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 observe the clinical features and visual prognostic factors of ethambutol-induced optic neuropathy (EON).MethodsA cohort study. Twenty-four inpatients (46 eyes) identified as EON in Neuro-Ophthalmology Department of Chinese PLA General Hospital from January 2014 to December 2017 were enrolled, including 14 males (26 eyes) and 10 females (20 eyes) with a ratio of 1.4/1 male/female. The average age was 42.79±15.12 years and the average weight was 62.46±12.31 kg. The average time duration between oral administration of ethambutol and occurrence of EON was 9.94±16.49 months. The average time of ethambutol duration was 7.06±11.68 months, with an average accumulative dose of 156.7±1 779.0 g and the average daily dose of 15.07±8.95 mg/(kg·d). All patients were tested with visual acuity, fundus photos, colour vision, OCT, visual field, VEP, orbital MRI and the gene of OPA1 and mitochondrial deoxyribonucleic acid (mtDNA). All the patients accepted drug withdrawal immediately after diagnosis, and were given the treatment of systemic nerve nutrition and improvement of microcirculation for 2 weeks. The time of follow-up was more than 12 months. According to whether the visual acuity (VA) in any of eyes was over than 0.1 at the last follow-up, all the patients were divided into two groups: the bad VA group (VA less than or equal to 0.1) and the better VA group (VA over than 0.1) group. The χ2 test and Fisher's exact probabilistic method test were used to compare the counting data between groups, and the Wlincox rank sum test was used to compare the measurement data. Multiple factors of VA outcome between the patients with bad or better va were analyzed by logistic regression.ResultsThirty eyes (65.2%) had VA less than or equal to 0.1 and 5 eyes (10.9%) had VA over than 0.5 at EON onset. The VA of the rest 11 eyes (23.9%) was higher than 0.1 and lower than 0.5. At the last follow-up, 20 eyes (43.5%) had VA less than or equal to 0.1 and 9 eyes (19.6%) had VA over than 0.5, the VA of the rest 17 eyes (36.9%) was higher than 0.1 and lower than 0.5. Fundus examination revealed 7 eyes (15.3%) with optic disc edema. OCT revealed significant loss of the retinal nerve fiber layer (RNFL) in the affected eyes, mainly in the temporal RNFL of the optic disc. All patients had dyschromasia, mainly in distinguishing the color of red and green. The types of visual field defect was as following: central dark spot (52.2%), diffuse visual acuity decreased (30.4%), temporal hemianopsia (17.4%). Orbital MRI revealed that 12/24 (50.0%) patients had T2 lesions with T1 enhancement in 6/24 patients (25.0%). Genetic test showed that 4 patients (16.7%) had gene mutation. Among them, there were 2 patients with OPA1 mutation, 1 with mtDNA 14340 point mutation and 1 with the mtDNA 11778 point mutation. Thirteen patients showed better VA outcomes (over than 0.1) while 11 showed bad VA outcomes after discontinuation of ethambutol. Between the better VA group and the bad VA group, there were statistically significant differences in the daily dose of ethambutol and gene mutation (P=0.031, 0.023). The daily dose was related to visual prognosis of EON while only the daily dose of more than 18 mg/(kg·d) may lead to bad VA outcomes according to the logistic analysis (95% CI 0.007-0.736, OR=0.069, P=0.027).ConclusionsEON may have OPA1 and mtDNA mutation with more bilateral eyes involved and less optic edema, which about 43.5% of the patients showed irreversible visual impact. The daily dose of ethambutol is related to the vision recovery.
ObjectiveTo observe and analyze the subfoveal choroidal thickness (SFCT), large choroidal vessel layer thickness (LCVT), and their early changes, and to evaluate their prognostic value for treatment outcomes in eyes with polypoidal choroidal vasculopathy (PCV) receiving anti-vascular endothelial growth factor (VEGF) therapy. MethodsA retrospective clinical study. A total of 120 patients (120 eyes) with unilateral PCV diagnosed and confirmed at Tangshan Eye Hospital from January 2020 to August 2024 were included. All affected eyes received intravitreal anti-VEGF injections. SFCT and LCVT were measured using swept-source optical coherence tomography (SS-OCT) before treatment and at 1, 3, 6, and 12 months after treatment. Based on the 12-month follow-up outcomes, the eyes were divided into a good prognosis group (69 eyes) and a poor prognosis group (51 eyes). Subretinal fluid (SRF) absorption was assessed by SS-OCT at 1 month after the first treatment (early stage). Repeated measures ANOVA was used to compare the dynamic changes of SFCT and LCVT between the two groups. Binary logistic regression, joint modeling, receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and mediation analysis were used to evaluate the predictive value of SFCT and LCVT for prognosis. ResultsCompared with the good prognosis group, the poor prognosis group had significantly greater disease duration, best-corrected visual acuity, branching vascular network area, maximum linear lesion distance, proportion of choroidal vascular hyperpermeability, pigment epithelial detachment height, and pre-treatment SFCT and LCVT (P＜0.05). The good prognosis group had significantly lower SRF height (SRFH) before treatment and at 1 month after treatment, and a greater reduction in SRFH (ΔSRFH) within the first month, compared with the poor prognosis group (P＜0.05). At 1 month after treatment, complete SRF absorption was observed in 65 eyes (94.20%, 65/69) in the good prognosis group and 32 eyes (62.75%, 32/51) in the poor prognosis group; the complete SRF absorption rate was significantly higher in the good prognosis group (χ2=18.731, P＜0.001). Repeated measures ANOVA showed that SFCT and LCVT significantly decreased after treatment at different time points in both groups (P＜0.05); at each post-treatment time point, SFCT and LCVT were significantly higher in the poor prognosis group than in the good prognosis group (P＜0.05). Cohen's d effect size analysis showed that the intergroup difference in LCVT was greater than that in SFCT. ROC curve analysis showed that pre-treatment SFCT and LCVT effectively predicted early complete SRF absorption, and LCVT had significantly better diagnostic performance than SFCT [area under the ROC curve (AUC)=0.82, 0.76; P=0.025]. Joint modeling analysis showed that longitudinal changes in SFCT and LCVT were significantly associated with the risk of poor prognosis (P＜0.01); for every 50 μm increase in LCVT and SFCT, the relative risk of poor prognosis was 1.615 and 1.512, respectively. The Akaike information criterion value of the LCVT joint model (3 719.42) was lower than that of the SFCT model (3 852.67). At 1 month after treatment, ΔLCVT and ΔSFCT were both significant predictors of poor prognosis; in all adjusted models, the odds ratio of ΔLCVT was lower than that of ΔSFCT, indicating better predictive value. ROC curve analysis showed that both ΔSFCT and ΔLCVT had significant predictive value for poor prognosis, and ΔLCVT had significantly better predictive performance than ΔSFCT (AUC=0.81, 0.74). DCA showed that both ΔSFCT and ΔLCVT provided clinical net benefit, with ΔLCVT showing higher benefit. Mediation analysis showed that ΔLCVT and ΔSFCT partially improved prognosis by promoting early SRF absorption, with the indirect effect of ΔLCVT (39.35%) being higher than that of ΔSFCT (32.70%). ConclusionsBoth SFCT and LCVT can serve as predictors of prognosis in PCV eyes treated with anti-VEGF therapy. After controlling for the effect of SFCT, LCVT maintains independent predictive value, and its predictive efficacy is superior to that of SFCT.