Objective To establish an rat model of the Anterior Isc hemic Optic Neuropathy (rAION), and identify its reliability by observing the fundus, fluorescein fundus angiography (FFA),optical coherence tomography (OCT), v isually evoked potential (VEP) and histopathology. Methods Thirty male Sprague-Dawley rats were randomly divided into group Naive with 5 rats, group Laser with 5 rats, group hematoporphyrin derivative(HPD) with 5 rats, group rAION with 15 rats. All of the right eyes were the experimental eyes and the left ones were the control. after administration of HPD in rats` vena caudalis. The rats in group Laser were treated with a krypton red 647nm/2/3disc spot laser for 120 seconds, the rats in group HPD were treated by administration of HPD in rats` vena caudalis, and the rats in group Na?ve were not treated. Results From 1 day to 6 day s after rAION induction, the ON was pale and swollen in the superior part. The ON at 90 days after induction was pale and shrunken.30 minutes after rAION induction, hyperfluoresc ence appeared in the superior part of the optic disc, and the hypofluorescence in the 23rd day. In early FFA, hypofluorescence appeared at the ischemic area of the optic disc, and in midst and later stage the ischemic area revealed hyperflu orescence in the 1st day after rAION induction, the hypofluorescence in midst and later stage in the sixth day after r-AION model. The latent period of F-VEP expanded. The amplitude cut down in the 1-2 days after r-AION induction and did not changed in 35nd day. The surface of optic disc showed higher and rougher tha n the surface of retina in the 6th day after r-AION induction in OCT. After fixation and hematoxylineosin staining of 6-mu;m sections, in high power field the o pt ic disc showed edema with the displacement of retina surrounding the disc 1 day after treatment. Rarefaction and degeneration in the nerve fiber of retina and r eduction of the number of nuclei of ganglion cells in the 23st day after the mod el induction, and the thinning of nerve fiber of the optic disc and its surround ings. In contrast, there was no change in group Na?ve, group Laser and group HPD. Conclusions The r-AION model is like the human AION in fundus, FFA, OCT, VEP and histopathology. The rAION model provides the ischemic changes of occurrence of AION, and is helpful for the fundamental study of the AION. (Chin J Ocul Fundus Dis,2008,24:90-94)
ObjectiveTo observe the characteristics of multifocal eletrotetinogram (mfERG) in nonarteritic anterior ischemic optic neuropathy (NAION) and its relationship with visual acuity and macular central retinal thickness (CRT). MethodsBy means of patients self-contrast analysis. 40 patients (40 eyes) with NAION were collected underwent the examinations of best corrected visual acuity, fundus color photography, fundus fluorescein angiography and field of vision. All the disease and normal eyes had underwent the examination of frequency-domain optical coherence tomography (fdOCT) and mfERG. The CRT and retinal thickness about perifovea, parafovea were documented with fdOCT. All patients underwent the retinal macular function exam with mfERG. Centered by macular fovea, the reaction zone were divided into 5 rings from inside to outside by circles, ring 1 0.00°, ring 2 5.44°, ring 3 10.31°, ring 4 16.31°, ring 5 23.42°. Treated ring 1 hexagon as macular center, the amplitude densities of P1 wave, the amplitude of P1 and N1 wave, and the latencies of P1and N1 wave at every ring were observed. The relationship between mfERG characteristics and visual acuity or CRT were analyzed by Spearman correlation analysis. ResultsfdOCT revealed that there was significantly statistical difference in the retinal thickness about perifovea between disease eyes and contralateral eyes (P < 0.05). The increase of CRT and retinal thickness about parafovea had no significantly statistical difference between diseases eyes and contralateral eyes (P > 0.05). mfERG revealed that the decrease of amplitude densities about P1 wave at ring 1 to 2 had significantly statistical difference between two groups (P < 0.05); there were no significantly statistical difference in the amplitude densities of P1 wave at ring 3 to 5; the decrease of amplitude about P1 and N1 wave at ring 1 had significantly statistical difference between two groups (P < 0.05). There was no significantly statistical difference in the amplitude of P1 and N1wave at ring 2 to 5, the latencies of P1 and N1 wave at ring 1 to 5 (P > 0.05). The correlation analysis revealed that the amplitude densities and amplitude of P1 wave at ring 1, amplitude of N1 wave at ring 1 had no effect on visual acuity (r=-0.087, 0.195, -0.134; P > 0.05) and CRT(r=-0.154, 0.365, 0.412; P > 0.05). ConclusionsCompared with contralateral eyes, the disease eyes were significantly decrease in amplitude densities of P1 wave at ring 1 to 2, amplitude of P1 and N1 wave at ring 1.There are no correlated between the amplitude densities of P1 wave at ring 1, amplitude of P1 and N1 wave at ring 1 and visual acuity or CRT.
ObjectiveTo observe the changes in subfoveal choroidal thickness (SFCT) and peripapillary choroidal thickness (pCT) in nonarteritic anterior ischemic optic neuropathy (NAION).MethodsNineteen newly occurred NAION patients were included. The patients were divided into group A (20 affected eyes of 19 patients) and B (18 fellow eyes of 18 patients). Twenty eyes of 20 age, gender, intraocular pressure and axial length-matched healthy volunteers (group C) were enrolled in this study. The differences of age (t=1.58), gender ratios (χ2=0.107), intraocular pressure (t=0.092) and axial length (t=0.148) between 3 groups were not significant (P＞0.05). SFCT, pCT were measured at first visit, 1 month and 3 months after treatment using enhanced deep imaging technique of spectral domain optical coherence tomography. The correlation of best corrected visual acuity (BCVA) and the choroidal thickness was investigated.ResultsAt the first visit, the mean SFCT and pCT in group A were significant thicker than group C (t=2.957, 2.844; P=0.006, 0.009). There was no difference of SFCT and pCT between group B and C (t=2.019, 2.024; P=0.053, 0.057). There was no correlation between BCVA and SFCT, pCT (F=0.161, 0.033; P=0.695, 0.859). One month after treatment, SFCT in group A was still thicker than group C (t=2.803, P=0.009); while pCT was decreased in group A when compared to group C, but the difference was not significant (t=1.871, P=0.084). Three months after treatment, the differences of SFCT and pCT were not significant between group A and C (t=1.223, 1.105; P=0.236, 0.282).ConclusionsAt first visit, SFCT and pCT in NAION eyes showed a significant increase when compared to normal eyes. One month later, pCT in NAION eyes decreased to normal. Three months later, both SFCT and pCT decreased. These findings may suggest that a thickened choroid is a clinical characteristic at acute stage in NAION eyes.
Objective To observe the results of multifocal visual evoked potential (mfVEP) examination in patients with anterior ischemic optic neuropathy (AION) before and ater treatment, and to probe its clinical significance. Methods A total of 90 patients (90 eyes) with AION were examined by mfVEP; the secondorder reaction of mfVEP was analyzed.The reaction was divided into upper and lower hemi field of visual field, or 1/4 quadrant visual field (superior nasal, inferior nasal, superior temporal, and inferior temporal). The sum of waves of each response was analyzed and the results in various regions were compared.The features of wave configuration was compared between the AION eyes and the contralateral eye, and between the AION eyes before and after treatment.Results The amplitude and latency of P-wave of mfVEP was 0.198plusmn;0.033 and 100.197plusmn;7.354 respectively in AION eyes before treatment, and was 0.271plusmn;0.024 and 98.567plusmn;6.794 in the contralateral eyes; the difference was significant (t=16.556,18.330; Plt;0.01). The amplitude and latency of P-wave of mfVEP was 0.229plusmn;0.016 and 100.104plusmn;10.603 respectively in AION eyes after treatment, which differed much from that before the treatment (t=13.649, 8.858; Plt;0.01) and also from that of the contralateral eyes (t=13.649，8.858；P＜0.01). ConclusionsThe amplitude and latency of P-wave of mfVEP may accurately reflect the recovery of local optic nerve damage in AION eyes before and after treatment with good repeatability. AION can be used as a new method for AION diagnosis and detection of the prognosis.
ObjectiveTo observe the changes in blood flow density of radial retinal peripapillary capillary (RPC) around the optic disc in patients with non-arteritic anterior ischemic optic neuropathy (NAION) at different stages of the continuous course of the disease. MethodsA prospective cohort study. From January to December 2020, 29 cases of 29 eyes of NAION patients diagnosed in the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine were included in the study. Among them, there were 18 males with 18 eyes and 11 females with 11 eyes. The average age was 53.62±6.67 years old. The affected eye underwent routine eye examination and visual field, optic cohenrence tomography angiography (OCTA) examination. Visual field inspection was performed to obtain the average visual mean defect (MD) value. OCTA was used to measure the thickness of the peripapillary retinal nerve flayer (pRNFL) around the optic disc, the whole en face image vessel density (wiVD), intro disc vessel density (diVD), RPC blood flow density around the optic disc, and macular ganglion cell complex (GCC). The course of disease ≤3 weeks was defined as the acute phase; 4-12 weeks was defined as the subacute phase; ＞12 weeks was defined as the chronic phase. The changes of visual field MD, optic disc RPC blood flow density, pRNFL thickness and macular GCC thickness were observed in the acute, subacute and chronic phases (12-24, ＞24 weeks). A completely randomized design of variance analysis was used to compare the differences in visual field MD, RPC blood flow density, GCC, and pRNFL thickness in different courses. Pearson correlation analysis was used to analyze the correlation between pRNFL thickness, macular GCC thickness, visual field MD changes and RPC blood flow density around the optic disc sex. ResultsThe wiVD of the eyes in the acute phase, subacute phase, and chronic phase (12-24 weeks, ＞24 weeks) were (44.96±2.76)%, (41.50±3.49)%, (39.08±5.43)%, (38.56±6.48)%. There was a statistically significant difference in wiVD of eyes with different disease courses (F=8.939, P＜0.001). The average difference of wiVD between 12-24 weeks and ＞24 weeks in the chronic phase was －0.984, and the difference was not statistically significant (P＞0.05). There was no statistically significant difference in diVD of patients with different courses of disease (F=1.079, P=0.365). The blood flow density of RPC around the optic disc of the affected eye, except for the lower part, the blood flow density of the nasal side, the temporal side, and the upper quadrant, decreased significantly with the progression of the disease, and the difference was statistically significant (F=8.816, 6.069, 8.943; P＜0.05). In the chronic phase, the average difference of blood flow density between the nasal, temporal, and upper sides of the eyes between 12-24 weeks and more than 24 weeks in the chronic phase was －0.984, －0.230, －0.198, and the difference was not statistically significant (P＞0.05). There was no statistically significant difference in the visual field MD of patients with different courses of disease (F=0.277, P=0.842); the overall pRNFL thickness and average macular GCC thickness were compared with statistical significance (F=47.122, 14.954; P＜0.001, ＜0.001), all became significantly thinner with the progression of the disease. The results of Pearson correlation analysis showed that the blood flow density of the entire optic disc wiVD, the blood flow density of RPC in the temporal quadrant around the optic disc and the visual field MD (r=－0.225, －0.268; P＜0.05), and the average thickness of GCC (r=0.480, 0.436; P＜0.01) were all related. ConclusionThe blood flow density of RPC in the entire optic disc and around the optic disc (except the lower quadrant) of NAION eyes gradually decrease with the progression of the disease, and stabilize after 12 weeks of the disease.
ObjectiveTo analyze retrospectively the risk factors of nonarteritic anterior ischemic optic neuropathy (NAION). MethodsThe complete clinical data of 116 patients (134 eyes) were collected. All patients were asked in detail about the disease history and symptoms and were examined for the visual acuity, intraocular pressure, fundus, visual field and fundus fluorescein angiography (FFA), blood pressure, blood glucose, blood fat and head MRI or CT. Suspicious cases and patients with incomplete clinical data were excluded. The relationship between NAION and age, visual field, FFA, systemic and ocular factors, onset seasons were retrospectively analyzed. Results80 patients (68.97%) were 55 to 70 years old. 97 patients (83.7%) had systemic diseases, including 38 patients (39.2) with diabetes mellitus, 32 patients (32.9%) with hypertension (8 patients had low blood pressure at night), 28 patients (28.9%) with hyperlipidemia, 16 patients (16.5%) with cerebrovascular diseases (mainly lacunar cerebral infarction), 6 patients (6.2%) with coronary heart disease. There were 8 patients with ocular factors, including 3 patients (2.6%) with cataract surgery history, 5 patients (4.2%) with small optic discs. The difference of percentage of with or without diabetes mellitus and hypertension was significant (χ2=362, 259; P < 0.05). There were 27.6% patients with disease onset at March to April, 24.1% patients with disease onset at September to October, much higher than other months (χ2=580, P < 0.05). Visual field test results showed that 49 eyes (36.5%) had inferior visual field defect, 12 eyes (9.0%) had superior visual field defect. FFA showed that in the early stage 103 eyes (76.9%) had optic weak fluorescence, 13 eyes (9.7%) had strong fluorescence; in the late stage, 110 eyes (82.1%) had strong fluorescence, 8 eyes (6.0%) had weak fluorescence. ConclusionsDiabetes mellitus, hypertension may be the system risk factors of NAION. The seasonal variation from spring to summer and from autumn to winter may also be another risk factor for the onset of NAION.
ObjectiveTo evaluate the effectiveness and safety of glucocorticoids in the treatment of non-arteritic anterior ischaemic optic neuropathy (NAION).MethodsGlucocorticoids published in the National Library of Medicine PubMed; Netherlands Medical Abstracts Database Embase; Cochrane Library, an evidence-based medical library; China Cnkipedia; China Biomedical Literature Service; Chongqing Vipul Chinese Science and Technology Journal Database, and Wanfang Science and Technology Journal Full Text Database were searched about computer. Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) for the treatments of NAION were subjected to meta-analysis. The search period was from the establishment of each database to March 2020. The literature was screened and data were extracted according to the inclusion and exclusion criteria. The methodological quality of the RCT and NRCT studies was evaluated using the Risk of Bias Assessment Tool and the MINORS evaluation scale, respectively. The data were analyzed using RevMan version 5.3 software which was provided by the Cochrane Collaboration Network.ResultsAn initial search of 395 papers was conducted, and 10 papers were finally included for this meta-analysis, including 3 RCT studies and 7 NRCT studies. A total of 1057 patients with NAION were included. The 3 RCT studies were analyzed descriptively as the outcome indicators were described in different ways. A meta-analysis of 7 NRCT studies showed that patients in the treatment group showed significantly better visual prognosis (relative risk=1.28, 95% confidence interval 1.09 to 1.51, P=0.003) and retinal nerve fibre layer thickness were obviously improved (mean difference=7.76, 95% confidence interval 1.58 to 13.94, P=0.01) than the control group. Four studies reported the occurrence of adverse reactions in the treatment versus control groups. None of the above studies provided a detailed analysis of the prognosis of patients with adverse reactions.ConclusionThe efficacy and safety of glucocorticoids in the treatment of NAION is unclear and needs to be validated in a larger sample of RCTs.
ObjectiveTo observe the blood perfusion of optic nerve and macular areas and investigate its relationship with visual field defect in nonarteritic anterior ischemic optic neuropathy (NAION).MethodsTwelve consecutive unilateral NAION patients (course of disease ＜3 months) and 12 healthy Chinese adults were enrolled in the study. The affected eyes and fellow eyes from 12 NAION patients were defined as group A and group B; 12 eyes from 12 healthy adults were defined as group C. Best corrected visual acuity (BCVA), intraocular pressure (IOP), indirect ophthalmoscope and computer optometry were performed on all of the three groups of patients. Visual field (VF) and optical coherence tomography (OCT) were performed on NAION patients. Logarithm of the minimum angle of resolution (logMAR) was used to calculate visual acuity. Compared to group B, logMAR BCVA, mean deviation (MD) and pattern standard deviation (PSD) in group A were significant decreased (t=3.278, ?4.909, 4.130, P＜0.05). There was no significant difference in spherical equivalent, IOP, peripapillary retinal nerve fibre layer (pRNFL) between group A and group B (t=0.000, 0.890, 1.215; P＞0.05). OCT angiography (OCTA) was used to measure the flow area (FA) at optic disc, flow area at radial peripapillary capillaries (RCFA) and FA, non-perfusion area (NFA), parafoveal vessel density (PVD) and parafoveal vascular index (PVI) in macular area. Pearson correlations between the deficiency of optic blood flow and visual field were analyzed.ResultsThe differences of FA at optic disc and peripapillary RCFA among 3 groups were significant (F=4.162, 3.357; P＜0.050). Compared to group B (t=?5.822, ?7.467; P＜0.001) and C (t=9.435, 4.615, P＜0.05), FA at optic disc and peripapillary RCFA in group A was significantly reduced. There is several NAION showed quadrantal FA decreased in optic nerve. However, there was no significant difference in optic disc FA and peripapillar RCFA between group B and C (F=0.004, 0.030; P＞0.050). There was no differences of FA, NFA, PVD and PVI among 3 groups (F=0.488, 1.107, 0.493, 1.086, 1.098, 0.093, 1.093, 1.221; P＞0.05). Positive correlation between optic disc FA, peripapillary RCFA and MD (r=0.542, 0.585; P＜0.05) were observed. However, there was no significant correlation between optic disc FA, peripapillary RCFA and PSD (r=?0.404, ?0.430; P＞0.05), and negatively correlated to BCVA (r=?0.617, ?0.596; P＜0.05). PRNFL was negatively correlated to optic disc FA (r=?0.643, P＜0.05), but not correlated to peripapillary RCFA (r=?0.377, P＞0.05).ConclusionsThe optic disc blood flow reduced in affected eyes of unilateral NAION whose disease course was less than 3 months, while the macular perfusion was normal. There was a positive correlation between optic disc flow and visual field.
Non-arteritic anterior ischemic optic neuropathy (NAION) is one of the most common acute optic neuropathy in adult characterized with impaired visual acuity and visual fields. The pathogenesis of NAION mostly result from the interactions between the systemic risk factors (such as diabetes mellitus, night hypotension, hereditary) and the local ocular risk factors (such as small optic disc and vitreo-papillary traction). A fully promoted diagnosis and treatment of NAION are based on the higher levels of clinical evidence, as well as the comprehensive assessment of relationship between the systemic and ocular risk factors in the pathogenesis of NAION. Secondary optic neuropathy of NAION and the early diagnosis with effective treatment of the fellow eye would be highly emphasized.
Objective To observe the characteristics of multifocal microperimetry and its relationship with visual acuity and multifocal ganglion cell complex (GCC) in nonarteritic anterior ischemic optic neuropathy (NAION). Methods A retrospective case study. A total of 38 patients (54 eyes) with NAION were enrolled in this study. 25 NAION eyes (25 patients) and 29 contralateral health eyes (29 patients) were randomly selected into case group and control group respectively. All eyes underwent best corrected visual acuity (BCVA), slit lamp microscope, indirect ophthalmoscope, color fundus photography, optical coherence tomography (OCT), visual field and multifocal microperimetry. Logarithm of the minimum angle of resolution (logMAR) was used to calculate BCVA. There were no significantly differences on age (t=?0.647), gender, dominant eyes ( χ2=0.128, 0.099), intraocular pressure (t=0.376) between two groups (P>0.05). Macular GCC thickness, superior and inferior GCC thickness were measured by OCT, focal loss volume (FLV) and global loss volume (GLV) were obtained at the same time. Microperimetry were measured by macular integrity assessment instrument (MAIA microperimetry), and mean retinal sensitivities (MS) in macular area 10° and fixation rate in the macular central 2° and 4° were determined. The relationship between MS, macular GCC and BCVA were analyzed by Spearman correlation analysis. Results The mean logMAR BCVA of case group and control group were 0.68±0.79 and 0.07±0.06, respectively. There was significantly statistical difference in MS between two groups (t=?2.507, P=0.037). There were no significantly statistical difference in mean GCC (t=?1.245, P=0.259), superior and inferior GCC (t=?1.336, ?1.024; P=0.230, 0.346), FLV (t=1.058, P=0.331) and GLV (P=0.182) between two groups. The correlation between BCVA and MS (r=?0.809, P=?0.005) was observed. However, there were no correlation between BCVA and GCC, superior and inferior GCC, FLV, GLV (r=?0.98, ?0.466, ?0.061, 0.442, 0.442; P=0.817, ?0.244, 0.885, 0.273, 0.273). And also, there were no correlation between MS and GCC, superior and inferior GCC, FLV, GLV (r=0.238, 0.524, 0.286, 0.643, ?0.619; P=0.570, 0.183, 0.493, 0.086, 0.102). Conclusions MS reduced in early stage NAION eyes, which did not correlate with macular GCC.