复方樟柳碱注射液治疗视神经挫伤的疗效

目的：探讨复方樟柳碱注射液治疗视神经挫伤的临床疗效。 方法：回顾分析2009-01/2011-05于沧州市人民医院住院治疗的视神经挫伤患者72例72眼。其中36例36眼应用复方樟柳碱注射液行颞浅动脉旁皮下注射为治疗组,36例36眼应用传统药物治疗为对照组。 结果：治疗28d后,治疗组的视力、眼底及视野恢复情况均明显优于对照组。 结论：复方樟柳碱注射液治疗视神经挫伤是一种有效易行的手段。     

视神经挫伤后的眼底血管造影

目的：用荧光素眼底血管造影（Fundus fluorescein angiography,FFA)和吲哚青绿血管造影（Indocyanine green angiography,IGGA)探讨视神经挫伤后，视神经及周围视网膜，脉络膜的循环改变。方法：对30例（30只眼）不同程度的眼球挫伤致视神经损伤的患者进行FFA与ICGA同步检查，并对它们的图像进行分析（本组除外脉络膜破裂）。结果：除1例视盘及周围视网膜，脉络膜荧光大致正常外，其余29例均出现了异常的荧光表现。FFA主要表现为：在造影早期视盘呈象限性或全视盘性的荧光充盈不良，后期荧光素渗漏或始终不能充盈，ICGA主要表现为：在FFA显示的视盘象限性弱荧光区的相邻区域脉络膜充盈时间明显延迟；FFA显示的全视盘性的弱荧光，盘周的脉络膜充盈时间明显延长，在局限性脉络膜灌注不良的对应区均出现了视网膜色素上皮（Retinal pigment epithelium,RPE)的损害，而盘周脉络膜灌注不良的区域，有9例相应区视网膜并未出现RPE的损害；有2例合并视网膜分支动脉阻塞；有19例视盘缺血的部分正是“分水区”的位置，占63.3%，本组病例中有80%视力在0.1以下。结论：眼球挫伤不仅可使视神经损伤，其周围的视网膜，脉络膜均可受到损害，应尽早施行FFA与ICGA检查，它可以详细观察，正确判断视神经挫伤后的视盘缺血情况及周围视网膜，脉络膜损害的范围和程度，及时正确地指导治疗。     

复方樟柳碱治疗视神经挫伤25例

目的:探讨复方樟柳碱注射液治疗视神经挫伤的临床疗效。方法:视神经挫伤患者共25例,进行复方樟柳碱治疗,颞部皮下注射,2mL/次,1次/d,1疗程/14d。结果:治疗后视力均有不同程度的提高,由治疗前的LP(-)～0.5上升至HM/眼前～1.5。结论:复方樟柳碱注射液治疗外伤性视神经病变有明显效果,对同时合并其他颅神经的损伤也有明显疗效。     

视神经管减压术治疗间接性视神经挫伤30例

目的评价视神经管减压术治疗视神经挫伤的疗效和影响疗效的因素。方法手术治疗限定于外伤后1月内,并且无严重颅脑损伤、无严重全身病患者。手术方式采用经眶—筛窦—蝶窦视神经管减压术,全麻或局麻下施行。术前、术后常规应用大剂量糖皮质激素和神经营养药物治疗。结果30例患者中19例术后视力有不同程度提高,有效率为63%(19/30),24例术前无光感者,13例术后1周以后恢复光感以上的视力,有效率为54%(13/24),6例术前有光感～0.04,术后视力提高显著,有效率100%。手术病程15d以内者优于15d以上者。结论对严重的视神经挫伤患者应尽早行视神经管减压术,手术的效果与患者手术前的视力状况及病程的长短有关,术前、术后大剂量糖皮质激素及神经营养药物的应用对提高有效率也尤为必要。     

复方樟柳碱联合神经生长因子治疗视神经视网膜挫伤26例

目的:观察复方樟柳碱联合神经生长因子(NGF)治疗视神经视网膜挫伤的疗效。方法:视神经视网膜挫伤患者26例31眼,应用复方樟柳碱联合神经生长因子(NGF)治疗,此为治疗组。并以用血管扩张剂、胞二磷胆碱、维生素治疗22例28眼为对照组。结果:两组疗效(主要观察指标是视力)比较显示,治疗组疗效(94%)明显优于对照组(64%),差异具有显著性(P<0.05)。结论:复方樟柳碱联合神经生长因子治疗视神经视网膜挫伤有显著疗效。     

Posture-Dependent Collapse of the Optic Nerve Subarachnoid Space: A Combined MRI and Modeling Study

PurposeWe hypothesize that a collapse of the optic nerve subarachnoid space (ONSAS) in the upright posture may protect the eyes from large translamina cribrosa pressure differences (TLCPD) believed to play a role in various optic nerve diseases (e.g., glaucoma). In this study, we combined magnetic resonance imaging (MRI) and mathematical modeling to investigate this potential ONSAS collapse and its effects on the TLCPD.MethodsFirst, we performed MRI on six healthy volunteers in 6° head-down tilt (HDT) and 13° head-up tilt (HUT) to assess changes in ONSAS volume (measured from the eye to the optic canal) with changes in posture. The volume change reflects optic nerve sheath (ONS) distensibility. Second, we used the MRI data and mathematical modeling to simulate ONSAS pressure and the potential ONSAS collapse in a 90° upright posture.ResultsThe MRI showed a 33% decrease in ONSAS volume from the HDT to HUT (P < 0.001). In the upright posture, the simulations predicted an ONSAS collapse 25 mm behind lamina cribrosa, disrupting the pressure communication between the ONSAS and the intracranial subarachnoid space. The collapse reduced the simulated postural increase in TLCPD by roughly 1 mm Hg, although this reduction was highly sensitive to ONS distensibility, varying between 0 and 4.8 mm Hg when varying the distensibility by ± 1 SD.ConclusionsThe ONSAS volume along the optic nerve is posture dependent. The simulations supported the hypothesized ONSAS collapse in the upright posture and showed that even small changes in ONS stiffness/distensibility may affect the TLCPD.     

Evaluation of the Optic Nerve Complex in the Orbit Using Coronal Fast Magnetic Resonance Imaging

Recently available coronal fast magnetic resonance imaging (MRI) has very high spatial resolution with good contrast between the optic nerves and cerebrospinal fluid (CSF). The aim of this study was to evaluate the diagnostic value of coronal fast imaging in optic nerve diseases. Thirty-five patients with various Neuro-ophthalmic conditions including 9 with optic neuritis, 6 with optic atrophy, 5 with glaucoma, 4 with segmental optic nerve hypoplasia and 11 with other optic neuropathies including orbital apex syndrome were evaluated with the three-dimensional fast imaging employing steady-state acquisition (FIESTA) sequence in addition to standard MRI protocols. The optic nerve complexes were evaluated on coronal images of the orbits. Detailed demonstration of the optic nerve complex—the optic nerve, the perineural CSF space and dural sheath—could be readily obtained with FIESTA sequence. The acute phase of both optic neuritis and perineuritis showed enlargement of the perineural CSF space; the optic nerve was swollen in optic neuritis but not in perineuritis. Cases of optic atrophy and glaucoma showed perineural CSF space enlargement with normal optic sheath circumference and a thinner optic nerve, while optic nerve hypoplasia showed a smaller dural sheath circumference without perineural CSF space enlargement. In the cases of orbital apex syndrome optic nerve compression by the extraocular muscles was clearly shown. Coronal FIESTA imaging of the orbit is capable of delineating detailed structural changes in the optic nerve complex and is of diagnostic value for the differentiation of optic nerve diseases.     

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。     

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.     

Bilateral Optic Nerve Involvement Combined with Unilateral Facial Palsy in a Patient with Acute Myeloid Leukaemia: A Case Report

Central nervous system (CNS) involvement, including optic nerve involvement, in a patient with acute myeloid leukaemia (AML) is an extremely rare condition. We report a case of bilateral optic nerve involvement combined with unilateral facial palsy in a patient with AML who achieved complete remission following allogenic peripheral blood stem cell transplantation as a young patient. After further evaluation, the patient was diagnosed with a recurrence of AML with CNS involvement. The presentation of multiple types of CNS involvement in AML may be suspicious evidence of AML recurrence.     

Characteristics of Optic Nerve Damage Induced by Chronic Intraocular Hypertension in Rat

Purpose:To set up the Sharma‘s chronic intraocular hypertension model and investigate the intraocular pressure (IOP) as well as the optic nerve damage of this model in rat.Methods :The operations of the chronic intraocular hypertension model were performed as described by Sharma in 60 male Lewis albino rats. IOP was measured using the TonoPen XL immediately after surgery and then at 5 day, 2 week or 4 week intervals. Cresyl violet staining of whole-mounted retinas was used to label retinal ganglion cells (RGCs),then RGCs were counted. Paraphenylenediamine (PPD) staining was performed in the semi-thin cross sections of optic nerve of rat, in order to know whether the axons of optic nerve were degenerated or not.Results:There were 47 rats with higher IOP after the episcleral veins cauterized in 60 rats. The ratio of elevated IOP was 78.3%. The IOPs were stable in 4 weeks. After cresyl violet staining, the RGCs loss was 11.0% and 11.3% was found in the central and peripheral retina respectively after 2 weeks of increased IOP. After 4 weeks of increased IOP, the loss of RGCs was 17% for the central retina and 24.6% for the peripheral retina. In the retinas without higher IOP, there was no loss of RGCs. PPD staining showed that optic nerve of rat with about 5.3% damage of axons located at the superior temporal region. Region of affected optic nerve 1 mm posterior to the globe by light microscope showed evidence of damaged axons with axonal swelling and myelin debris.Conclusion:Sharma‘s chronic intraocular hypertension model is a reproducible and effective glaucoma model, which mimics human glaucoma with chronically elevation IOP and induced RGCs loss and damage of optic nerve.     

Analysis of the Activation of the Nrf2-ARE Pathway Following Optic Nerve Injury in Mice

 Purpose:Nrf2-ARE pathway plays a cytoprotective role in many tissues,but its protective function in the optic nerve is unclear. The purpose of the study is to investigate the changes of the activation of Nrf2-ARE pathway following optic nerve injury (ONI) in mice. Methods:Using ONI mice models, the expression levels of Nrf2 in optic nerves were determined by real-time PCR at various time points. Results:The expression of Nrf2mRNA was significantly upregulated at 1 d after ONI, peaking at 30min after ONI. Conlusions: Nrf2-ARE pathway was activated after ONI, providing evidence for the study of the protection and underlying mechanism of Nrf2-ARE pathway on optic nerves.     

Electrical Stimulation with a Needle-type Electrode Inserted into the Optic Nerve in Rabbit Eyes

Purpose To investigate whether electrical stimulation of the optic nerve can elicit an electrical evoked potential (EEP) in rabbits and to determine whether such stimulation is a useful approach for the placement of a visual prosthesis.Methods Two needle-type electrodes were inserted into the optic nerve using a transvitreal approach. For electrical stimulation, monophasic and biphasic pulses were used. By stimulating the optic nerve, the EEP was elicited. After evaluation of the EEP, a histological study was carried out.Results When electrical stimulation was applied, the EEP could be recorded. The threshold with monophasic and biphasic stimulation was 10 ± 0µA and 20 ± 8.2µA, respectively. Histological examination revealed no major complications, such as bleeding or degeneration, which might have resulted from the insertion of electrodes or the electrical stimulation.Conclusions Electrical stimulation of the optic nerve can elicit an EEP, suggesting that this approach may be useful for a visual prosthesis system. Jpn J Ophthalmol 2004;48:552–557 © Japanese Ophthalmological Society 2004     

Visual Function Improvement After Optic Nerve Sheath Fenestration in Osteopetrosis Patients with Optic Canal Stenosis: A Report of Two Cases

The outcome of two patients with visual loss from osteopetrosis who underwent an optic nerve sheath fenestration (ONSF) is reported. A 20-year-old male and 26-year-old female with osteopetrosis had optic nerve edema. Computed tomography and magnetic resonance imaging demonstrated optic canals stenosis. Both patients underwent unilateral ONSF.?After ONSF, the patients experienced improvement in visual acuity and optic nerve appearance. Therefore, when papilledema is recognized in osteopetrosis patients, it may be reasonable to start with an ONSF even if the optic canal seems to be stenotic because of the lower morbidity that is associated with this procedure compared with other surgical options.     

Characteristics of the Optic Nerve Head in Myopic Eyes Using Swept-Source Optical Coherence Tomography

PurposeTo investigate the characteristics of the optic nerve head (ONH) in myopia using swept-source optical coherence tomography (SS-OCT).MethodsParticipants were divided into three groups according to the axial length (AL). The optic disc morphology, retinal nerve fiber layer (RNFL) thickness, and radial peripapillary capillary (RPC) vessel density (VD), optic disc tilt, rotation, Bruch''s membrane opening distance (BMOD), border length (BL), border tissue angle, focal lamina cribrosa (LC) defects, β- and γ-zone peripapillary atrophy (PPA), microvasculature dropout (MvD), choroidal thickness (CT), and the choroidal vascularity index (CVI) were compared. Linear regression analysis evaluated relationships between spherical equivalent, AL, and ONH parameters.ResultsOne hundred five, 98, and 118 eyes were included in groups 1, 2, and 3, respectively. With AL increasing, the mean, superior and temporal CT, central mean and temporal, pericentral mean, inferior and nasal RPC VD, and temporal CVI decreased, whereas the mean and temporal RNFL thickness, optic disc, RIM and β-PPA area, presence and area of γ-PPA, BMOD and BL increased. Compared to other groups, group 3 depicted a larger cup area, more focal LC defect and total and juxtapapillary MvD; a lower central superior, inferior and nasal, pericentral superior, and temporal RPC VD. Group 1 demonstrated more tilted disc, larger inferior and nasal CT, mean, superior, inferior, and nasal CVI.ConclusionsMyopia eyes have larger ONH changes, PPAs, regional RNFL, and MvD, but smaller regional CTs, RPC VD, and CVIs. SS-OCT may be useful in detecting ONH variations during myopia.     

Inflammatory Papillitis in Uveitis: Response to Treatment and Use of Optic Nerve Optical Coherence Tomography for Monitoring

Purpose: To describe the clinical course of uveitis-associated inflammatory papillitis and evaluate the utility and reproducibility of optic nerve spectral domain optical coherence tomography (SD-OCT). Methods: Data on 22 eyes of 14 patients with uveitis-related papillitis and optic nerve imaging were reviewed. SD-OCT measure reproducibility was determined and parameters were compared in active vs. inactive uveitis. Results: Papillitis resolution lagged behind uveitis resolution in three patients. For SD-OCT measures, the intraclass correlation coefficients were 99.1–100% and 86.9–100% for intraobserver and interobserver reproducibility, respectively. All SD-OCT optic nerve measures except inferior and nasal peripapillary retinal thicknesses were significantly higher in active vs. inactive uveitis after correction for multiple hypotheses testing. Mean optic nerve central thickness decreased from 545.1 to 362.9 µm (p?=?0.01). Conclusions: Resolution of inflammatory papillitis can lag behind resolution of uveitis. SD-OCT assessment of papillitis is reproducible and correlates with presence vs. resolution of uveitis.     

Topographic Characteristics of the Optic Nerve Head Measured with Scanning Laser Tomography in Normal Japanese Subjects

Purpose

Few studies have been performed regarding the topographic information obtained with the Heidelberg retina tomograph (HRT) in normal Japanese. In this study, we examined the factors influencing optic disc parameters and hemisphere symmetry obtained with the HRT in normal Japanese subjects.

Methods

Mean values and the standard deviation range for the main HRT parameters were evaluated in 223 eyes of 223 normal Japanese subjects. The influence of age, sex, and disc size on HRT topographic data was analyzed. The superior and inferior hemisphere topographic parameters were compared.

Results

Disc area showed a significant difference by sex (P = 0.0493). Rim volume (r = ?0.208, P = 0.019), height variation contour (r = ?0.275, P = 0.001), and mean retinal nerve fiber layer (RNFL) thickness (r = ?0.366, P = 0.001) declined with age. All parameters except height variation contour and mean RNFL thickness showed a clinically significant correlation with disc size (?0.159 < r < 0.719, P < 0.01). Cup parameters in the superior hemisphere were significantly greater than those in the inferior hemisphere. In contrast, rim parameters in the superior hemisphere were significantly smaller than those in the inferior hemisphere.

Conclusions

Some factors, namely, sex, age, and disc size, affected the optic disc parameters in the HRT measurements. Possible parameter asymmetry between the two hemispheres should be considered in normal eyes. Jpn J Ophthalmol 2005;49:469–476 © Japanese Ophthalmological Society 2005     

Evaluation of Retinal Nerve Fiber Layer in Patients with Idiopathic Optic Perineuritis using Optical Coherence Tomography

Abstract

The aim of this study was to assess the effect of idiopathic Optic perineuritis on the retinal nerve fiber layer, and determine the ability of optical coherence tomography to evaluate retinal nerve fiber loss after idiopathic Optic perineuritis. Four patients were assessed in this study. In all cases, average retinal nerve fiber layer was significantly thinner in the affected eye in comparison with the normal reference value and with the value for the contralateral normal eye at 12 months after the onset of optic perineuritis. Our study revealed that retinal nerve fiber layer loss occurs in idiopathic optic nerve sheath inflammation.     

Congenital Pits of the Optic Nerve Head: II. Clinical Studies in Humans

The clinical characteristics of 75 eyes with congenital pits of the optic nerve head were reviewed, particularly in relation to associated serous retinal detachment. Retinal detachment was found in 52% of all eyes with pits and 63% of eyes with temporally located pits. Of 20 untreated eyes with a pit and coexistent macular retinal detachment followed for more than one year, 55% (11/20) had visual acuity 6130 and 75% (15/20) had subretinal fluid at the most recent visit. Visual fields and intravenous fluorescein angiographic characteristics of pits are discussed and clinical evidence is presented supporting the theory that the associated subretinal fluid is derived from liquified vitreous.     

Evaluation of Relative Afferent Pupillary Defect Using RAPDx Device in Patients with Optic Nerve Disease

We previously reported the standard values of the amplitude and latency scores in the RAPDx device for evaluating relative afferent pupillary defect (RAPD). Here, we evaluated RAPD in patients with optic nerve disease by using these standard values. Twenty-eight patients with current or previous optic nerve disease were enrolled in this study. Additionally, the data of 84 healthy subjects from our previous report were used as control data. We measured the amplitude and latency scores using RAPDx. We then compared their mean values and the percentages of individuals with standard values within a certain range between the optic nerve disease group and healthy group. Additionally, we evaluated their correlation with visual acuity and the critical flicker fusion frequency in the optic nerve disease group. Both parameters were significantly higher in the optic nerve disease group than in the control group (p < 0.0001). The detection rate of RAPD when using the standard value of amplitude score was 75%. Additionally, both parameters showed a significant correlation with laterality-based differences in visual acuity and critical flicker fusion frequency values in the optic nerve disease group (r = 0.59–0.75, p < 0.001). The amplitude and latency scores determined using RAPDx are useful in evaluating RAPD, particularly the standard value of the amplitude score.