Evulsion of the optic nerve in association with basketball injuries

A case of optic nerve evulsion resulted from a finger poke injury to the globe during a basketball game. Significantly, almost no external damage to the eye was evident. The damage may be caused by sudden forceful anterior-posterior displacement and rotation of the globe, inducing a tear of the optic nerve at the papilla. The seriousness and permanence of this injury stress the importance of protective eye wear in contact sports.     

大鼠视神经损伤视网膜病理改变的实验研究

目的研究现神经损伤早期视网膜的病理改变。方法采用大鼠球后视神经横断伤和钳夹伤模型,观察视网膜组织学及超微结构的改变。结果1）光镜：早期表现为神经纤维层血管扩张,损伤后7、14天可见散在的核染色质边聚。空化的节细胞。2）电镜：损伤后1天节细胞出现胞浆成分疏松,内质网扩张等变性样改变,横断伤3天及钳夹伤7天可见节细胞坏死,部分节细胞凋亡。结论视神经损伤导致节细胞出现迟发性死亡,提示早期治疗具有重要意义。     

碱性成纤维生长因子在视神经中的表达及在视神经损伤后的反应

目的 观察碱性成纤维生长因子（bFGF）在视神经中的表达及在视神经损伤后的反应，探讨bFGF在视神经损伤中的作用。方法 采用大鼠球后视神经钳夹伤模型，利用免疫组化法和计算机图像分析技术，于术后1，3，7，14天检测视神经bFGF的表达。结果 视神经损伤后1－14天bFGF的表达明显增高，与假伤对照组相差显著（P＜0．05）。结论 视神经损伤提高bGFG在视神经中的表达，对视神经损伤的修复具有积极的作用。     

Examination of the optic nerve state in children with orbital injuries

The results of comprehensive examinations of 13 children with orbital injuries, in whom injuries to the optic nerve were diagnosed, are analyzed. Computer-aided tomography and examinations with visual evoked potentials helped detect the signs of optic nerve injuries in the first days after the injury even in cases without ophthalmoscopic changes. Grave disorders of the involved eye visual evoked potentials were detected, that evidenced organic changes of the third neurone, despite high vision acuity. Disordered visual evoked potentials of the intact eye as against age-specific norm were detected in 8 children.     

Contusion of the optic nerve after minor blunt ocular trauma: case report and review of the literature

INTRODUCTION: Isolated trauma of the optic nerve usually occurs in association with blunt skull trauma involving fractures of the skull and optic canal, but rarely occurs from blunt ocular trauma. CASE REPORT: A 7-year old boy fell and struck his left eye against a toy antenna. The initial examination revealed a visual acuity of 0.2 and slight edema of the optic nerve head. Perimetry revealed a defect in the superior and nasal visual fields. CT and MRI scans of the orbit were normal. Nine months after the injury, vision had improved to 1.0. On examination, optic nerve atrophy had developed and perimetry continued to display a defect in the superior visual fields. DISCUSSION: The mechanism of optic nerve damage secondary to trauma can be classified as primary or secondary. Primary damage occurs as a result of external forces at the moment of trauma, e.g., rupture of nerve fibers or of capillary vessels. Secondary damage may not be present initially, but may occur later on and results from compromised blood supply to the optic nerve, e.g., following edema or angiospasm. In our patient, it is not clear whether the damage was primary or secondary. CONCLUSION: Damage to the optic nerve can be caused by blunt skull trauma and, rarely, also by blunt ocular trauma. This fact is of importance when considering legal and reimbursement issues.     

大鼠视神经部分损伤后视神经纤维再生的形态学观察

目的探讨大鼠视神经不同程度损伤后视网膜神经节细胞（RGC）和轴突的变化规律及神经再生能力。方法用夹持力为148g的反向镊夹持大鼠视神经3、6、12、30、60S建立不同程度视神经损伤的动物模型,计数视神经损伤后0．5、1、2、3、7个月RGC和损伤后1、2、3个月轴突随时间的变化规律,透射电镜观察损伤的再生反应,在银染的视神经纵切片上计数后计算视神经横断面上纤维数目,根据横断面的纤维数目计算损伤视神经的再生指数以衡量不同程度视神经损伤后的再生能力。再生指数的计算为（损伤点后0．5mm纤维数-损伤点后2．5唧纤维数）／（球后0．5唧纤维数-损伤点后2．5mm纤维数）。结果视神经部分损伤后RGC和轴突持续丢失,这种丢失可分为伤后2周内的急性丢失和其后的缓慢丢失两个时期,并呈指数形式下降。随着致伤程度的加重,RGC的丢失率上升而存活率降低,RGC和轴突的丢失率随致伤程度的加重而增高,轻度损伤时这种继发损伤具有自限性。视神经损伤后,有大量丛状聚集、区域化分布的无髓再生纤维。视神经夹持损伤3、6、12、30、60s后,再生指数分别为1．409、1．490、0．916、1．119、1．224（χ^2=281．2,P〈0．01）,不同程度损伤后神经的再生能力可能不同,轻度损伤的再生能力较强。结论不同程度视神经部分损伤后继发反应和再生能力不同,轻度损伤后的继发损伤具有自限性并具有更强的再生能力,在一定程度的损伤下修复与损伤可能达到某种平衡而导致成功再生。     

Contusion injuries and their ocular effects

A 22‐year‐old female optometry student presented with a one‐day history of a contusion injury to the right eye with blurred vision inferiorly. Slitlamp examination showed mild anterior chamber reaction. Angle recession was visible by gonioscopy and dilated fundus examination revealed commotio retinae with macular involvement and vitreal haemorrhages. Peripheral retinal tears were later detected. The management of a patient with a history of a contusion injury is discussed.     

尼莫通高压氧对外伤性视神经损伤的治疗

目的　观察尼莫通 (Nimotop)及高压氧治疗外伤性视神经损伤的疗效 ,探索治疗外伤性视神经损伤新的有效方法。方法　将脑外伤合并视神经损伤 63例 (71眼 )随机分成 3组 ,分别采用常规治疗 ;常规治疗加尼莫通 ;高压氧联合尼莫通 3种方法进行治疗 ,观察视力恢复程度 ,判断疗效。结果　尼莫通组和高压氧联合尼莫通治疗组视功能恢复的总有效率分别为82 .61%和 91.67% ,常规治疗组有效率为 45 .83 %。尼莫通组和高压氧联合尼莫通治疗组分别与常规治疗组差异均有显著意义 (P <0 .0 5 )。结论　尼莫通或高压氧联合尼莫通治疗外伤性视神经损伤有良好疗效。     

Surgical decompression of the optic nerve in intracanal injuries. Indications and results]

Fifteen patients with traumatic optic neuropathy (anatomical section excluded) underwent surgical anterior decompression of the optic nerve, via the trans ethmoid-sphenoid approach. Improvement of visual function assessed by visual acuity and visual field measurements, was obtained in 10 patients. Results remained stable for a follow-up period of at least 6 months. There was a delay of several weeks before improvement in some of the patients. Thus a long follow-up period seems recommended. Trans ethmoid-sphenoid optic nerve decompression is a reliable procedure with low morbidity, and represents a promising therapy for indirect injuries of the optic nerve.     

大鼠视神经部分损伤后自发再生的实验研究

目的观察大鼠视神经部分损伤后自发再生纤维的形成。方法采用荧光金顺行标记和生长相关蛋白免疫电镜的方法观察反向夹持镊损伤视神经后的再生纤维情况。结果视神经损伤2周后，损伤点后0．5mm内有较密集的荧光金标记，损伤远端散在条状、线状荧光；损伤区前的神经纤维的朗飞氏结的轴突内及损伤区后的无髓神经纤维内有生长相关蛋白-43的阳性表达。生长相关蛋白-43位于轴浆内呈区域性或，临近轴膜分布。结论大鼠视神经部分损伤后具有自发再生能力。     

颅脑闭合性外伤并管内段视神经损伤的治疗

本文报告颅脑闭合性外伤合并管内段视神经损伤的治疗33例。其中药物治疗组17例无明显效果。手术治疗组16例施行视神经管减压术或视神经鞘膜减压术，病人视力多比术前改善，视力改善的有13例，无变化3例，有效率81．3％。     

Isolated optic nerve lymphoma diagnosed by optic nerve biopsy

PURPOSE: To report a case of isolated optic nerve lymphoma diagnosed by optic nerve biopsy. DESIGN: Case report. METHODS: A 66-year-old woman was referred to the Neuro-Ophthalmology Service because of a decrease in visual acuity and right optic disk edema. RESULTS: A magnetic resonance image of the brain showed only enhancement of the optic nerve. An examination that included ANA, c-ANCA, p-ANCA, Lyme titers, FTA-ABS, ACE level, chest x-ray, and lumbar puncture was negative. Because of rapid progression on clinical examination and serial imaging, an optic nerve biopsy was performed, which showed B-cell lymphoma. CONCLUSION: Optic nerve lymphoma can be confused with a variety of inflammatory and neoplastic infiltrations of the optic nerve on clinical and radiographic examinations. Optic nerve biopsy can be valuable in diagnosing isolated optic nerve lymphoma if other diagnostic tests are unrevealing, but the procedure carries considerable risk of loss of visual acuity and should be recommended judiciously.