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.     

视神经萎缩和视神经炎时VEP潜时异常的比较

目的 :比较视觉诱发电位 (VEP)检查在视神经萎缩和视神经炎两种疾病时的区别。方法 :3 7例 66眼视神经萎缩和 14厘 2 6眼视神经炎患者接受了给撤图型VEP (P -VEP)和闪光VEP (F -VEP)检查 ,其中最佳矫正视力低于 0 0 3者仅接受F -VEP检查。结果 :视神经萎缩时的P -VEP潜时均值延迟程度低于视神经炎 (P <0 0 5 ) ,但F -VEP恰好相反。视神经萎缩和视神经炎时的P -VEP和F -VEP潜时异常率分别是 74%和 65 % ,90 %和 42 % (P <0 0 5 )。视神经萎缩和视神经炎时仅在F -VEP检查时表现出潜时异常的患眼百分率 ,在全部患眼和视力低于 0 0 3患眼分别是 2 3 %和 9% ,12 %和 5 %。结论 :视神经萎缩时的P -VEP潜时延迟程度低于视神经炎 ,但F -VEP相反 ;因此 ,视神经萎缩时F -VEP联合应用的检查价值比视神经炎时高。另外 ,两种疾病时F -VEP联合应用的检查价值不仅仅在具有不能接受P -VEP检查的视力患眼中存在 ,而且在具有能接受P -VEP检查的视力患眼中也仍然存在。     

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.     

The visual evoked potential in glaucoma and ocular hypertension: effects of check size, field size, and stimulation rate

In order to determine the optimum stimulus conditions for the detection of optic nerve damage due to glaucoma and ocular hypertension, checkerboard pattern reversal visual evoked potentials (VEPs) were recorded from 20 glaucoma patients, 20 ocular hypertensive patients, and 20 age-matched normals. Two check sizes (12' and 48'), two field sizes (14 degrees and 28 degrees), and two alternation rates (1.9 and 7.5 alt/sec) were used. All subjects had visual acuities of 20/40 or better in each eye and equal pupils of 2 to 5 mm diameter. The largest number of VEP abnormalities were found with large checks (48') reversing at a fast rate (7.5 alt/sec). After correcting for the effects of age, visual acuity, and pupil size, 16 of 30 eyes with glaucomatous visual field defects had abnormally long VEP latencies under this condition (beyond the 99% confidence limit of the normal subjects). Nine of 40 ocular hypertensive eyes also had abnormally long latencies. Increased pattern VEP latency was significantly correlated with both the severity and location of visual field defects and the degree of cupping and pallor of the optic disc. VEP latency was not significantly related to intraocular pressure.     

Visual evoked potential and relative afferent pupillary defect in patients with unilateral optic neuritis]

The relationships between relative afferent pupillary defect (RAPD) and visual evoked potential (VEP), visual acuity or visual field in 14 patients with idiopathic unilateral optic neuritis, were investigated during the period of recovery from an acute episode. Grading of RAPD into four steps mainly based upon an escape phenomenon in a swinging flashlight test, was used to determine the degree of RAPD. The degree of RAPD significantly correlated with a reduction in VEP amplitude, visual acuity and loss of central visual field, while it did not correlate with delay in VEP latency. These results suggest that RAPD is mainly related to the integrity of central vision, and that grading of RAPD, as well as a comparison of VEP amplitude between the affected and contralateral eyes, is useful for an objective evaluation of visual functions of the affected eyes in patients with unilateral optic neuritis.     

视觉诱发电位在挫伤眼视神经损伤的应用

目的探讨视觉诱发电位（VEP）对挫伤眼的视神经损伤诊断和鉴定的意义。方法对单侧眼挫伤59例（59眼）进行视力检查及VEP检查，以自体健侧眼为对照。按视力与VEP结果是否相符分为两组，相符者为A组，40例，占67．80％；不相符者为B组，19例，占32．20％。分析两组间VEPP100波幅值及P100峰潜时值。结果A组中伤眼VEPP100波幅明显降低，P100峰潜时明显延长，差异有统计学意义。B组有16例证实为伪盲，另3例伤眼眼睑、球结膜肿胀减退后视力好转。结论VEP对挫伤眼的视神经损伤的诊断和鉴定有重要价值。     

Correlation between morphological and functional retinal impairment in multiple sclerosis patients.

PURPOSE: To assess whether a correlation exists between optic nerve fiber layer (NFL) thickness and the retinal or visual pathway function in multiple sclerosis (MS) patients previously affected by optic neuritis. METHODS: Fourteen patients with a diagnosis of definite MS were examined. All had been affected by optic neuritis (MSON) with complete recovery of visual acuity (14 eyes included in study). These were compared with 14 eyes from 14 age-matched control subjects. NFL thickness was measured by optical coherence tomography (OCT). Three different measurements in each quadrant (superior, inferior, nasal, and temporal) were taken and averaged. The data in all quadrants (12 values averaged) were identified as NFL Overall, whereas the data obtained in the temporal quadrant only (3 values averaged) were identified as NFL Temporal. Retinal and visual pathway function was assessed by simultaneously recording pattern electroretinograms (PERGs) and visual evoked potentials (VEPs) using high-contrast (80%) checkerboard stimuli subtending 15 minutes and 60 minutes of the visual arc (min arc) and reversed at the rate of two reversals per second. RESULTS: In MSON eyes there was a significant (P < 0.01) reduction in NFL thickness in both NFL Overall and NFL Temporal evaluations compared with the values observed in control eyes. PERG, (15-min arc checks) and VEP (15-min arc and 60-min arc checks), showed a significant (P < 0.01) delay in latency and reduction in amplitude. NFL Overall and NFL Temporal values were significantly correlated (P < 0.01) to the PERG P50 latency and P50 to N95 amplitude recorded with 15-min arc checks. No correlations (P > 0.01) between NFL values and the other electrophysiological data (PERG recorded with 60-min arc checks and VEP recorded with 15-min arc and 60-min arc checks) were found. CONCLUSIONS: There is a correlation between PERG changes and NFL thickness in MS patients previously affected by optic neuritis, but there is no correlation between VEP changes and NFL thickness.     

Fluorescein angiographic features of choroidal insufficiency in anterior ischemic optic neuropathy

Anterior ischemic optic neuropathy(AION) is known to be caused by circulatory disturbance in the anterior optic nerve(AON). Because the AON shares blood supply from the paraoptic short posterior ciliary artery with peripapillary choroid, the authors investigated the angiographic evidences of combined choroidal insufficiency in patients with acute AION. Fundus fluorescein angiograms from 30 eyes from 28 patients with acute AION were enrolled in this study. The diagnosis of acute AION was based primarily on angiographic evidences of filling delay of optic nerve head and the various clinical features, such as decreased visual acuity, visual field defects, afferent pupillary defect, and optic disc swelling. Angiographic evidences of combined choroidal filling delay were as follows: 1) circular or localized filling delay of peripapillary choroid in 15 eyes (50%), 2) generalized filling delay of posterior pole in 11 eyes (36.7%), 3) filling delay of unilateral choroid divided by watershed zone in 5 eyes (16.7%), and 4) choriocapillary filling delay in 10 eyes (33.3%). In this study, various types of choroidal insufficiency in patients with AION were observed, which helped us to differentiate AION from the other various diseases of the anterior optic nerve.     

中国人McCune-Albright综合征的临床分析

目的 探讨McCune-Albright综合征(MAS)的眼部临床特点.方法 系列病例研究.分析从2008年1月至2011年6月就诊北京协和医院眼科的6例MAS患者最佳矫正视力、视野、色觉、视网膜神经纤维层厚度、视觉诱发电位、眼底、视神经管CT扫描,多科综合治疗方法及随访结果.结果 6例MAS患者中男性3例,女性3例,就诊年龄在4～ 43岁(中位数16岁).视神经管CT扫描发现6例(12只眼)MAS患者视神经管有不同程度的缩窄,其中全周缩窄3例(6只眼)、部分缩窄3例(6只眼),视神经管全周缩窄中有2例(3只眼)发现有视神经病变,其余9只眼均未发现有视神经病变.有4例(8只眼)MAS患者视神经被不同程度拉长.结论 MAS患者视神经管有不同程度的缩窄,部分患者出现视神经病变,应当在临床上受到高度关注.     

前部缺血性视神经病变患者治疗前后多焦视觉诱发电位检测结果分析

目的 观察前部缺血性视神经病变(AION)治疗前后多焦视觉诱发电位(mfVEP)的检查结果,初步探讨其临床应用意义.方法 对AION患者90例90只眼进行mfVEP检测,分析mfVEP的二阶反应,将反应分上、下半侧视野,及鼻上、鼻下、颞卜、颞下4个象限视野;分析各反应总和波,对各区域进行比较.观察AION眼与对侧眼及AION眼治疗前后各部分的波形特征.结果 治疗前AION眼病变受累区域mfVEP P波振幅及潜伏期分别为0.198±0.033、100.197±7.354,对侧眼相应区域分别为0.271±0.024、98.567±6.794,两者比较差异均有统计学意义(t=16.556,18.330;P＜0.01).治疗后AION眼病变区域P波振幅及潜伏期分别为0.229±0.016、100.104±10.603,与治疗前相比,差异均有统计学意义(t=7.622,5.501;P＜0.01);与对侧眼相比差异均有统计学意义(t=13.649,8.858;P＜0.01).结论 mfVEP P波振幅及潜伏期能够准确反映AION患眼治疗前后局部视神经损害及恢复情况,具有良好的可重复性.可以作为AION诊断及检测预后的新方法.     

Evaluation of retinal nerve fibre layer thickness and visual evoked potentials in optic neuritis associated with multiple sclerosis

Background: The aim was to compare the retinal nerve fibre layer (RNFL) thickness and visual evoked potentials (VEP) among eyes with multiple sclerosis (MS)‐associated optic neuritis, unaffected eyes of the same patients and eyes of disease‐free controls. Changes in RNFL thickness, visual acuity (VA) and VEP over time are evaluated in MS‐associated optic neuritis. Methods: Forty‐six eyes of 23 patients (six male and 17 female), who suffer from MS and were diagnosed with unilateral or bilateral optic neuritis, participated in the study. Forty eyes of 20 age‐ and gender‐matched controls were tested. VA measurement, optical coherence tomography and VEP were performed in all patients at presentation and at one, three and six months thereafter. Results: There was a statistically significant difference in VA between MS eyes with optic neuritis and controls (p < 0.0001), as well as between MS eyes with and without optic neuritis (p < 0.005). VA improved over time. Average RNFL thickness was reduced in MS eyes with or without optic neuritis in comparison to control eyes. This reduction in RNFL thickness was more marked over time. The amplitude of P₁₀₀ was significantly decreased in MS eyes with optic neuritis in comparison to controls (p < 0.0001) and there was a statistically significant delay in peak time of P₁₀₀ in MS eyes with optic neuritis versus the eyes of normal subjects (p < 0.0001), which improved over time. Conclusion: The present study suggests that there is a progressive decrease in RNFL over time in eyes with optic neuritis associated with MS. The amplitude and latency of P₁₀₀ in VEP examination returned to normal ranges over time.     

Evidence for preserved direct pupillary light response in Leber's hereditary optic neuropathy.

AIMS/BACKGROUND--Pupillary light response is usually defective in all types of optic neuropathy. However, the authors have observed in patients with Leber's hereditary optic neuropathy (LHON) relatively normal light response, with consequent misdiagnosis psychogenic visual loss in some cases. To confirm this clinical impression, afferent pupillary defect was assessed by measurement of adjusted constriction amplitude (CA) and escape rate (ER) by infrared videopupillography (Iriscorder-C 2515). METHODS--Thirteen consecutive patients (26 eyes) with LHON (average age 27.2 years) were examined; 12 had the mitochondrial DNA 11778 mutation and one the 14484 mutation. Seven of these patients had a positive family history. For comparison, the above rates were determined in 19 patients (23 eyes) with idiopathic optic neuritis (ON; average age 35.1 years), 18 patients (19 eyes) with anterior ischaemic optic neuropathy (AION; average age 58.1 years), and 25 volunteers (50 eyes) with healthy eyes (average age 39.6 years). RESULTS--The distribution of visual acuity was essentially the same in all optic neuropathy groups. Reduction in CA and increase in ER were significant in patients with ON and AION, but not in those with LHON. Only slight afferent pupillary defect was evident even 2 years after the onset of LHON. CA in AION and ER in ON were correlated statistically with visual acuity and Humphrey mean threshold deviation, while CA and ER in LHON were not. CONCLUSION--Pupillary light response in patients with LHON obviously differs from that in patients with other types of optic neuropathy. LHON appears to be pathophysiologically characterised by well preserved afferent fibres for pupillary light response (probably from W cells). Besides being of pathogenetic interest, the detection of clinical features should facilitate the diagnosis of LHON particularly when family history provides no indication.     

Recovery of visual field defects in ischemic optic neuropathy and idiopathic optic neuritis]

Fifty-four eyes of 41 patients with optic nerve disease demonstrating acute visual field defects without any traumatic, compressive, or other known etiology were classified into four categories. Those showing poor recovery of visual field defects were ischemic optic neuropathy which was subclassified into either anterior ischemic optic neuropathy (AION) or posterior ischemic optic neuropathy (PION) according to the ophthalmoscopic changes in the optic nerve head. Those showing good recovery of visual field defects were idiopathic optic neuritis which was subclassified into either papillitis or retrobulbar neuritis according to the ophthalmoscopic pathology of the optic disc. Patients with ischemic optic neuropathy were significantly older than those with optic neuritis. All eyes with optic neuritis showed good recovery of vision, whereas those with ischemic optic neuropathy showed varying outcomes of vision. With regard to the pattern of field defect, central or paracentral scotoma was predominant in all but eyes with AION in which altitude defect predominated. Pale swelling of the optic nerve head and angiographic evidence of circulatory disturbance in the optic disc or adjacent choroid were common findings in eyes with AION, whereas such findings were never observed in eyes with papillitis. The amplitude of pattern visual evoked potential was significantly lower in eyes with PION than in those with retrobulbar optic neuritis. Four patients classified as optic neuritis developed into multiple sclerosis in the follow-up study. It was concluded that poor recovery of visual field defect is one of the most convincing evidences for the diagnosis of ischemic optic neuropathy.     

Recovery of visual function in patients with biopsy-proven giant cell arteritis

OBJECTIVE: To assess the visual function of patients with giant cell arteritis (GCA) who had visual loss from either anterior ischemic optic neuropathy (AION) or central retinal artery occlusion and had a subsequent improvement in visual acuity after treatment with corticosteroids. DESIGN: Retrospective, observational case series. PARTICIPANTS: Thirty-two consecutive patients with biopsy-proven GCA treated at one institution between January 1992 and December 1997. INTERVENTION: Treatment with intravenous methylprednisolone 250 mg every 6 hours for 3 days, followed by oral prednisone 1 mg/kg daily for at least 4 weeks duration. MAIN OUTCOME MEASURES: The number of patients with an improvement in visual acuity after treatment with intravenous methylprednisolone; neuro-ophthalmic evaluation, including visual acuity, funduscopy, and visual field examination of these patients. RESULTS: Improvement in visual acuity occurred in 5 of 39 eyes (13%) with visual loss from biopsy-proven GCA, and all 5 patients had AION. Despite the improvement of visual acuity in these 5 patients, perimetry revealed marked constriction of the visual field in each affected eye. CONCLUSIONS: The prognosis for visual improvement in GCA is poor. Although an improvement in visual acuity occurred in 5 of our patients, marked constriction of the visual field was present in all of them.     

Optic nerve dysfunction in familial dysautonomia

We examined 12 patients with familial dysautonomia who had clear corneas to determine if there was any optic nerve involvement. The patients ranged in age from 6 to 34 years. Visual acuity ranged from 20/20 to 20/100. Nineteen eyes of 12 patients (79%) had abnormal (mean +/- 3 S.D.) pattern reversal visual-evoked potentials as compared to 50 control eyes (P100 = 98.8 msec; S.D., +/- 4.5 msec). P100 latency appeared to worsen with age. Exodeviation was present in seven patients (58%) and correlated with visual acuity and P100 latency. Ophthalmoscopic examination showed some degree of optic nerve pallor in all eyes.     

弥散张量成像在急性后部缺血性视神经病变诊断中的应用价值

目的　探讨弥散张量成像（DTI）在急性后部缺血性视神经病变(PION)诊断中的应用价值。 方法　选取30例急性PION患者进行双侧视神经的DTI及视觉诱发电位（VEP）检查,分别测量双眼视神经各向异性分数（FA）、表观扩散系数（ADC）及VEP参数P100潜化期和波幅。采用配对样本t检验对患眼及健眼DTI及VEP参数测量结果进行比较,并采用Pearson分析患眼视神经VEP参数与DTI参数之间的相关性。结果　30例急性PION患者患眼视神经的FA及ADC分别为0.383±0.050、(1596.93±144.07)×10^-6 mm²·s^-1,健眼视神经的FA、ADC分别为0.636±0.080、(1197.80±93.09) ×10^-6 mm²·s^-1;与健眼相比,患眼视神经FA明显下降,ADC升高,差异均有统计学意义（t=-14.53、11.54,均为P<0.01）。患眼与健眼VEP参数P100潜伏期分别为（135.38±7.51）ms、(96.76±6.35）ms,波幅分别为（4.79±1.15）μV、 (10.05±1.45）μV;与健眼相比,患眼VEP参数P100潜伏期明显延长、波幅明显降低,差异均有统计学意义（t=21.67、-15.19,均为P<0.01）。患眼视神经DTI参数FA与VEP参数P100潜伏期呈负相关（r=-0.540, P<0.01）,与P100波幅呈明显正相关（r=0.662,P<0.01）;患眼视神经DTI参数ADC与P100波幅呈明显负相关（r=-0.711,P<0.01）,与P100潜伏期无相关性（r=0.234,P＞0.05）。结论　DTI能够早期发现急性PION患者视神经的弥散障碍,能够为其早期诊断提供影像学依据。     

Electroretinogram and visual-evoked potentials in children with optic nerve coloboma

The aim was to evaluate alterations in Visual-Evoked Potentials (VEP) and Electroretinogram (ERG) and discover whether these tests are useful for determining residual visual acuity in cases where a patient is unable to collaborate. Flash and, when possible, Transient Pattern Reversal Visual-Evoked Potentials and Maximal Response ERG were recorded in 8 children (under three years old) affected by different aspects of optic nerve coloboma. None of them had visual acuity evaluated because of poor collaboration. All examinations were carried out using skin electrodes. Amplitude of the a and b component of ERG, amplitude, morphology and latency of the major components of Flash VEP and amplitude and latency of P100 Pattern Reversal VEP were evaluated. Four of the patients were examined three years later and visual acuity was compared with the previous electrofunctional results. Alterations in ERG were found only in the case of significant retinal anomalies (great coloboma, retinal detachment), huge alterations were found in both Flash VEP and in Pattern Reversal VEP. The retrospective study of VEP traces and visual acuity showed a good correlation between electrofunctional data and visual capability. Electrofucntional examinations can identify important conductive retinocortical anomalies. The possibility of correlating electrophysiological results with residual visual acuity is important for rehabilitative management in such optic disc malformations. This revised version was published online in July 2006 with corrections to the Cover Date.     

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。     

降眼压治疗对前部缺血性视神经病变PVEP的影响

目的 研究降眼压治疗对前部缺血性视神病变图形视诱发电位（PVEP）的影响。设计 回顾性比较性病例系列。研究对象 2008-2011年甘肃省第二人民医院住院的前部缺血性视神病变68例（68眼）,非眼压干预30例（30眼）、眼压干预38例（38眼）。方法 眼压干预组患者在发病时用药物降低眼压≥8 mm Hg或降低眼压≥30%。对两组患者患眼治疗前后的PVEP指标变化进行比较。主要指标 PVEP P100潜伏期、P100振幅。结果 眼压干预组P100潜伏期（93.82±1.97 ms）比非眼压干预组（对照组）（112.38±1.45 ms）短（t=46.36, P＜0.001）;眼压干预组P100振幅（3.64±0.23 μv）比非眼压干预组（3.14±0.26 μv）高（t=8.76, P＜0.001）。结论 降眼压治疗对前部缺血性视神病变PVEP有明显的利好作用。（眼科, 2012, 21: 316-318）     

严重视神经损伤后视觉诱发电位变化分析

目的 利用视觉诱发电位（ＶＥＰ）判断严重神经损伤的预后。方法 回顾分析３０例严重视经损伤的ＶＥＰ检测及临床治疗资料,按伤后视力分为Ａ、Ｂ两组,统计学分析两组ＶＥＰ变化及治疗效果。结果 闪光视诱发电位（ＦＶＥＰ）是两组差异显著的指标,Ａ、Ｂ组ＦＶＥＰ平均波幅下降率分别为７９％、４３％,治疗后有效率分别为１３％、８０％,两组间存在显著差异（Ｐ〈０．０１）。结论 ＦＶＥＰ对于判断严重视神经损伤的视力预后