Study of long term structural and functional changes in medically controlled glaucoma

AIM:Prospectively analyze the long term structural and functional changes in patients of primary open angle glaucoma (POAG) receiving medical therapy (beta blockers and non beta blockers). In this study an attempt has been made to evaluate whether medical reduction of IOP prevents or delays the progression of glaucomatous visual field loss and/or optic nerve damage in patients with open angle glaucoma.METHODS:Study conducted over a period of 27 months, at a tertiary eye care hospital including both eyes of 40 patients with POAG. Group 1 (20 patients, 40 eyes) received beta-blockers, and Group 2 (20 patients, 40 eyes) received non-beta-blockers. Each patient underwent intraocular pressure measurement, best corrected visual acuity, slit-lamp, fundus examination, gonioscopy, central corneal thickness, visual field assessment by Humphrey automated perimetry and retinal nerve fibre layer thickness by Stratus optical coherence tomography at baseline and at two subsequent visits. The average time interval between each visit was 10-11 months. The statistical analysis was done using one-way analysis of variance (ANOVA). Post-hoc test, using tukey’ method were adopted. Probablity (P) value of 0.05 or less was considered to be statistically significant.RESULTS:A total of 80 eyes of 40 patients of POAG were enrolled, 24 males, 16 females, age group 50-80 years. In both beta and non beta blocker group, reduction (improvement) in mean IOP from initial levels to the levels achieved at the 2nd and 3rd visits was statistically significant. One way ANOVA (df=2), fisher f value=11.64, P=0.000, one way ANOVA (df=3), fisher f value=35.61, P=0.000. Both mean deviation (MD) and pattern standard deviation (PSD) in both beta and non beta blockers at different visits were not statistically significant. Retinal nerve fibre layer thickness (RNFL) -only mean inferior retinal nerve fibre layer, the difference between the mean value in beta and non beta blocker groupwere statistically significant. [unpaired t test value (df=78) =2.27, P=0.03]. Side effects with beta blocker were conjunctival hyperemia (10%), burning (5%), and conjunctival hyperemia (5%) in non beta blockers.CONCLUSION: Non-beta-blockers are as effective as beta-blockers in bringing about a significant lowering of intraocular pressure to the normal range, and in preventing progressive damage to the visual fields and retinal nerve fibre layer. The absence of systemic side effects and superior IOP lowering efficacy has made non beta-blockers attractive for first line therapy for the treatment of glaucoma worldwide.     

Morphometric analysis of the optic disc surface

Purpose: Since the glaucomatous loss of nerve fibers changes the appearance of the optic disc, we evaluated the morphology of the surface of the optic disc in normal and glaucomatous eyes by using a computerized system to provide the reciprocal position of a large number of points placed on its surface in order to study the clinical significance of differences in the smoothness of optic disc surface. Methods: The morphology of the optic disc surface was evaluated by means of simultaneous stereoscopic videographic pictures (IMAGEnet X Rev-3.51b — Topcon Europe, The Netherlands): the reciprocal distribution of a large number of points located on the surface of one eye of 100 subjects randomly chosen (45 normal and 55 glaucoma patients) was studied.In order to define the level of smoothness of the optic disc surface, the differences of the relative position of each surface point were studied by measuring the standard deviation (SD) from the average heights of the points (n. ranging from 623 to 1916 depending on the size of the disc area) that identify the optic disc surface. Results: The coefficient of variation of the reciprocal location of the points, placed on the optic disc surface at the different measurements performed by a single operator was 10.4%. The differences in Optic Disc Surface Smoothness (ODSS) between glaucoma and normal group were statistically significant (p < 0.0001 using Mann-Whitney U test). No correlation was detectable between age and standard deviation.The best threshold value, calculated using ROC methodology, able to separate the two groups was: normal group: SD <- – 17.79 (–1 × 10^–2 mm); glaucoma group: SD > – 17.79 (– 1 × 10^–2 mm).Such threshold value had a sensitivity of 82.1 %, a specificity of 92.2% and a diagnostic precision (DP) of 86.5% in dividing the glaucoma group from the normal group. Conclusion: ODSS is a global index of optic disc conditions based on quantitative measurements of the morphology of the optic disc surface. As such it does not provide information about the location and the characteristics of optic disc damage. Nevertheless, ODSS measurement is able to separate normal from glaucomatous optic disc with a rather interesting sensitivity, specificity and diagnostic precision (DP). As such it could be useful both for research and clinical applications.     

Effects of Nerve Growth Factor in the Treatment of Non-Arteritic Anterior Ischemic Optic Neuropathy

Objective: To observe the effects of nerve growth factor (NGF) in the treatment of non-arteritic anterior ischemic optic neuropathy (NA-AION). Methods: This was a prospective, randomized, controlled study. Fifty-eight NA-AION patients (58 eyes) admitted to Lianshui County People's Hospital from July 2016 to June 2019 were selected, and then were divided into a control group and an observation group based on the random numerical table method. The control group (29 patients with 29 eyes) were given glucocorticoid hormones, Huoxue Tongluo granules and an anisodine compound. While the observation group (29 patients with 29 eyes), were treated with NGF in addition to the treatment plan previously described. The total effective rate, best corrected visual acuity (BCVA), the 30-degree visual-field examination mean deviation (MD) and the disc retinal nerve fiber layer (RNFL) thickness of the two groups were compared. Data were analyzed by the Fisher's exact test, a t test and a non-parametric test. Results: After treatment, the total effective rate for the observation group was significantly higher than that for the control group (P=0.04),the percentage of BCVA above 0.1 in the observation group was significantly higher than that in the control group (P<0.001), and both the MD and RNFL thickness in the observation group were significantly lower than those in the control group (t=2.59, P=0.01; t=4.86, P<0.001). There were no obvious adverse reactions for either group after treatment. Conclusions: The treatment of NA-AION with NGF can obtain a better effective rate, improve the patient's vision, improve the visual field and reduce RNFL thickness.     

神经生长因子治疗非动脉炎性前部缺血性视神经病变的临床效果

目的：观察神经生长因子（NGF）治疗非动脉炎性前部缺血性视神经病变（NA-AION）的临床疗效。 方法：前瞻性随机对照研究。选择2016年7月至2019年6月涟水县人民医院眼科收治的NA-AION患 者58例（58眼）,根据随机数字表法分为对照组和观察组,对照组29例（29眼）予以糖皮质激素+活血 通络颗粒+复方樟柳碱治疗,观察组29例（29眼）在对照组基础上加NGF治疗。比较2组治疗的总有 效率、治疗前后最佳矫正视力（BCVA）、30°范围视野检查平均缺损（MD）、视盘视网膜神经纤维层 （RNFL）厚度。数据采用Fisher精确检验、t检验及非参数检验。结果：治疗后,观察组总有效率明 显高于对照组（P=0.04）,观察组BCVA小数视力0.1以上所占百分比明显高于对照组（P<0.001）,但 观察组的MD和RNFL厚度均明显低于对照组（t=2.59,P=0.01;t=4.86,P<0.001）。2组治疗后均无明 显不良反应。结论：加用NGF治疗NA-AION可获得更好的疗效,能提高患者视力,改善视野,降低 RNFL厚度。     

屈光间质混浊对Humphrey视野计及倍频视野计检查结果的影响(英文)

目的:用弥散滤片模拟瞳孔及屈光间质的变化,以比较这些变化对Humphrey视野计(HFA)及倍频视野计(FDT)的影响。方法:测试15位23-39岁正常人的左眼: (1) Snellen视力表; (2) Pelli-Robson(P-R)对比敏感度视力表; (3)白视标白背景自动视野计检查,HFA Model630,采用30-2程序,刺激视标为III; (4) FDT检查,采用N-30程序。每一只眼均经无滤片,1, 2, 3, 4, 5个滤片进行测试,测试顺序为随机。结果:Snellen视力表: 1个滤片只对2名受试者有影响,仅丢失1行; 2个滤片对所有受试者影响甚微,对2名受试者无影响(9名丢失1行,4名丢失2行); 3个滤片对所有受试者效果一样,均丢失3行; 4个滤片可致5名受试者丢失4行,5名受试者丢失5行, 3名受试者丢失6行, 2名受试者丢失7行;5个滤片可致所有受试者丢失全部9行。P-R视力表:3个滤片便可致13名受试者看不到所有字母,2名受试者仅看到1组字母。HFA和FDT的平均偏差值(MD)均随滤片增加而降低,HFA和FDT的图形标准差值(PSD)较小且非常一致。结论:以上结果表明,由弥散滤片所致的照明降低,光散射及瞳孔缩小对HFA及FDT均有明显影响,其视野缺损比较弥散均匀,而屈光间质混浊对FDT的影响比对HFA的影响要大。各组滤片的PSD值比较小且非常一致。     

Morphometry of Axons in Optic Nerves of Siamese‘s Twins

Purpose: To observe the development of optic nerve, we examined four optic nerves from Siameses Twins by absolute counts of axons.Methods: Mean axon diameter, mean axon density, totally axonal population and optic nerve area were noted for each optic nerve. The mean axon diameter and the mean axon density were compared between paraxial(inner sectors) and cortical(outer sectors) areas of the nerves.Results: More myelinated axons were seen in the inner sectors as compared to the outer sectors (average 11 axons/1 000 jjum2 in inner sectors and 34 axons/1 000 u,m2 in outer sectors( P = 0. 036) . The myelinated fibers were also smaller(63 microns) in the outer sectors as compared to the inner sectors(72 microns) ( P - 0. 001). The average cross sectors area for the four 40 week stage optical nerves of Siamese Twins was 3. 32 x 103 as compared to 1 million axons for 32-week-old normals.Conclusion: Our finding of fewer axonal number and small myelinated fibers in the Siamese Twins suggests hypoplasia. Myelinat     

Neuro-Ophthalmologic MRI Findings in the Detection of Rhinorrhoea Aetiology

The purpose of this study is to evaluate the importance of neuro-ophthalmological magnetic resonance imaging (MRI) findings in the identification of the aetiology of rhinorrhoea, and the differentiation of spontaneous rhinorrhoea from non-spontaneous rhinorrhoea.

MR images of 25 patients with spontaneous and 21 patients with non-spontaneous rhinorrhoea were evaluated for the presence of neuro-ophthalmological findings of intracranial hypertension (IHT). These include optic nerve vertical tortuosity, optic nerve sheath enlargement, flattening of the posterior sclera and optic nerve protrusion, as well as other MRI findings of ICH, such as partial empty sella, dilatation of Meckel’s cave and the presence of arachnoid pits.

IHT findings were more common in the spontaneous group. Six criteria (optic nerve distention, optic nerve vertical tortuosity, posterior flattening of the sclera, partial empty sella, Meckel’s cave dilatation and presence of arachnoid pits) differentiate between patient and control groups.

Patients with spontaneous cerebrospinal fluid (CSF) leaks should be evaluated for signs of IHT on MRI, as they are present in the majority of spontaneous CSF leaks and are representative of increased intracranial pressure.     

Midbrain angioma with disconjugate vertical gaze palsy

Loss of depression in one eye with contralateral loss of elevation is rare. It has been attributed to a subnuclear lesion of the oculomotor nerve nuclear complex. We present a patient with these signs who has an arteriovenous malformation occupying his rostral midbrain. We argue that attributing these findings to a subnuclear lesion of the oculomotor nerve complex does not take into consideration the secondary, vertical action of the obliques.     

The Significance and Reliability of Imaging Findings in Pseudotumor Cerebri

The objective of our study was to provide a comparative assessment of previously reported magnetic resonance imaging (MRI) parameters in primary and secondary pseudotumor cerebri (PTC) patients, to examine their diagnostic contribution, and to evaluate their association with symptoms, neuro-ophthalmological findings, laboratory results, and cerebrospinal fluid characteristics.

Twenty-eight consecutive patients with PTC were included in the study. Age- and sex-matched 20 individuals with normal neurologic examination served as the control group. Modified Dandy Criteria were used for the diagnosis of PTC. Orbital and cranial MRI and MR venography of all patients and controls were assessed by three radiologists.

According to our study, posterior flattening of the globe (64% sensitive, 100% specific), optic nerve sheath distention (46% sensitive, 100% specific), vertical tortuosity of the optic nerve (30% sensitive, 95% specific), and partial empty sella (43% sensitive, 100% specific) emerged as particularly valuable markers for a diagnosis of PTC.     

骨管部视神经挫伤的诊断及治疗体会

目的探讨骨管部视神经挫伤早期诊断及治疗。方法16例患者均进行早期的CT或MRI检查，确诊后给予皮质类固醇及脱水剂等治疗，对其中4例进行视神经管减压术。结果3日内确诊者视力恢复至0．1以上的9例，3～7日确诊者视力恢复至0．1以上的3例，7例日后确诊者，视力恢复至0．1以上的0例，7日后确诊者，视力恢复至0．1以上的0例。结论骨管部视神经挫伤应避免漏诊，预后与早期发现并合适的治疗手段密切相关。     

Ex-press青光眼引流器植入术对视野和视网膜神经纤维层厚度影响

目的：观察并分析Ex-press 青光眼引流器植入术对原发性开角型青光眼视野和视网膜神经纤维层厚度影响。
　　方法：选取原发性开角型青光眼患者14例24眼,均行Ex-press青光眼引流器植入术。收集术前裸眼视力、眼压、角膜内皮细胞计数、视野平均缺损( MD)、视野模式标准差(PSD)、视网膜神经纤维层厚度,术后1wk,1、3mo的裸眼视力、眼压,术后3 mo的角膜内皮细胞计数、MD、PSD、视网膜神经纤维层厚度,观察随访期间的并发症及相关处理,统计手术成功率。
　　结果：术前,术后1wk,1、3mo 裸眼视力分别进行两两比较,得出差异均无统计学意义(P>0.05),术后视力无明显下降。术后1wk,1、3mo眼压与术前降低,差异有统计学意义(P<0.05),且术后3mo内眼压保持平稳。术后3mo视网膜神经纤维层厚度和术前比较差异有统计学意义(P=0.018)。术后3 mo MD绝对值和 PSD 较术前相比,差异均无统计学意义(P>0.05)。术后3mo的角膜内皮细胞较术前减少,差异有统计学意义(Z=-2.585,P=0.01)。手术成功率：完全成功19眼(79%),条件成功2眼(8%),失败3眼(13%)。
　　结论：Ex-press青光眼引流器植入术术后短时间内可能会引起视网膜神经纤维层厚度变薄,稳定的降眼压效果能有效减缓视野进展,手术未影响视力,降眼压效果好,是治疗原发性开角型青光眼安全、有效的手术方法。     

Five rules to evaluate the optic disc and retinal nerve fiber layer for glaucoma.

A systematic approach for the examination of the optic disc and retinal nerve fiber layer is described that will aid in the detection of glaucoma. This approach encompasses 5 rules: evaluation of optic disc size, neuroretinal rim size and shape, retinal nerve fiber layer, presence of parapapillary atrophy, and presence of retinal or optic disc hemorrhages. A systematic process enhances the ability to detect glaucomatous damage as well as the detection of progression, and facilitates appropriate management.     

Magnetic resonance diffusion tensor imaging of optic nerve and optic radiation in healthy adults at 3T

AIM: To investigate the diffusion characteristics of water of optic nerve and optic radiation in healthy adults and its related factors by diffusion tensor imaging (DTI) at 3T.METHODS: A total of 107 healthy volunteers performed head conventional MRI and bilateral optic nerve and optic radiation DTI. The primary data of DTI was processed by post-processing software of DTI studio 2.3, obtaining fractional anisotropy value, mean diffusivity value, principal engine value, orthogonal engine value by measuring, and analyzed by the SPSS13.0 statistical software.RESULTS:The bilateral optic nerve and optic radiation fibers presented green color in directional encoded color (DEC) maps and presented high signal in fractional anisotropy (FA) maps. The FA value of the left optic nerve was 0.598±0.069 and the right was 0.593±0.065; the mean diffusivity (MD) value of the left optic nerve was (1.324±0.349)×10^-3mm²/s and the right was (1.312±0.350)×10^-3mm²/s; the principal engine value (λ‖) of the left optic nerve was (2.297±0.522)×10^-3mm²/s and the right was (2.277±0.526)×10^-3mm²/s; the orthogonal engine value (λ⊥) of the left optic nerve was (0.838±0.285)×10^-3mm²/s and the right was (0.830±0.280)×10^-3mm²/s; the FA value of the left optic radiation was 0.636±0.057 and the right was 0.628±0.056; the mean diffusivity (MD) value of the left optic radiation was (0.907±0.103)×10^-3mm²/s and the right was (0.889±0.125)×10^-3mm²/s; the principal eigenvalue (λ‖) of the left optic radiation was (1.655±0.210)×10^-3mm²/s and the right was (1.614±0.171)×10^-3mm²/s; the orthogonal enginvalue (λ⊥) of the left optic radiation was (0.531±0.103)×10^﹣3mm²/s and the right was (0.524±0.152)×10^-3mm²/s. There was no obvious difference between the FA, MD, λ‖, λ⊥ of the bilateral optic radiation and the bilateral optic nerve (P＞0.05) and no obvious difference between male and female group. The FA, MD, λ‖, λ⊥ of the bilateral optic radiation and the bilateral optic nerve had no obvious correlations to the age.CONCLUSION: DTI is sensitive to the optic nerve and radiation and the relevant DTI parameters of the optic nerve and radiation are established preliminarily in this study.     

Morphological changes in the visual pathway induced by experimental glaucoma in Japanese monkeys

Glaucoma, an optic neuropathy, is the leading cause of world blindness. In this condition, the damage extends from the retina to the visual center in the brain, although the primary region of damage is thought to be the optic nerve head (ONH), with the lateral geniculate nucleus (LGN) being secondarily affected. We investigated time-dependent alterations in the ONH, the optic nerve (ON), and the LGN after intraocular pressure (IOP) elevation in Japanese monkeys (a species more similar to humans than other macaque species). Nine Japanese monkeys, each with an experimental glaucomatous left eye, and two naive monkeys were studied. Ocular-testing sessions (including IOP measurement and fundus photography) were held weekly. Eyes and brains were enucleated at 2-48 weeks after IOP elevation, and alterations in ONs and LGN were evaluated. The IOP of the treated eyes was monitored periodically and found to be elevated continuously throughout the observation period in each monkey. The ONH of the glaucomatous eyes exhibited time-dependent deep cupping and thinning of the rim area from 2 weeks after the IOP elevation. Loss of axons and a decrease in the area of ON were first observed at 4 and 28 weeks, respectively. Neuronal loss was first observed at 2 weeks in layers 1 and 2 of LGN [magnocellular (M)-layer] and at 12 weeks in layers 3-6 of LGN [parvocellular (P)-layer]. Neuronal shrinkage was first observed at 2 weeks in all layers in LGN. These findings indicate that in Japanese monkeys, damage to neurons in LGN can be detected in the early phase (first few weeks) after an IOP elevation, as can damage to ONH.     

视神经束内营养小动脉硬化引起视神经纤维形态学变化的组织病理学研究

目的研究颈内动脉粥样硬化和视神经干小动脉硬化与视神经萎缩的关系。方法收集猝死于心脑血管疾病的60～83岁老年人的双侧脑组织标本30例（60个）,取颈内动脉和相应的视神经切片行苏木精-伊红染色和Wegert染色,进行病理解剖学研究。结果颈内动脉有粥样硬化改变者55个,占91.7%;视神经内小动脉有硬化改变者45个,占75%。其中纤维增生型15个,占25.0%;纤维斑块型和粥样斑块型28个,占46.6%;钙化斑块型（复合斑块型）17个,占28.4%。视神经束内小动脉有轻度硬化改变者35个,占63.7%;中度改变者14个,占25.3%;重度硬化改变并阻塞小动脉而致视神经萎缩者6个,占11%。结论颈内动脉硬化可同时伴视神经小动脉硬化,小动脉硬化可致视神经缺血萎缩,是引起老年人视野缺损的原因之一。     

Pallor of the optic disc in children

This report discusses the subject of pallor of the optic disc from the viewpoint of a paediatric neurologist. The paper is divided into two sections, one on optic atrophy in childhood and the second on optic nerve hypoplasia. Optic atrophy in children is a topic which is very poorly covered in standard textbooks either of neurology or ophthalmology. This review attempts to develop a working approach to the management of children who present with optic nerve atrophy as their primary neurological finding.     

Longterm follow‐up of children with traumatic optic nerve avulsion

Purpose: We report the longterm follow‐up of children with optic nerve avulsion (ONA) caused by traumatic events. The remarkable differences in courses and outcomes may elucidate the spectrum of ONA‐associated symptoms and injuries. Methods: During the last 15 years, three children with ONA were referred to our department. These cases are presented with special attention to their longterm follow‐up. Results: Two patients suffered from complete ONA after head injury. The third patient presented with partial ONA caused by a bicycle accident. Longterm follow‐up varied between 7 and 15 years. In the first patient, a pale swollen retina without any visible retinal vasculature was observed early in the course of follow‐up. The retina later completely detached. In the second patient, extended fibroglial scarring occurred and an extremely large epiretinal membrane formed and was finally released spontaneously into the vitreous. The third patient developed only mild fibroglial scarring and retinal pigment epithelium hyperplasia. The optic nerve head in this patient came to resemble a morning glory disc. Conclusions: Optic nerve avulsion can adopt different courses and outcomes in different patients. Final visual outcome seems to depend on the degree of visual acuity immediately after injury. Substantial intraocular architecture changes can occur as a result of ONA.     

视神经周围炎的研究进展

视神经周围炎(OPN)是指涉及视神经鞘膜的一系列病理性炎症.OPN的经典三联征包括单侧视神经病变伴随疼痛和/或视盘水肿,此病症与其它视神经病变相似,导致诊断延迟和治疗欠佳.2016年1月,我们对发表于Medline和Ovid数据库的关键词为“视神经周围炎”的各种语言的文献进行了检索,共查找到60篇文献,发表于1956-2015年.两位作者(Tai ELM和Tevaraj JMP)分别对论文摘要进行了独立筛选,并筛选出相关文章.本次综述,我们强调OPN的特点,特别是OPN和视神经炎之间的临床差异.虽然大多数OPN的病例是特发性的,但仍需进行调查以排除特异性感染和继发性OPN的炎症原因.MRI是非常重要的检查方法,由于OPN视神经周围炎症的影像学诊断.糖皮质激素治疗可使症状与体征迅速好转,长期口服糖皮质激素并慢速递减可以降低复发的风险.     

A review of optic perineuritis

Optic perineuritis (OPN) refers to a spectrum of conditions involving pathologic inflammation of the optic nerve sheath. The classic triad of OPN consists of unilateral optic neuropathy associated with pain and/or disc oedema, but the condition often mimics other optic neuropathies, resulting in delayed diagnosis and suboptimal treatment. We performed a database search of Medline and Ovid in January 2016 for articles published in any language with the keywords ‘optic perineuritis’. Sixty articles were found, published from 1956 to 2015. Two reviewers (Tai ELM and Tevaraj JMP) performed an independent screening of abstracts. Articles of interest were subsequently examined. In this review, we highlight the salient features of OPN, with particular emphasis on the clinical differences between OPN and optic neuritis. Although the majority of cases of OPN are idiopathic, investigations are required to rule out specific infectious and inflammatory causes of secondary OPN. MRI is an invaluable component of the workup, as radiographic demonstration of peri-neural inflammation is diagnostic of OPN. Corticosteroid therapy results in dramatic and rapid reversal of the signs and symptoms, but prolonged therapy with slow tapering of oral corticosteroids may be necessary to reduce the risk of relapses.