视神经炎研究现状、热点与趋势——基于PubMed数据库的文献计量分析

背景视神经炎研究领域近年来发展较快,分支较多且复杂,了解视神经炎相关研究现状、研究热点,预测未来发展趋势,对于相关的科研和临床工作均十分重要。目的了解视神经炎研究文献的分布规律、学科知识结构并预测未来发展趋势。方法利用PubMed数据库为数据源,对2000年1月至2012年7月收录的视神经炎相关文献进行统计分析,采用多元统计方法对高频主题词共现矩阵进行转换、降维和聚类分析,绘制战略坐标图,并根据社会网络分析方法绘制可视化网络图谱。结果共检出视神经炎相关文献2191篇,发文量逐年增加。美国、英国、德国、荷兰和日本5个国家总发文量为1615篇,占发文总数的73．71％。相关高频主题词共52个,成功建立视神经炎学科知识可视化图谱,直观展示了视神经炎的知识分布,并形成重点研究聚类,结果显示当前的热点主要集中在9个领域,其中免疫学研究已经较为成熟但处于边缘的地位,视神经炎病因及诊断、病理学研究、病理生理学研究和视神经脊髓炎（NMO）专题研究是目前研究的核心领域,药物治疗、非中枢性脱髓鞘性视神经炎研究、流行病学研究和遗传学研究相对薄弱,有较大的提升空间。结论近年国际上对视神经炎的关注和发文量逐年增加,欧美国家的发文量占主导地位。国际视神经炎的研究热点主要集中在9个领域,可能为今后研究的发展方向。     

基于Pubmed数据库的缺血性视神经病变文献计量分析

目的 了解缺血性视神经病变(ION)研究文献的研究热点.方法 利用Pubmed数据库为数据源,对2000年1月至2012年7月所收录的ION相关文献进行统计分析,采用多元统计方法对高频主题词共现矩阵进行聚类分析,根据社会网络分析方法绘制可视化网络图谱.结果 共检出ION相关文献1045篇.美国、英国、德国、法国和荷兰5个国家总发文量为748篇,占发文总数的71.58％.相关高频主题词共28个.聚类结果显示,当前的热点主要集中在4个领域,依次为:(1)手术源性及动脉炎性ION的研究;(2)ION的流行病学、病理学及诊断学研究;(3)ION的病理生理及治疗研究;(4)药物源性ION的研究.结论 ION研究文献的研究热点主要集中在4个领域,可能为今后研究的发展重点和方向.     

前部缺血性视神经病———非动脉炎性与动脉炎性简

前部缺血性视神经病（anterior ischemic optic neuropathy,AION）病变位于筛板前的视神经,视力下降、视野缺损、眼底视盘水肿是常见的临床表现。AION按照血管病因分为非动脉炎性与动脉炎性,后者在欧美国家主要针对巨细胞动脉炎（giant cell arteritis,GCA）。     

黄斑水肿相关国际文献的计量分析

目的：分析国际对黄斑水肿的研究热点。方法：对1946/2011年美国国立医学图书馆Pubmed数据库收录的相关文献采用书目信息共现挖掘系统（BICOMS）进行了文献计量分析,利用PASW18.0统计软件对高频主题词进行了共词聚类分析并描绘了聚类关系图。结果：共检出黄斑水肿相关文献5871篇,发文量逐年增加。英语语种发表的文献占总文献量的83.87%。美国发文量为2921篇（49.75%）。相关高频主题词共51个,共词聚类分析发现高频主题词聚类为7个类别,依次为糖皮质激素治疗黄斑水肿的不良反应、黄斑水肿诊断、黄斑水肿的病理/生理学、黄斑水肿的外科疗法、黄斑水肿的药物治疗、黄斑水肿治疗后所引起的不良反应、白内障摘除及超声乳化手术后黄斑水肿。结论：国际近年对黄斑水肿的关注和发文量逐年增加,欧美国家和作者的科研发文量占主导地位。国际上黄斑水肿的研究热点主要集中在基础研究、诊断技术、手术、药物治疗几个方面。     

老年性黄斑变性研究热点的文献计量分析

目的 分析国际近年在老年性黄斑变性(AMD)的研究热点.方法 对2002年1月至2010年12月美国国立医学图书馆Pubmed数据库收录的相关文献采用书目信息共现挖掘系统(BICOMS)进行文献计量分析,利用PASW 18.0统计软件对高频主题词进行共词聚类分析并描绘聚类关系图.结果 共检出AMD相关文献8529篇,发文量逐年增加.2009年的发文量为2002年发文量的2.45倍;美国、英国和德国总发文量6514篇,占总发文数的76.37％.相关高频主题词共52个,共词聚类分析发现高频主题词聚类为6个类别,依次为生理/遗传学基础研究,病因学与预防控制,病理学和体层摄影术等诊断技术,手术疗法,药物疗法和光化学疗法,以及药物和激光疗法.结论 国际近年对AMD的关注和发文量逐年增加,欧美国家的发文量占主导地位.国际AMD的研究热点主要集中在基础研究,病因及预防控制,诊断技术,手术治疗,药物治疗和光化学治疗,药物和激光治疗等6个领域.     

外伤性视神经病变研究热点的文献计量分析

目的:分析和揭示世界各国外伤性视神经病变(traumatic optic neuropathy,TON)研究领域的研究热点和不同时间、国家及期刊的发文量趋势及研究侧重点。方法:检索PubMed数据库2000-01/2012-08有关TON的文献,对年代、作者、语种、国家等进行统计分析,采用共词聚类分析方法构造高频主题词共现矩阵,并进行聚类分析,通过分析不同类别主题词相关的文献,得出目前TON的研究热点。结果:共检出TON相关文献785篇,美国、英国、中国产文量最高,数量上英语文献占绝对优势。统计出高频主题词50个,聚类分析显示高频主题词主要聚类于10个类别。作者中,以Levkovitch-Verbin H发文量最大,来源期刊中,以《Investigative Ophthalmology&Visual Science》载文量最多。共提取出主题词1383个,得出出现频率>12次的高频主题词32个。聚类分析显示近期TON研究热点在于:(1)TON的手术治疗研究;(2)视神经损伤的病理生理学研究;(3)TON的病理学及诊断研究;(4)TON动物模型及药物治疗研究;(5)TON流行病学研究。结论:近期TON文献增长不快,美国、英国是TON研究大国。国内外TON的研究热点主要集中在TON的手术治疗、诊断、病理和药物治疗等5个方向,我们的研究结果为国内相关科研和临床工作者提供了重要参考信息。     

拟似缺血性视神经病变的成人浸润性胶质瘤

年龄大的患者出现急性发作的视力丧失、伴视盘水肿而无静脉充盈或视网膜出血，提示为前部缺血性视神经病变（AION）。在非动脉炎性AION，最具代表性的表现是视力下降在发作时最严重。然而，有一类AION患者，在最初的4周内视力呈进行性下降’。在巨细胞性动脉炎，可因为AION或后部缺血性视神经病变而引起视力下降，后者没有视盘肿胀。这两种病情均可快速进展，甚至在数小时或数天内视力降至无光感。视神经的恶性或浸润性胶质瘤是一类最初可能与非动脉炎性或动脉炎性AION相混淆的病变，因为它们可具有视力变坏、     

近20a DR研究热点的文献计量分析

目的:分析和揭示世界各国在糖尿病性视网膜病变(diabetic retinopathy,DR)研究领域的研究热点和不同国家、机构及期刊的发文量趋势及研究侧重点。方法:对1990/2010年PubMed数据库收录的相关文献进行了计量分析,利用SPSS统计软件对高频主题词进行同篇聚类分析并描绘聚类关系图。结果:共检出DR相关文献11909篇,统计出高频主题词50个,聚类分析显示高频主题词主要聚类于10个类别。结论:国内外DR的研究热点主要集中在DR的药物治疗、并发症和病因及流行病学研究等10个方向,我们的研究结果为国内相关科研和临床工作者提供了重要参考信息。     

前部缺血性视神经病变与腔隙性脑梗死的相关临床分析

目的探讨前部缺血性视神经病变（AION）与腔隙性脑梗死的相关性。方法回顾2007年3月至2010年6月就诊的53例（79只眼）前部缺血性视神经病变患者的视力、视野、眼底,以及视觉电生理、荧光素眼底血管造影、CT或MRI等检查资料,分析AION与腔隙性脑梗死的关系。结果所有患者经视野检查确诊为AION;在53例患者中有47例做了CT或MRI检查,其中16例诊断为腔隙性脑梗死,占34%。在53例患者中,高血压者23例,占43.4%,糖尿病者14例,占26.4%,腔隙性脑梗死者16例,占30.2%,其中单眼10例,双眼6例。结论AION与腔隙性脑梗死密切相关;对于AION患者应常规行脑CT或MRI检查。     

基于PubMed数据库的角膜移植手术文献计量分析

目的:了解角膜移植手术研究文献的分布规律和国际研究趋势。方法:利用美国国立图书馆的PubMed数据库为数据源,对2000/2012年所收录的角膜移植手术相关文献的年代分布、国家和地区、发文语种及作者情况等进行统计分析,并利用书目共现分析系统(BICOMB)、SPSS19.0分析软件对高频主题词进行聚类分析。结果:2000/2012年累计收录角膜移植手术相关研究文献3363篇,文献数据逐渐增多;研究文献以英语为主,我国文献量位列第4;统计出高频主题词50个,聚类分析显示高频主题词主要聚类于3个类别,分别为角膜内皮移植手术、角膜移植手术后并发症治疗、角膜移植手术后的免疫排斥反应。结论:角膜移植手术研究文献呈增长趋势,研究热点为角膜内皮移植手术。     

Delayed choroidal perfusion in giant cell arteritis.

The fundus fluorescein angiograms of 13 patients with visual disturbance due to biopsy-proven giant cell arteritis (11 with anterior ischemic optic neuropathy (AION); 2 with visual obscurations only) were compared with the fluorescein angiograms from 33 patients with acute nonarteritic AION and 23 age-matched normal eyes. In all 13 patients with giant cell arteritis, the fluorescein angiograms showed a significant delay of choroidal filling time (mean 69 seconds) in comparison with either normal subjects (mean 5.8 seconds) or patients with nonarteritic AION (mean 5.5 seconds). In patients presenting with acute AION, the finding of delayed choroidal filling on fluorescein angiography should raise the index of suspicion of giant cell arteritis and lead to prompt investigation and treatment.     

Ischemic optic neuropathy

Ischemic optic neuropathy is one of the major causes of blindness or seriously impaired vision, yet there is disagreement as to its pathogenesis, clinical features and especially its management. This is because ischemic optic neuropathy is not one disease but a spectrum of several different types, each with its own etiology, pathogenesis, clinical features and management. They cannot be lumped together. Ischemic optic neuropathy is primarily of two types: anterior (AION) and posterior (PION), involving the optic nerve head (ONH) and the rest of the optic nerve respectively. Furthermore, both AION and PION have different subtypes. AION comprises arteritic (A-AION – due to giant cell arteritis) and, non-arteritic (NA-AION – due to causes other than giant cell arteritis); NA-AION can be further classified into classical NA-AION and incipient NA-AION. PION consists of arteritic (A-PION – due to giant cell arteritis), non-arteritic (NA-PION – due to causes other than giant cell arteritis), and surgical (a complication of several systemic surgical procedures). Thus, ischemic optic neuropathy consists of six distinct types of clinical entities. NA-AION is by far the most common type and one of the most prevalent and visually crippling diseases in the middle-aged and elderly. A-AION, though less common, is an ocular emergency and requires early diagnosis and immediate treatment with systemic high dose corticosteroids to prevent further visual loss, which is entirely preventable.Controversy exists regarding the pathogenesis, clinical features and especially management of the various types of ischemic optic neuropathy because there are multiple misconceptions about its many fundamental aspects. Recently emerging information on the various factors that influence the optic nerve circulation, and also the various systemic and local risk factors which play important roles in the development of various types of ischemic optic neuropathy have given us a better understanding of their pathogeneses, clinical features and management. This knowledge should help us not only to manage them better but also to reduce their incidence. For example, clinically, the evidence that about 40% of NA-AION eyes experience spontaneous improvement in visual acuity and that systemic steroid therapy during early stages in both NA-AION and NA-PION has a significant beneficial effect for visual outcome are encouraging developments. This review discusses the current concepts on various issues related to various types of ischemic optic neuropathy.     

Management of ischemic optic neuropathies

Ischemic optic neuropathies (IONs) consist primarily of two types: anterior ischemic optic neuropathy (AION) and posterior ischemic optic neuropathy (PION). AION comprises arteritic AION (A-AION: due to giant cell arteritis) and non-arteritic AION (NA-AION: due to other causes). PION consists of arteritic PION (A-PION: due to giant cell arteritis), non-arteritic PION (NA-PION: due to other causes), and surgical PION (a complication of several systemic surgical procedures). These five types of ION are distinct clinical entities etiologically, pathogenetically, clinically and from the management point of view. In the management of AION, the first crucial step with patients aged 50 and over is to identify immediately whether it is arteritic or not because A-AION is an ophthalmic emergency and requires urgent treatment with high-dose steroid therapy to prevent any further visual loss in one or both eyes. Patients with NA-AION, when treated with systemic corticosteroid therapy within first 2 weeks of onset, had significantly better visual outcome than untreated ones. Systemic risk factors, particularly nocturnal arterial hypotension, play major roles in the development of NA-AION; management of them is essential in its prevention and management. NA-PION patients, when treated with high-dose systemic steroid therapy during the very early stages of the disease, showed significant improvement in visual acuity and visual fields, compared to untreated eyes. A-PION, like A-AION, requires urgent treatment with high-dose steroid therapy to prevent any further visual loss in one or both eyes. There is no satisfactory treatment for surgical PION, except to take prophylactic measures to prevent its development.     

Treatment of anterior ischemic optic neuropathy: Clues from the bench

Anterior ischemic optic neuropathy (AION) is due to optic nerve head ischemia, and there is currently no effective treatment. Age is a significant risk factor for both arteritic and nonarteritic AION (NAION), although we do not fully understand the changes that occur in aging that lead to selective vulnerability of the optic nerve head. Arteritic AION, which is most often seen in the setting of giant cell arteritis, is caused by vasculitis and thromboembolism of the ophthalmic circulation leading to impaired perfusion of the short posterior ciliary artery and infarction of the optic nerve head. More commonly, AION is nonarteritic, and vision loss is typically altitudinal and noted most commonly upon awakening. NAION has been associated with a variety of risk factors, including disc-at-risk, vascular risk factors including diabetes, vasospasm and impaired autoregulation, nocturnal hypotension, and sleep apnea. This review summarizes the clinical presentation of non-arteritic AION and arteritic AION associated with giant cell arteritis and the current and future treatment approaches for human NAION based on lessons from photochemical thrombosis models of NAION.     

Bilateral arteritic anterior ischemic optic neuropathy

Background

Arteritic anterior ischemic optic neuropathy (AION) is a disease of the optic nerve head seen in patients over the age of 50 and more commonly over the age of 70. With few exceptions, arteritic AION is caused by giant cell arteritis. Early diagnosis and prompt treatment with corticosteroids are essential for preventing potentially devastating visual loss from this disease.

Case Report

A 63-year-old white man presented with the complaints of blurred vision of the right eye and visual field loss of the left eye. Ocular examination found bilateral swollen optic nerve heads. Visual field testing showed altitudinal defects in each eye. Laboratory testing was significant for elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. The patient was treated with oral prednisone for arteritic AION and referred to a rheumatologist. At follow-up, the patient’s ESR and CRP levels showed significant improvement. The optic nerve head of the left eye showed a reduction in swelling, and the visual field finding was stable.

Conclusion

Arteritic AION is an ocular emergency. Optometrists need to be able to recognize and diagnose this condition quickly to initiate critical corticosteroid treatment.     

Anterior ischemic optic neuropathy in patients younger than 50 years

PURPOSE: To characterize anterior ischemic optic neuropathy (AION) in patients younger than 50 years. DESIGN: Retrospective study. METHODS: Records of all AION patients seen between 1989 and 2006 were reviewed. Patients younger than 50 years when initial visual loss occurred were included. RESULTS: Of 727 consecutive patients with AION, 169 (23%) were younger than 50 years (median, 43 years; range, 13 to 49 years; 58% men; 93% White). Involvement was unilateral in 59% of patients and bilateral in 41%. At least one cardiovascular risk factor was found in 74% of patients. Hypercoagulable states and vasculitis were found in 8%. An underlying small or anomalous optic disk was found in 92% of eyes (210/230). Isolated disk anomalies (without systemic risk factors) were present in 26% of eyes. Final visual acuities were 20/40 or better in 64% of eyes and 20/200 or worse in 22%. Among patients with bilateral involvement, final visual acuity was similar in the two eyes in 70% of patients. Anemia and type I diabetes were associated significantly with fellow eye involvement. Recurrent AION in the same eye occurred in 6% of patients. CONCLUSIONS: AION in younger patients is not uncommon and represents 23% of AION patients in a tertiary neuro-ophthalmic service. Except for giant cell arteritis, ocular and systemic risk factors and associated disorders are similar to those described in older AION patients. Younger AION patients have better visual acuity outcomes but a higher risk of fellow eye involvement than older AION patients.     

Optic disc structure in anterior ischemic optic neuropathy

The etiology of anterior ischemic optic neuropathy (AION), when not associated with giant cell arteritis, is usually unknown. Clinical, pathologic, and experimental studies have not determined a cause. The optic disc appearance in both the involved and normal fellow eye was studied in 51 patients with acute nonarteritic AION. The number of discs (both involved and fellow) without a physiologic cup was significantly greater than would be expected from normal population studies. The etiology of nonarteritic AION may be related to the anatomic configuration of the optic nerve.     

Anterior ischemic optic neuropathy and aging

The records of 293 patients admitted to Padua University Eye Clinic with diagnosis of optic neuropathy were reviewed. Age and sex distribution of different types of optic neuropathies were analyzed. 84 patients (28.7%) with a mean age of 61.9 years had anterior ischemic optic neuropathy (AION). The mean follow up of these patients was 3 years. In less than 30% of patients stabilized visual acuity of the first affected eye was better than 20/200; however, patients younger than 65 showed a significantly (p less than 0.01) better visual acuity than patients older than 64. Involvement of the second eye was found in 26 patients with AION (30.9%), of whom only five were considered idiopathic. The latency before controlateral eye involvement was significantly (p less than 0.05) shorter in patients over 64 years of age than in the younger group. Commonly known associated conditions such as giant cell arteritis (3.6%), arterial hypertension (34.5%), diabetes mellitus (10.7%), both arterial hypertension and diabetes (8.3%), migraine (7.2%) or intracapsular cataract extraction (1.2%) were considered. The frequency of a number of risk factors was found out in patients with arterial hypertension and/or diabetes and in patients with idiopathic AION. Symptoms or signs of ischemic cardiopathy and/or peripheral nonarteritic vascular disease, TIAs prior to AION onset, elevated plasma cholesterol or triglyceride levels, excessive smoking were considered. These risk factors were not found in 11.1% of diabetic patients with AION, in 37.9% of hypertensives, in 14.2% of both diabetic and hypertensive patients and in 31% of patients with idiopathic AION. Our data seem to indicate that the onset of AION may be influenced more strongly from these risk factors than aging.     

Ischaemic optic neuropathy

Ischaemic optic neuropathy is of two types: anterior (AION) and posterior (PION), the first involving the optic nerve head (ONH) and the second, the rest of the optic nerve. Pathogenetically AION and PION are very different diseases. AION represents an acute ischaemic disorder of the ONH supplied by the posterior ciliary artery (PCA), while PION has no specific location in the posterior part of the optic nerve and does not represent an ischaemic disorder of any definite artery. The most important step towards a logical understanding of the underlying causes, clinical features, pathogenesis and rational management of AION, is to understand the basic scientific issues involved; these are discussed in some detail. AION clinically is of two types: (1) that due to giant cell arteritis (arteritic AION: A-AION) and (2) non-arteritic AION (NA-AION). NA-AION, the more common of the two, is one of the most prevalent and visually crippling diseases in the middle-aged and elderly, and is potentially bilateral. NA-AION is a multifactorial disease, with many risk factors collectively contributing to its development. Although there is no known treatment for NA-AION, reduction of risk factors is important in decreasing chances of involvement of the second eye and of further episodes. Our studies have suggested that nocturnal arterial hypotension is an important risk factor for the development and progression of NA-AION. The role of nocturnal arterial hypotension in the pathogenesis of NA-AION and management of nocturnal hypotension is discussed. Potent antihypertensive drugs, when used aggressively and/or given at bedtime, are emerging as an important risk factor for nocturnal hypotension, and there is some evidence that NA-AION may be occurring as an iatrogenic disease in some individuals. A-AION, by contrast, is an ocular emergency and requires immediate treatment with systemic corticosteroids to prevent further visual loss. The clinical parameters which help to differentiate the two types of AION, and their respective management are discussed.