Revascularization decompression of the optic nerve: a new surgery of the optic nerve in progressive glaucomatous optic neuropathy

A new operation on the optic nerve scleral canal, revascularization compression of the optic nerve, was carried out in 21 patients (21 eyes) in order to improve the visual functions and stabilize the glaucomatous process. The operation combines the advantages of decompression of the optic nerve by dissection of the posterior scleral ring with creation of an additional source of blood supply to the optic nerve from the myovascular bundle of the internal rectal muscle. Good functional effect and notable improvement of hemoperfusion of the optic nerve and retina were attained (period of observation up to 2 years). The degree of visual field extension correlated with the degree of increase in hemoperfusion values. Comparative analysis showed a higher functional efficiency of revascularization decompression of the optic nerve in comparison with optic nerve decompression, which is due to a more essential improvement of ocular hemoperfusion.     

Inflammatory optic neuropathies

The article presents a study on 94 patients hospitalized in the Clinic of Ophthalmology of Cluj-Napoca, during 1993-1998, with optic neuritis. There are presented the clinical and functional aspects of optic neuritis, especially the importance of static perimetry, for the diagnosis, and her superiority, compared with the dynamic perimetry, in finding minor visual field defects in the diagnosis of the optic neuritis too. After treatment, 75% of the cases have a favorable evolution, but the static perimetry reveals sequela visual field defects at 85.3% of the eyes which suffered optic neuritis. According with this findings, static perimetry has a important role in the diagnosis of optic neuritis, in the revealing the functional sequela defects and in the monitoring of the patients.     

原发性开角型青光眼的早期诊断及研究进展

青光眼是一种进展性视神经疾病,它能够引起视神经结构改变,最终导致不可逆性视功能损害。早期诊断是青光眼早期治疗的关键,并减缓或阻止进行性的视功能损害。近年来出现的视神经结构检查及视神经功能检查方法与传统视野检查相比,可提高原发性开角型青光眼(primary open angle glaucoma,POAG)的早期诊断率。     

Correlations between clinico-functional and computerized tomography parameters in patients with optic atrophy of diverse etiology

Comprehensive examinations of the optic nerve anatomy and function in atrophies of various origins have revealed a correlation between computerized tomography data and clinical and functional characteristics in 67 patients. A staged pattern of the development of anatomic shifts corresponding to CT data on the changes in the optic nerve diameter and density in accord with the length of the disease has been determined, as well as a relationship between these shifts and the patients' age and the degree of the calcification of the internal carotid arterial walls. CT signs of the optic nerve atrophy are related to functional disorders. Impaired circulation in the internal carotid arteries augments the atrophic process in the optic nerve. These data may be useful for the selection of a method for the management of optic nerve atrophy and for assessment of the treatment efficacy.     

Ischemic optic neuropathies

Primary or secondary impairment of blood supply to the optic nerve results in a spectrum of ischemic optic neuropathies with multiple etiopathogenesis. Among these the clinical features of traumatic and radiation optic neuropathy are outlined. Diagnostic criteria, associated conditions, risk factors and functional prognosis of anterior ischemic optic neuropathy are reviewed and discussed in the light of the contribution of recent literature.     

原发性开角型青光眼的早期诊断

青光眼是进行性视网膜神经节细胞(retinal ganglion cells,RGCs)丢失引起视神经乳头及视野特征性改变的一组疾病,最终将导致不可逆视功能损害。早期诊断是疾病早期治疗使进行性视功能损害停止或延缓的关键。近年来出现的视神经结构检查及视神经功能检查方法与传统视野检查相比,可提高原发性开角型青光眼(primary openangle glaucoma,POAG)的早期诊断率。不同检查的联合应用可提高诊断的敏感性,在临床应用中可以根据敏感度及特异度的要求来选择相应的结构或功能检查方法。     

Nerve fibre bundle defects and their perimetric correlation

The importance of red-free fundus examination in revealing functional loss of the retinal nerve fibre layer is highlighted in some optic nerve diseases as corroborated by a good correlation observed between NFBDs and visual field defects. Red-free fundus examination could predict the site of a visual field defects, thus enabling the perimetrist to concentrate on that area and to detect field defects which were missed in a previous field examination. In cases of optic atrophy, the extent of nerve fibre layer loss correlated better with the functional loss in terms of visual acuity rather than the pallor of the disc, which was quite often misleading as an indicator of functional damage of the optic nerve. The technique of red-free fundus photography employed was fairly inexpensive and simple.     

Functional and structural analysis of partial optic nerve avulsion due to blunt trauma: case report

Partial optic nerve avulsion (ONA) secondary to finger gouging is an uncommon but devastating injury. A 21-year-old man who had an acute vision loss after accidentally getting poked by himself in his right eye when he fell down during jogging is reported. The patient was diagnosed with partial ONA. Magnetic resonance imaging revealed intact optic nerve. Optical coherence tomography (OCT) revealed deep cavity at the inferior-temporal half of the optic disc. Retinal nerve fiber layer thickness was also thin at the inferior quadrant with circumpapillary OCT scan. Visual field test and electrophysiological tests showed functional abnormality compatible with optic nerve lesion. Diagnostic tools for anatomical and functional evaluation may reveal the course of this injury.     

Ethambutol and the optic nerve

Author describe two clinical observations of optic neuropathy due to the systemic absorption of antibiotics used against tuberculosis. Two items are pointed out: swelling of the optic disc and functional improvement of electro-physiologic and colorimetric tests 6 months after the end of the treatment. He think that optic disc swelling is the clinical manifestation of an anatomical and volumetrical increase of the neuronal axon due to blockade of the axoplasmic transport without demyelinating lesions. This could explain the functional improvement.     

Neuritis nervi optici

Optic nerve neuritis is one of the most important differential diagnoses of visual loss in young and middle aged adults. The prognosis in terms of functional outcome is generally good. The diagnosis of optic neuritis is clinical. Steroids can reduce the recovery time but do not affect the long-term functional outcome. Magnetic resonance imaging (MRI) is the most important investigation for assessing an associated risk of multiple sclerosis. Optical coherence tomography (OCT) contributes additional details on the course and functional outcome of optic neuritis. In the future OCT may additionally contribute to the relationship between optic neuritis and possible associated multiple sclerosis.     

Morphofunctional characteristics of the retina and optic nerve in endocrine ophthalmopathy

Optic neuropathy is a serious complication of endocrine ophthalmopathy (EOP). The morphological characteristics of the optic nerve (provided by a Heidelberg, HRT II retinotomograph) were compared with the functional impairments of various canals of light, color, and contrast sensitivities (detected by an Offon programme complex, MBN, Moscow). There were decreases in contrast and color sensitivities just at the early stages of the disease and deteriorated functions of contract and color sensitivity canals as optic neuropathy progressed. The HRT II retinotomograph has shown a significant change in the thickness of optic nerve fibers, the area of the optic disk (OD), and the volume of the neuroretinal ring, which corresponds to the magnitude of clinical manifestations and the severity of OD lesion. The first retinal changes appear long before optic nerve compression at the orbital apex (orbital apex syndrome), which are caused by ischemic and hypoxic processes due to orbital soft tissue edema. The most sensitive test in detecting the latent stage of optic neuropathy in EOP is a color and contrast sensitivity topography test. In EOP, the morphological optic nerve changes correlate with functional impairments in different canals of the visual system, reflecting the stage of the disease.     

Relationship between structure of optic nerve/nerve fiber layer and functional measurements in glaucoma

PURPOSE OF REVIEW: Glaucoma is a progressive optic neuropathy characterized by structural changes of the optic nerve and retina that are associated with the development of visual functional defects. The temporal relation between structural signs of the disease with psychophysical measures such as visual field tests is important to clarify to determine the best methods to detect glaucoma and progressive glaucomatous damage in the clinical setting. This paper reviews recent advancement in the perception of this structure-function relation. RECENT FINDINGS: Quantitative measurement of optic disc and nerve fiber layer integrity have shown initial promise in early longitudinal studies in detecting progressive glaucoma before the development of progression using standard perimetry. Additionally, selective measures of visual function may be able to detect glaucoma before conventional methods as well; however, the relation between these newer specialized functional tests and optic disc analyzers in detecting progression awaits further study. SUMMARY: Defining the clinical relation between structure and function cannot be done outside of the context of the instrumentation used to assess these parameters. Unfortunately, longitudinal studies that compare newer clinical instruments that measure the structural and functional characteristics of the optic nerve to current conventional testing are lacking, but are required to validate these emerging technologies.     

病理性近视视盘及其相关结构的形态学改变

病理性近视眼的视盘及其相关结构的形态学改变,包括视网膜神经纤维层厚度改变、视盘形态改变等,由此可引起相应的视功能改变.病理性近视眼因后巩膜葡萄肿的形成及生物力学特性的改变,可能导致视神经的结构和功能发生异常.这其中一些变化可能与青光眼的发生密切相关,或者对青光眼诊断造成困扰.     

Perimetric aspects in optic nerve drusen

The drusen of the optic nerve head is a relative rare occurrence in ophthalmologic practice, but it induce more or less important functional alterations. In this issue we present some characteristics of visual field impairment present at the patients with drusen of optic nerve head.     

视神经损伤后修复与再生的研究进展

视神经损伤后的治疗和功能恢复是医学领域的历史性难题。由于作为中枢神经系统一部分的视神经损伤后缺乏神经修复和再生所需的微环境,为此,有效的神经保护、防止神经元死亡和促进神经修复至关重要。大量研究证明:视功能的恢复与视网膜神经节细胞(retinal ganglion cells,RGCs)的损伤程度、轴浆转运物质合成功能状态、自身修复和再生能力均密切相关。近10a来,随着对神经损伤机制的深入了解,各类神经保护的研究也有了很大进展,在治疗视神经损伤方面展现出诱人的前景。我们通过阅读近年国内外相关文献,针对视神经损伤后RGCs再生及视神经保护相关实验研究和临床治疗方法作一综述。     

Idiopathic Inflammatory Neuroretinitis Simulating Optic Nerve Sheath Dural Ectasia

Abstract

We report a case of a 32-year-old female patient who presented with decreased vision on both eyes and headache. In fundus examination, both eyes had elevation of the optic disc and star shaped hard exudates in the macula. Magnetic resonance imaging was completely normal except the saccular dilatation of bilateral optic nerve sheath. The patient was treated with oral steroids following high-dose intravenous methylprednisolone. She displayed good anatomical and functional results during the follow-up. This case raises the possibility that optic nerve sheath enlargement, probably induced by an idiopathic inflammatory optic neuritis, may simulate dural ectasia of the optic nerve sheath.     

Functional visual effects of lesions located near the optic nerve head

Three patients with retinal lesions near or impinging on the optic nerve head are presented. Three different functional disruptions are demonstrated by quantitative layer-by-layer perimetry. In one, a patient who primarily exhibited subretinal neovascularization, inner retinal functions were anomalous; but the overlying nerve fiber bundle was as yet not affected. In the second patient, an individual with possible histoplasmosis causing an outer retinal/choroidal lesion, the overlying nerve fiber bundle was affected causing apparent retrograde changes in inner retinal function at remote visual field locations; but another aspect of optic nerve function (time-dependent response) was not anomalous. These apparently retrograde changes were essentially identical to functional changes previously demonstrated in patients with established open-angle glaucoma. In the third patient, with presumed toxoplasmosis, there were clear-out time-dependent anomalous responses consistent with optic nerve involvement, as previously reported in patients with optic neutitis. There were also modest, time-stable, nerve fiber bundle defects present in this third patient. Together, these results demonstrate that lesions in the area of the disc can have very different functional consequences, and that quantitative psychophysical techniques can elucidate these differences.     

The diagnostic importance of the macular color test in vascular optic neuropathies

A color-macular test is proposed for diagnosing functional changes in the optic nerve in acute vascular optic neuropathies. The diagnostic value of the test was proved in investigation of sick and clinically healthy fellow eyes of 80 patients with acute vascular optic neuropathies associated with atherosclerosis, aged from 30 to 74 years, as compared with a control group (60 persons of the same age and with the same general vascular pathology).     

OCT测量视网膜神经纤维层厚度及视盘参数在青光眼早期诊断中的应用

青光眼是一种进行性视神经疾病,它能引起视神经结构改变,最终导致不可逆的视功能损害。青光眼的早期诊断对保护视功能有重要意义。光学相干断层扫描仪是一种准确性和可重复性高的视网膜神经纤维层厚度和视盘参数检测技术,为早期诊断青光眼,监测视神经损害及指导青光眼的治疗提供了新的思路。我们主要阐述该技术在青光眼早期诊断中的应用。     

Zellul?re Begleitreaktionen bei seit 30?Jahren bestehender Siderosis N.?optici

Metal foreign bodies located in the optic nerve are a rare clinical picture and sooner or later often associated with vision loss. We report on a patient who had a foreign body in the optic nerve for 30?years. Histochemical analysis of the optic nerve after the requisite enucleation with complete functional loss of the eye revealed amazing results. Even 30?years after entry of the foreign body into the optic nerve neuronal structures with organized axons surrounded by cytoblasts, glial cells, and immunocompetent cells still remoined. These findings hold out hope and may serve as the starting point for regenerative medicine to potentially restore neuronal function.