Non-arteritic ischemic optic neuropathy (NAION) is a neurological disease due to poor perfusion in optic disk. It causes severe visual function impairment, characterized by loss of vision and visual field defect. Optical coherence tomography (OCT) is vital for detecting anterior laminar depth, peripapillary nerve fiber layer thickness, ganglion cell complex thickness and peripapillary choroid thickness change in eyes with NAION at different course of the disease. In addition, OCT features are in accordance with visual function impairment. OCT angiography (OCTA) reveals retinal and choroidal vasculature networks in optic and macular area. OCTA revealed vasculature perfusion decline in eyes with NAION, even if their visual sensitivity and visual evoked potential were normal. Studying OCT and OCTA features is vital for exploring the pathogenesis and prognosis of NAION.
Objective To observe the characteristics of multifocal microperimetry and its relationship with visual acuity and multifocal ganglion cell complex (GCC) in nonarteritic anterior ischemic optic neuropathy (NAION). Methods A retrospective case study. A total of 38 patients (54 eyes) with NAION were enrolled in this study. 25 NAION eyes (25 patients) and 29 contralateral health eyes (29 patients) were randomly selected into case group and control group respectively. All eyes underwent best corrected visual acuity (BCVA), slit lamp microscope, indirect ophthalmoscope, color fundus photography, optical coherence tomography (OCT), visual field and multifocal microperimetry. Logarithm of the minimum angle of resolution (logMAR) was used to calculate BCVA. There were no significantly differences on age (t=−0.647), gender, dominant eyes ( χ2=0.128, 0.099), intraocular pressure (t=0.376) between two groups (P>0.05). Macular GCC thickness, superior and inferior GCC thickness were measured by OCT, focal loss volume (FLV) and global loss volume (GLV) were obtained at the same time. Microperimetry were measured by macular integrity assessment instrument (MAIA microperimetry), and mean retinal sensitivities (MS) in macular area 10° and fixation rate in the macular central 2° and 4° were determined. The relationship between MS, macular GCC and BCVA were analyzed by Spearman correlation analysis. Results The mean logMAR BCVA of case group and control group were 0.68±0.79 and 0.07±0.06, respectively. There was significantly statistical difference in MS between two groups (t=−2.507, P=0.037). There were no significantly statistical difference in mean GCC (t=−1.245, P=0.259), superior and inferior GCC (t=−1.336, −1.024; P=0.230, 0.346), FLV (t=1.058, P=0.331) and GLV (P=0.182) between two groups. The correlation between BCVA and MS (r=−0.809, P=−0.005) was observed. However, there were no correlation between BCVA and GCC, superior and inferior GCC, FLV, GLV (r=−0.98, −0.466, −0.061, 0.442, 0.442; P=0.817, −0.244, 0.885, 0.273, 0.273). And also, there were no correlation between MS and GCC, superior and inferior GCC, FLV, GLV (r=0.238, 0.524, 0.286, 0.643, −0.619; P=0.570, 0.183, 0.493, 0.086, 0.102). Conclusions MS reduced in early stage NAION eyes, which did not correlate with macular GCC.
Objective To observe the therapeutic effect of ai-weizhi on anterior ischmic optic neuropathy (AION). Methods In 58 patients (60 eyes) who were diagnosed as with AION, 29 patients (30 eyes) underwent intravenous drip with ai-weizhi (1200 mg/d) (treatment group), and the other 29 patients (30 eyes) underwent intravenous drip with 1-2 kinds of thrombolytic coagulant or vasodilator (once per day) (control group) with the period of treatment of 15 days. In the control group, ocular local injection, including gluco-corticosteroid and 654-2 behind or beside the eyeball injected once per day or every 2 days for 3-5 times, was perfomed on 20 eyes simultaneously. The changes of visual acuity and ocular fundus of the patients after injection were recorded, and the visual field was counterchecked in the patients who had underwent the examination before the treatment. Results The visual acuity was better in treatment group than which in control group with a significant difference (t=2.74, Plt;0.01). The visual acuity in treatment group didnprime;t differ much from which in the control group 3 days after treatment (t=1.34, P＞0.05). At the 5th、10th and 15th day after treatment, the visual acuity was better in treatment group than which in control group with a significant difference(t=2.01, Plt;0.05; t=2.07, Plt;0.05；t=2.74, Plt;0.01). In 15 eyes in control group which had undergone examination of visual field, the visual field improved in 13 (87.00%) and of remained still in 2 (13.00%). In 13 eyes in treatment group which had undergone examination of visual field, the visual field improved in 4 (31.00%) and remained still in 9 (69.00%). There was a significant difference between the two groups (chi;2=9.66, Plt;0.01). Conclusion Ai-weizhi is efficacious in treatment of AION. (Chin J Ocul Fundus Dis, 2006, 22: 97-99)
Objective To analyze the clinical features of retinal detachment in macular spontaneous hemorrhage to improve the level of diagnosis and treatment of this disease. Methods The serial clinical data of 23 patients (23 eyes) with subretinal hemorrhage in macular region with the area over 4DDtimes;5DD who were diagnosed in our hospital from Sep, 1998 to Mar, 2003 were analyzed retrospectively. The patients included 12 males (12 eyes) and 11 females (11 eyes) with the average age of 64.1 (47-75). Fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and B-scan examination were performed on the patients to analyze the pathogenic factors, and the visual acuity and manifestation of ocular fundus were observed during the 8-24 months followed-up period. Results The visual acuity decreased to less than 0.2 or light perception suddenly in all affected eyes. In 23 eyes, choroidal neovascularization (CNV) of age-related macular degeneration (AMD) was found in 7, polypoidal choroidal vasculopathy (PCV) was in 5, retinal macroaneurysm was in 2, and unknow pathogenic factor in 9. Among the 23 eyes, hemorrhage was absorbed and no cicatritial formation at the fovea in 3 eyes with the visual acuity of 0.4-0.8; scar and pigment proliferation in the hemorrhage area were seen in 12 eyes with the visual acuity of finger counting (FC) to 0.2; combined vitreous hemorrhage was found in 8 eyes, including massive scar in the macular area in 3 who had undergone vitrectomy with the visual acuity of FC/66cm to 0.2 and blindness in the other 5 eyes. Conclusion Spontaneous hemorrhagic retinal detachment always arises in old people whose symptoms were sudden decrease or loss of the visual acuity. The configuration of the hemorrhage is local and diffuse. The prognosis of the visual acuity of most of the patients is poor due to the serious tissue injury in macula area. (Chin J Ocul Fundus Dis, 2006, 22: 228-231)
ObjectiveTo observe the characteristics of multifocal eletrotetinogram (mfERG) in nonarteritic anterior ischemic optic neuropathy (NAION) and its relationship with visual acuity and macular central retinal thickness (CRT). MethodsBy means of patients self-contrast analysis. 40 patients (40 eyes) with NAION were collected underwent the examinations of best corrected visual acuity, fundus color photography, fundus fluorescein angiography and field of vision. All the disease and normal eyes had underwent the examination of frequency-domain optical coherence tomography (fdOCT) and mfERG. The CRT and retinal thickness about perifovea, parafovea were documented with fdOCT. All patients underwent the retinal macular function exam with mfERG. Centered by macular fovea, the reaction zone were divided into 5 rings from inside to outside by circles, ring 1 0.00°, ring 2 5.44°, ring 3 10.31°, ring 4 16.31°, ring 5 23.42°. Treated ring 1 hexagon as macular center, the amplitude densities of P1 wave, the amplitude of P1 and N1 wave, and the latencies of P1and N1 wave at every ring were observed. The relationship between mfERG characteristics and visual acuity or CRT were analyzed by Spearman correlation analysis. ResultsfdOCT revealed that there was significantly statistical difference in the retinal thickness about perifovea between disease eyes and contralateral eyes (P < 0.05). The increase of CRT and retinal thickness about parafovea had no significantly statistical difference between diseases eyes and contralateral eyes (P > 0.05). mfERG revealed that the decrease of amplitude densities about P1 wave at ring 1 to 2 had significantly statistical difference between two groups (P < 0.05); there were no significantly statistical difference in the amplitude densities of P1 wave at ring 3 to 5; the decrease of amplitude about P1 and N1 wave at ring 1 had significantly statistical difference between two groups (P < 0.05). There was no significantly statistical difference in the amplitude of P1 and N1wave at ring 2 to 5, the latencies of P1 and N1 wave at ring 1 to 5 (P > 0.05). The correlation analysis revealed that the amplitude densities and amplitude of P1 wave at ring 1, amplitude of N1 wave at ring 1 had no effect on visual acuity (r=-0.087, 0.195, -0.134; P > 0.05) and CRT(r=-0.154, 0.365, 0.412; P > 0.05). ConclusionsCompared with contralateral eyes, the disease eyes were significantly decrease in amplitude densities of P1 wave at ring 1 to 2, amplitude of P1 and N1 wave at ring 1.There are no correlated between the amplitude densities of P1 wave at ring 1, amplitude of P1 and N1 wave at ring 1 and visual acuity or CRT.
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.