time.Conclusions:This study demonstrates the feasibility of retinal function imaging to quantify macular blood flow velocity in patients with acute NAION.There were no statistically significant differences in blood flow velocity detected between NAION-affected eyes and healthy controls at any of the time points examined;however,there was a trend toward an increase in both arteriolar and venular BFV subacutely,then a decrease in the chronic phase after NAION,which could be suggestive of a mechanism of attempted compensation in the setting of acute ischemia.

Atherogenic indices in non-arteritic ischemic optic neuropathy

AIM:To evaluate the atherogenic indices and the relationship with visual acuity and bilateral sequential involvement in patients with non-arteritic ischemic optic neuropathy(NAION).METHODS:A total of 65 patients with NAION and 48 age-sex matched healthy individuals were included in this retrospective study.The demographic characteristics and laboratory findings of the patients and control subjects were obtained from the electronic medical records.The atherogenic indices were calculated using the lipid parameters.The association between visual acuity,bilateral sequential involvement,and atherogenic indices was investigated.RESULTS:The mean age was 63.8±12.5 y in the NAION group and 64.7±10.1 y in control group(P=0.707).Although there were no significant differences in terms of total cholesterol(TC)and low-density lipoprotein cholesterol(LDL-c)between two groups(P=0.089,0.091),all the nontraditional serum lipid ratios were significantly higher in NAION group(P<0.05).In the NAION subgroup analysis,with visual acuity≤20/200 had higher TC/high-density lipoprotein cholesterol(HDL-c),LDL-c/HDL-c,and non-HDL-c/HDL-c values than the patients in the NAION group with visual acuity>20/200(P=0.032,0.025,0.032,respectively).The values for the atherogenic indices were higher in NAION patients with bilateral sequential involvement in comparison to those with unilateral involvement(P=0.271,0.127,0.197,0.128,0.127,respectively).CONCLUSION:The study reveals a relationship between NAION and the non-traditional lipid ratios.Atherogenic indices may predict the visual loss severity and second eye involvement in patients with NAION.

Longitudinal Measurement of Hemodynamic Changes within the Posterior Optic Nerve Head in Rodent Nonarteritic Anterior Ischemic Optic Neuropathy

ObjectiveTo assess the in vivo dynamic blood flow features of posterior optic nerve head (ONH) in rat model of nonarteritic anterior ischemic optic neuropathy (rNAION). MethodsrNAION was established with Rose Bengal and argon green laser in Sprague-Dawley rats. Fundus photography and fundus fluorescein angiography (FFA) were performed to assess the dynamic changes of optic disc in morphology in 90 days and in blood perfusion in 3 hours after the induction of disease. Histological examinations were performed to evaluate the success of modeling. Thedynamic blood flow kinetics of posterior ONH in rNAION were measured by Laser Doppler Flowmetry (LDF) on the day 3, 7, 14, 21, and 40 after the disease induction. One-way ANOVA, Student'st-test and Bonferroni adjustment were used for multiple comparisons of kinetic measurements of blood flow. ResultsOptic disc edema and subsequent resolution associated with the development of optic disc pallor were observed in rNAION. FFA showed that the optic disc was hypofluorescence in the early phase and hyperfluorescence in the late phase. Histological studies suggested edema and loosened tissues of ONH, loss of retinal ganglion cells (RGCs), optic nerve substance and gliosis. Compared to the naive rats, the blood flow kinetics of posterior ONH in rNAION significant reduced at each time point after modeling (F=175.06,P<0.0001). The reductions were specifically remarkable in 14 days after the disease induction (AllP<0.01). Conclusions Continuous blood perfusion reduction was found in rNAION, with significant alteration in 14 days after disease induction. Our results provided important information for understanding the hemodynamic changes in rNAION.

Change of retinal nerve fiber layer thickness in patients with nonarteritic inflammatory anterior ischemic optic neuropathy

In this study, 16 patients （19 eyes） with nonarteritic anterior ischemic optic neuropathy in the acute stage （within 4 weeks） and resolving stage （after 12 weeks） were diagnosed by a series of complete ophthalmic examinations, including fundus examination, optical coherence tomography and fluorescein fundus angiography, and visual field defects were measured with standard automated perimetry. The contralateral uninvolved eyes were used as controls. The retinal nerve fiber layer thickness was determined by optical coherence tomography which showed that the mean retinal nerve fiber layer thickness and the retinal nerve fiber layer thickness from temporal, superior, nasal and inferior quadrants were significantly higher for all measurements in the acute stage than the corresponding normal values. In comparison, the retinal nerve fiber layer thickness from each optic disc quadrant was found to be significantly lower when measured at the resolving stages, than in the control group. Statistical analysis on the correlation between optic disc nerve fiber layer thickness and visual defects demonstrated a positive correlation in the acute stage and a negative correlation in the resolving stage. Our experimental findings indicate that optical coherence tomography is a useful diagnostic method for nonarteritic anterior ischemic optic neuropathy and can be used to evaluate the effect of treatment.

Efficacy of granulocyte-colony stimulating factor treatment in a rat model of anterior ischemic optic neuropathy

Non-arteritic anterior ischemic optic neuropathy （NA-AION） is the most common cause of acute ischemic damage to the optic nerve （ON）, and the leading cause of seriously impaired vision in people over 55 years of age. It demonstrated that subcutaneous administration of Granulocyte colony-stimulating factor （G-CSF） reduces RGC death in an ON crush model in rats, and that the neuroprotective effects may involve both anti-apoptotic and anti-inflammatory processes. Our recent work shows that the protective actions of G-CSF in rAION models may involve both anti-apoptotic and anti-inflammatory processes. However, the exact rescuing mech- anisms involved in the administration of G-CSF in rAION models need further investigation. In addition, further studies on the administration of G-CSF at different time intervals after the induction of rAION may be able to illustrate whether treatment given at a later time is still neu- roprotective. Further, it is unknown whether treatment using G-CSF combined with other drugs will result in a synergistic effect in a rAION model. Inflammation induced by ischemia plays an essential role on the ON head in NA-A1ON, which can result in disc edema and compartment changes. Therefore, it is reasonable that adding an anti-inflammatory drug may enhance the therapeutic effects of G-CSF. An ongoing goal is to evaluate the novel sites of action of both G-CSF and other anti-inflammatory drugs, and to identify the functionally protective pathways to enhance RGC survival. These investigations may open up new therapeutic avenues for the treatment of ischemic optic neuropathy.

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.

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 tria 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 rim, 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 v/a 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.

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.

A case of branch retinal artery obstruction complicated after anterior ischemic optic neuropathy

AIM: To report a case of branch retinal artery obstruction (BRAO) complicated after anterior ischemic optic neuropathy (AION). METHODS: A 42 year-old woman who complained of visual disturbance was performed ophthalmological examinations such as fundus photography, fluorescent angiography (FAG) and visual field test. RESULTS: At first visit, disc swelling was noted and arterial circulation was intact, however, 1 week after onset, the inferior branch retinal artery began to shrink and the flame hemorrhage intensified. Sixteen months later, the optic disc evidenced an atrophic change; additionally, a ghost vessel in the inferior branch retinal artery was found. CONCLUSION: We report a case of complications of BRAO arising after AION which caused the mechanical compression on the arterial circulation.

Non-arteritic anterior ischaemic optic neuropathy in Malaysia: a 5 years review

AIM: To evaluate the clinical presentations and visual outcomes of non-arteritic anterior ischaemic optic neuropathy (NAION).METHODS: A retrospective study was conducted involving 18 consecutive patients (20 eyes) with NAION attending Hospital Universiti Sains Malaysia from January 2005 until December 2009.RESULTS: Most patients were Malay (94.4%),and followed by Chinese (5.6 %).The female-to-male ratio was 3.5:1.The age of patients ranged from 36 to 85 years (mean,57.1 years).The main risk factors in systemic diseases were hypertension (55.5%),diabetes mellitus (44.4%),and ischaemic heart disease (11.1%).Most patients (77.8%) presented with acute loss of vision while gradual onset was in 22.3% of cases.Majority had visual acuity worse than 1/60 (80%).The most common fundoscopic findings were peripapillary splinter haemorrhage (90%),sectorial swollen optic disc (60%) and hyperemic disc (60%).During follow up,20% of the patients showed stabilization in visual acuity,and 80% showed worsening of vision.CONCLUSION: Majority of patients with NAION presented with acute poor vision involving middle-aged and elderly individuals.Hypertension and diabetes mellitus were among the main risk factors involved.NAION can lead to permanent visual loss despite treatment.

Acute changes in ganglion cell layer thickness in ischemic optic neuropathy compared to optic neuritis using optical coherence tomography

AIM:To elucidate the changes of different ganglion cell layer(GCL)thinning patterns between the optic neuritis(ON)and non-arteritic anterior ischemic optic neuropathy(NAION).METHODS:A prospective,observational study was conducted to evaluate the timing of GCL changes between acute ON and NAION using optical coherence tomography.RESULTS:Thinning on optical coherence tomography in the NAION group occurs as early as 11 d after symptomatic onset of vision loss and follows an altitudinal pattern.The mean superior-inferior GCL thickness difference in the NAION cohort was clinically significant at 5.7μm in the NAION cohort compared to controls of 0.8μm(P=0.032),but not significant in the ON group compared to controls with both groups measuring 1.1μm.Global thinning was significant for the ON group compared to controls at 7.2μm(P=0.011)but not the NAION group compared to controls at 1.35μm.CONCLUSION:These findings suggest that future treatments for NAION should be given early,and possibly before 11 d in order to prevent GCL and irreversible vision loss.

Ischemic optic neuropathies-update

This submission will briefly review the anatomy and physiology of the optic nerve,and highlight various ischemic optic neuropathies including anterior ischemic optic neuropathies(non-arteritis and arteritic),diabetic papillopathy,posterior ischemic optic neuropathies,and ischemic optic neuropathies in the setting of hemodynamic compromise.

Imageology of internal carotid artery siphon in nonarteritic anterior ischaemic optic neuropathy

AIM:To evaluate whether narrowing of internal carotid artery siphon(ICAS)may increase the risk of developing non-arteritic anterior ischaemic optic neuropathy(NAION).METHODS:Totally 30 consecutive patients who had unilateral NAION and 30 gender-matched control subjects were recruited in the present study.The diameter of ICAS of all the participants were measured using head-and-neck computed tomographic angiography(CTA).Color doppler flow imaging(CDI)was used to measure the haemodynamics parameters of ICAS and short posterior ciliary arteries(SPCAs)in all subjects.Comparison of parameters between the NAION patients and controls as well as between the two sides within the patients were performed.The correlation between the diameter of ICAS and NAION was analyzed.RESULTS:A comparison of parameters between the affected side of the NAION patients and the controls,including the diameter of ICAS,the resistance index(RI)of ICAS,the blood flow velocities of SPCAs and RI of SPCAs,showed significantly difference(P<0.01),while there was no significant difference in terms of the mean blood flow velocity(Vm)of ICAS;Similar results were found while comparing all the measurements of the affected and unaffected side of patients(P for RI of SPCAs<0.05).No marked difference was detected in nearly all parameters except for RI of ICAS and SPCAs between the unaffected side of the NAION patients and the controls(P<0.05).The diameter of ICAS were significantly positive correlated with both peak systolic velocity(PSV)of SPCAs and end diastolic velocity(EDV)of SPCAs in patients with NAION(r=0.514,P<0.01 and r=0.418,P<0.05,respectively).CONCLUSION:Narrowing of ICAS may increase the risk of developing NAION.

Correlation of ischemic ophthalmopathy with lacunar infarction

AIM:To investigate the correlation of ischemic ophthalmopathy(IO)with lacunar infarction(LI),an ischemic lesions in the cerebrovascular system.METHODS:Totally 204 cases of IO without any nervous system symptom and previously diagnosed LI served as the observational group.All 204 cases without IO,nervous system symptoms and previous LI served as the control group.Age and sex between the two groups matched well.LI was diagnosed by magnetic resonance imaging(MRI)and the results of the two groups were statistically analyzed and compared.RESULTS:IO included 174 eyes of 156 patients with non-arteritis anterior ischemic optic neuropathy(NAION),42 eyes of 36 patients with central retinal artery occlusion(CRAO)or branch retinal artery occlusion(BRAO)and 12 eyes of 12 patients with ocular ischemia syndrome(OIS).The detection rate of LI(72.54%)in IO group was obviously higher than that(15.68%)in the control group(P<0.001).IO was positively correlated with LI(r=0.573,P<0.05).In addition,most infarction sites located in the basal ganglia(67.57%),which were not the vital areas of cerebrum and not easy to be found due to their small size.The majority of those first visited IO patients(72.54%)without nervous system symptom and previously diagnosed LI had already suffered from LI.CONCLUSION:According to our studies,there is a positive correlation between IO and LI.IO can be used as an important predictor for the present of LI,especially obvious signs of the patient.

头面部美容填充物致眼动脉及其分支动脉阻塞的临床特征和视力预后影响因素分析

目的总结头面部美容填充物注射引起的眼动脉及其分支动脉阻塞的临床特征和视力预后影响因素。方法本研究为回顾性病例研究。共纳入头面部美容填充物注射后立即出现视力下降、视物重影或上睑下垂等眼科症状的患者26例,收集并分析所有患者的临床和影像学资料。结果26例患者中,注射透明质酸者23例,注射自体脂肪者2例,注射干细胞制剂者1例。注射点位于额部8例、额部+眉间4例、眉间3例、眉间+鼻根1例、鼻根4例、鼻翼1例、眼睑4例、颞侧头皮1例。临床表现:眼动脉阻塞2例,视网膜中央动脉阻塞(central retinal artery occlusion,CRAO)7例(其中不完全性CRAO 1例),睫状后短动脉阻塞12例[其中非动脉炎性前部缺血性视神经病变(non-arteritic anterior ischemic optic neuropathy,NAION)6例、非动脉炎性后部缺血性视神经病变3例、局限性脉络膜水肿3例],眼外肌麻痹5例(其中眼动脉肌支阻塞4例,动眼神经麻痹1例),上睑下垂4例,瞳孔散大2例。其中6例患者同时发生2种眼部受累表现,包括CRAO+局限性脉络膜水肿2例,NAION+局限性脉络膜水肿1例,NAION+肌支阻塞1例,NAION+动眼神经麻痹1例,上睑下垂+肌支阻塞1例。头颅MRI检查显示新发性脑梗死灶3例。18例视网膜或视神经受累患者中,11例患者表现为完全性CRAO或弥漫性视神经缺血,治疗前后患者视力无改变;7例患者表现为不完全性CRAO或节段性视神经缺血,治疗后患者视力有明显改善。结论头面部美容填充物注射引起的眼动脉及其分支动脉阻塞视力预后差,不完全性CRAO、节段性视神经缺血和初诊时最佳矫正视力≥0.02的患者视力预后较好。