Objective To observe the efficiency and security of enhanced external counter pulsation (EECP) as an adjunctive therapy for nonarteritic anterior ischemic optic neuropathy (NAION). Methods This was a retrospective casecontrol study. Forty-eight patients (48 eyes) with NAION were enrolled in this study. Thirty-two patients (32 eyes) who had been treated with blood vessel dilation and nerve nutrition drugs comprised the medicated group. Sixteen of the patients (16 eyes) in the medicated group were treated with EECP combined with blood vessel dilating and nerve nutrition drugs as EECP group. The differences were not statistically significant between groups in gender(chi;2=0.000), age (t=1.096), course (t=1.613) and visual acuity (chi;2=0.000,P＞0.05). EECP was done once a day, one hour per time, five times a week. Fourteen eyes were treated 12 times EECP and two eyes were treated 36 times EECP within the EECP group. Systemic and ocular side effects were observed during EECP treatment. Corrected visual acuity was examined after treatment and the differences of visual acuity between medicated group and EECP group treated six times and or 12 times with EECP treatment were analyzed. The correlation of visual acuity level, and course, and acuity before treatment were analyzed. A significant improvement in visual acuity was defined as a sustained improvement of three or more visual acuity gradations. An effective of treatment was defined as a sustained improvement of two or less visual acuity gradations. No effective of treatment was defined as visual acuity dropped or showed no progress. Results After six treatments of EECP, within the 16 eyes of EECP group, two eyes achieved significant improvement, five eyes had effective improvement, and nine eyes did not show any improvement. Within the 32 eyes of medicated group, three eyes achieved significant improvement, eight eyes had effective improvement, and 21 eyes did not show any improvement. There was no statistically significant difference in vision between the two groups (chi;2=0.404,P＞0.05). After 12 treatments of EECP, within the 16 eyes of EECP group, six eyes achieved significant improvement, nine eyes had effective improvement, and one eye did not show any improvement. Within the 32 eyes of medicated group, four eyes achieved significant improvement, 10 eyes had effective improvement, and 28 eyes did not show any improvement. The difference was statistically significant comparing the vision level between the two groups (chi;2=11.621,P＜0.05）. The curative effect of patients negatively correlated with course of the disease (r=-0.860，P＜0.05), but positively correlated with visual acuity before treatment (r=1.380,P＜0.05). Skin bruises, hematoma, new retinal bleeding and other side effects did not occur in patients during EECP treatment. Conclusions Many time therapy of EECP can improve vision of NAION patients. There is no local and general complications after a certain number of therapy.
Objective To observe the effect of lowering intraocular pressure(IOP) treatment on ocular hemodynamics in patients with nonarteritic anterior ischemic optic neuropathy (NAION). Methods A total of 68 patients with NAION (68 eyes) were enrolled in this study. The patients were randomly divided into treatment group (38 eyes of 38 patients) and control group (30 eyes of 30 patients). All the patients were received methylprednisolone pulse therapy (200 mg, three days), vasodilator therapy with intravenous infusion of Xueshuantong solution (300 mg), optic nerve nutritional therapy with mouse nerve growth factor (30 mu;g) and acupoint injection in temporal with compound anisodine (2 ml). The total course was 10 days. The patients of treatment group received IOP lowering treatment to reduce the IOP to ge;8 mm Hg (1 mm Hg=0.133 kPa) or in a 30% reduction. The patients of control group received no IOP lowering treatment. The peak systolic velocity (PSV), pulsatility index (PI) and resistance index (RI) of ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (PCA) before and after treatment were comparatively analyzed by color doppler flow imaging. Results The differences of PSV (t=1.023, 1.145, 0.569), PI (t=0.679, 0.956, 1.634) and RI (t=0.816, 1.657, 0.998) of OA, CRA and PCA before treatment in treatment group and control group were not statistically significant (P＞0.05). Compared with before treatment, PSV (t=3.150, 7.650, 3.520) and PI (t=2.420, 5.430, 7.650) of OA, CRA and PCA increased obviously (P＜0.05), RI of OA, CRA and PCA decreased obviously (t=5.320, 9.640, 18.360;P＜0.05) after treatment in treatment group. In control group, the differences of PSV (t=2.090, -2.550, -2.100) and PI (t=-2.310, -2.230, -4.490) of OA, CRA and PCA between before and after treatment were not statistically significant (P＞0.05); but the differences of RI of OA, CRA and PCA between before and after treatment was statistically significant (t=2.970, 2.160, 2.690;P＜0.05). Compared with control group, PSV (t=2.632, 2.135, 5.364) and PI (t=3.251, 2.432, 4.243) of OA, CRA and PCA increased obviously (P＜0.05), RI of OA, CRA and PCA decreased obviously (t=3.664, 2.938, 4.324;P＜0.05) after treatment in treatment group. Conclusion Lowering intraocular pressure treatment can improve the ocular hemodynamics in NAION patients.
Objective To learn the hotspots of study in ischemic optic neuropathy (ION). Methods Literature on ION published in January 2000 to July 2012 was identified in Pubmed database. MeSH terms that frequently appeared were identified and co-word analysis was carried out by cluster analysis. Then a network was drawn using social network analysis. Results A total of 1045 papers were included. The United States, England, Germany, France and Netherlands together accounted for 71.53% (748) of the articles. There were 28 high-frequency MeSH terms and hot topics clustered into four fields. The appearance frequency of MeSH showed that most research focused on: (1)postoperative or arteritic ION; (2)epidemiology, pathology and diagnosis of ION; (3)pathophysiology and therapy of ION; (4) chemically induced ION. Conclusion The international main research focus of ION includes four fields, which may provide reference or scholars both in scientific research and clinical research.
Objective To observe the clinical characteristics and therapeutic effects of carotid artery stenosisrelated ocular ischemic appearance(OIA).Methods The clinical data of 210 patients of carotid artery stenosis (81 of them with OIA) were retrospectively reviewed. They were diagnosed by color doppler image（CDI）or digital subtraction angiography (DSA),and had undergone medicine,carotid artery stenting (CAS)and carotid endarterectomy (CEA). Of 81 patients with OIA,49 patients (60.49%) with OIA only, 32 patients（39.51%）with ocular ischemic disease (OID).24/32 OID patients received ophthalmic treatment such as retinal laser photocoagulation and anti glaucoma therapy (drugs and cyclocryotherapy). Results The ocular manifestations of 81 OIA patients included transient amaurosis in 38 cases (47.14%),flash before the eye in 30 cases (36.67%), periorbital swelling and pain in 28 cases (34.57%), diplopia in 11 cases (13.58%) and vision loss in 9 cases (11.11%). The ocular manifestations of 32 OID patients included ischemic optic neuropathy in 9 cases (28.13%), ocular ischemic syndrome in 6 cases (18.75%), central or branch retinal artery occlusion in 6 cases (18.75%), retinal hemorrhage in 5 patients (15.62%)，extraocular muscle paralysis in 4 patients (12.50%) and neovascular glaucoma in 2 patients (6.25%). The higher the degree of carotid stenosis,the higher incidence of ocular ischemic disease,there was highly positive correlation between each other (R=0.837, P＜0.05).The total effective rate of carotid artery stenting and carotid endarterectomy was significantly higher than drug treatment alone (t=2.73, 3.14; P＜0.01). Conclusion The ocular manifestations of carotid stenosis related ocular ischemic appearance can be transient amaurosis, eyes flashing,eye redness,periorbital pain, diplopia and decreased visual acuity.The ocular manifestations of carotid stenosisrelated ocular ischemic disease can be ischemic optic neuropathy, ocular ischemic symptoms, central or branch retinal artery occlusion and neovascular Carotid artery stenting and carotid endarterectomy are more effective than drug treatment alone for those patients.
Objective To observe the characteristics of fundus fluorescein angiography（FFA）and optical coherence tomography（OCT）in nonarteritic anterior ischemic optic neuropathy (NAION),and investigate its relation with visual acuity and course of disease.Methods The clinical data of 47 patients (47 eyes) with NAION were retrospectively analyzed. All the patiens had undergone visual acuity，fundus and visual field examination，meanwhile FFA and OCT were carried out at first visit. FFA and visual field were carried out by routine. OCT was carried out by line and circle shape scanning in macula and optic disc. Thirtyfive NAION patients were checked with OCT at half, one, two, three and six month after onset in respectively. Take the healthy fellow eyes of 36 NAION patiens as control group.The FFA,visual field,OCT characteristics and relation with visual acuity and course disease were comparatively analyzed.ResultsFFA showed that all the eyes appear as delayed filling of the optic disc in early stage and hyperfluorescence leakage of the optic disc in late stage，besides hyperfluorescence presented to macular area in 24 eyes. OCT showed that optic papilla swelling and physiological depression narrow or nearly disappearance, neuroepithelial layer thickening or neuroepithelial layer eminence and subretinal fluidity area opaca between optic disc and macula. There were 14 eyes with normal physiological depression and 22 eyes with small physiological depression or non physiological depression in control group. Half month after onset，the neuroepithelial layer thickness of macula fovea, the maximum thickness of neuroepithelial layer between optic disc and macula，and the average retinal nerve fiber layer（RNFL）thickness in NAION group were higher than those in the control group，the difference were statistically significant (F=6.51，26.12，75.49；P＜0.05).Two months after onset，the maximum thickness of neuroepithelial layer between optic disc and macula, the average RNFL thickness, and the RNFL thickness of temporal optic disc in NAION group were significant thinner, but the elevated height of the optic disc in NAION group were near those of the control group. Three months after onset，the average RNFL thickness and the RNFL thickness of temporal optic disc in NAION group decreased continually, they were lower than those of the control group, the difference were statistically significan（F=75.49，37.92；P＜0.05）.Visual field showed that inferior defect were found in 21 eyes (45%). With progress, the superior RNFL thickness obviously decreased, coincidence with appearance of visual field. It indicate that the superior optic atrophy serious. Visual acuity had significant negative correlation with the neuroepithelial layer thickness of macula fovea, the neuroepithelial layer maximum thickness between optic disc and macula, the average RNFL thickness, the RNFL thickness of temporal optic disc(r=-0.394,-0.424,-0.412,-0.464；P＜0.05).Conclusions FFA showes that hyperfluorescence leakage appearanced in part macula. OCT showes that RNFL becomes thinner as the disease duration increases. The results of OCT and visual field examinaion in the configuration of optic disc and changes of RNFL are accordant.
Objective To observe the relationship between shallow optic cup，small disc and occurrence in patients with nonarteritic anterior ischemic optic neuropathy (NAION).Methods Ninetysix patients（96 diseased eyes）who accorded with the diagnosis criteria for NAION，with duration ge; three months and optic disc edema in paracmasis were selected. The fellow eyes of 96 NAION patients and 80 normal eyes were selected in our study. The horizontal and vertical disc and cup diameters，optic cup depth, and peripapillary retinal nerve fiber layer (RNFL) thickness were measured by quot;crossquot; and quot;ringquot; scan of optical coherence tomography (OCT，Humphrey 2000，German Carl Zeiss Company) inspection system. The cup depth were classified four grades by cup shape according to OCT images：GradeⅠ，bottom of optic cup above the anterior plane of peripapillary neuroepithelial layer（PNL）；GradeⅡ，bottom of optic cup above the plane of PNL；Grade Ⅲ，bottom of optic cup between the plane of PNL and choroidal pigment epithelium；Grade Ⅳ，bottom of optic cup under the plane of choroidal pigment epithelium connection. The grades of optic cup and value in three groups were statistically analyzed. The follow up ranged from six months to three years.Results The disc diameter in horizontal scanning of diseased eyes，fellow eyes and normal eyes were (1.29plusmn;0.19), (1.32plusmn;0.17), (1.40plusmn;0.15) mm，and diameters in vertical scanning were (1.52plusmn;0.14), (1.49plusmn;0.17), (1.60plusmn;0.22) mm, respectively. Compared the diseased eyes and fellow eyes with normal eyes，the difference were statistically significant in horizontal scanning (t=4.291,3.315; P＜0.05) and in vertical scanning (t=2.812, 3.654; P＜0.05). Compared the diseased eyes with fellow eyes，the difference of average diameter were not statistically significant in horizontal and vertical scanning (t=1.153,1.335; P＞0.05). Of the diseased eyes，GradeⅠoptic cup in 36 eyes（37.50），Grade Ⅱ-Ⅲoptic cup in 52 eyes（54.17%），Grade Ⅳoptic cup in eight eyes（8.33%），and GradeⅠ-Ⅲ optic cup in 88 eyes（91.67%）were found. Of the fellow eyes，GradeⅠoptic cup in 18 eyes（18.75%），Grade Ⅱ-Ⅲoptic cup in 69 eyes（71.88%），Grade Ⅳoptic cup in nine eyes（9.34%），and GradeⅠ-Ⅲ optic cup in 87 eyes（9066%）were found. Compared the average RNFL thickness of diseased eyes with the fellow eyes and normal eyes，the differences were statistically significant in temporal, upper, nasal, lower quadrant(t=12.862，10.147，15.046，8.180，12.859，9.562，12.174，8.632；P＜0.001). Compared the average RNFL thickness of the fellow eyes and normal eyes，the differences were not statistically significant in all quadrants（t=1.040，1.576，1.062，1.192；P＞0.05）. During the followup，eight eyes with recurrence which optic cup were GradeⅠand Ⅱin diseased eyes；44 eyes（45.8%）occurred NAION. Correlation analysis showed that there was negative correlation between incidence of fellow eye and optic cup depth(t=-0.757, P=0.000). Conclusion Optic cup and disk in NAION patients are smaller than that in the normal，the anatomical characteristics of shallow cup and small disc was one of the NAION pathogenesis.
The characteristics of nonarteritic anterior ischemic optic neuropathy (NAION) include sudden decline of visual acuity, sectorshaped visual field defect connected with the physiological blind spot or hemivisual field defect, and optic disc edema.Early angiographic abnormalities of optic disc and peripapillary choroidal circulation are important cues for the diagnosis. Angiography combined with visual field test can make the diagnosis more accurate. The pathological mechanism and process of NAION and ischemic cardiovascular/cerebrovascular disease are essentially the same. There are several critical issues in this field we need focus on,including strengthening the cooperation with relevant professional disciplines; improving the ocular ischemia through drugs, intervention and other means; preventing more serious cardiovascular events and intervening in a number of highrisk populations to reduce the incidence of AION.
Objective To establish an rat model of the Anterior Isc hemic Optic Neuropathy (rAION), and identify its reliability by observing the fundus, fluorescein fundus angiography (FFA),optical coherence tomography (OCT), v isually evoked potential (VEP) and histopathology. Methods Thirty male Sprague-Dawley rats were randomly divided into group Naive with 5 rats, group Laser with 5 rats, group hematoporphyrin derivative(HPD) with 5 rats, group rAION with 15 rats. All of the right eyes were the experimental eyes and the left ones were the control. after administration of HPD in rats` vena caudalis. The rats in group Laser were treated with a krypton red 647nm/2/3disc spot laser for 120 seconds, the rats in group HPD were treated by administration of HPD in rats` vena caudalis, and the rats in group Na?ve were not treated. Results From 1 day to 6 day s after rAION induction, the ON was pale and swollen in the superior part. The ON at 90 days after induction was pale and shrunken.30 minutes after rAION induction, hyperfluoresc ence appeared in the superior part of the optic disc, and the hypofluorescence in the 23rd day. In early FFA, hypofluorescence appeared at the ischemic area of the optic disc, and in midst and later stage the ischemic area revealed hyperflu orescence in the 1st day after rAION induction, the hypofluorescence in midst and later stage in the sixth day after r-AION model. The latent period of F-VEP expanded. The amplitude cut down in the 1-2 days after r-AION induction and did not changed in 35nd day. The surface of optic disc showed higher and rougher tha n the surface of retina in the 6th day after r-AION induction in OCT. After fixation and hematoxylineosin staining of 6-mu;m sections, in high power field the o pt ic disc showed edema with the displacement of retina surrounding the disc 1 day after treatment. Rarefaction and degeneration in the nerve fiber of retina and r eduction of the number of nuclei of ganglion cells in the 23st day after the mod el induction, and the thinning of nerve fiber of the optic disc and its surround ings. In contrast, there was no change in group Na?ve, group Laser and group HPD. Conclusions The r-AION model is like the human AION in fundus, FFA, OCT, VEP and histopathology. The rAION model provides the ischemic changes of occurrence of AION, and is helpful for the fundamental study of the AION. (Chin J Ocul Fundus Dis,2008,24:90-94)
Objectives To evaluate the risk factors of nonarteritic a nterior ischemic optic neuropathy（NAION）in a population of China and to provide theory basis for clinical decision. Methods Demographic features and clinical data of NAION were recorded. Cerebral infarction (CI) patients were also collected as control group. Systemic evaluations including whole blood chemical test, brain MRI, carotid artery ultrasound and fundus photography were perfor med in NAION and CI patients. The fundus photography and cup/disk ratio were als o acquired in a healthy controlgroup with matched age and gender. Statistical a nalysis was done by SPSS11.5 software. Results Thirtyeight N AION patients and 40 CI patients with intact data were included. Fundus photography and cup/disk ratio were acquired in 41 healthy individuals. No statistically significant difference regard to incidences of diabetes, male gender and lipid metabolic abnormalities was found between NAION and CI patients (Pgt;0.05). H ypertension, clinical and subclinical cerebral vascular disease and carotid ar tery stenosis were statistically more commonin CI patients than in NAION patien ts (Plt;0.01, 0.05). Cup/disk ratio was statistically significant smaller in NAION than in CI patients while no statistical difference (Pgt;0.05) was fo und between the CI group and healthy individuals. Conclusions NAION shared similar risk factors with cerebral infarction, but exposure of these risk factors was different between NAION and cerebral infarction. Hypertension , cerebral vascular disease and carotid artery stenosis were more common in cere bral infarction while diabetes, male gender and lipid metabolic abnormalities were similar. Small cup/disk ratio was an independent and the most important risk factor for NAION. (Chin J Ocul Fundus Dis,2008,24:86-89)