ObjectiveTo evaluate the occurrence of nocturnal hypotension (NHP) in nonarteritic anterior ischemic optic neuropathy (NAION). MethodsA evidence-based medicine study. Chinese and English as search terms for NAION and NHP was used to search literature in PubMed of National Library of Medicine, Embase, Web of science, Cochrane Library, Clinical Trials, Wanfang, and China National Knowledge Infrastructure and China Biology Medicine disc. Incomplete or irrelevant literature and review literature were excluded. The literature was meta-analyzed using Review Manager 5.4 and STATA 15.0. The 95% confidence interval (CI) were selected as the estimated value of effect size, the occurrence of NHP in NAION was calculated, and sensitivity analysis and publication bias analysis were also performed to assess the robustness of pooled outcomes. ResultsAccording to the search strategy, 159 articles were initially retrieved, and 8 articles were finally included for meta-analysis, three prospective studies and five retrospective studies. The occurrence of NHP in NAION was 43% (95%CI, 0.36-0.50). Sensitivity analyses confirmed that the evidence was robust. Subgroup analyses showed that the occurrence of NHP in NAION nearly the same in White patients (47%, 95%CI 0.39-0.55) and Chinese patients (41%, 95%CI 0.32-0.51). The occurrence of NHP in NAION was higher in using night mean artery pressure (45%, 95%CI 0.31-0.60) as the diagnostic criteria than using night systolic blood pressure & night diastolic blood pressure (40%, 95%CI 0.32-0.50). ConclusionsThe occurrence of NHP in NAION was 43%; the occurrence was similar in patients of different ethnicities. The diagnosis rate could be improved by using nMAP ＜ 70 mm Hg (1 mm Hg=0.133 kPa) as a diagnostic criterion for NHP. Careful intervention should be taken for the blood pressure of patients with NAION and NHP.
ObjectiveTo observe the changes in blood flow density of radial retinal peripapillary capillary (RPC) around the optic disc in patients with non-arteritic anterior ischemic optic neuropathy (NAION) at different stages of the continuous course of the disease. MethodsA prospective cohort study. From January to December 2020, 29 cases of 29 eyes of NAION patients diagnosed in the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine were included in the study. Among them, there were 18 males with 18 eyes and 11 females with 11 eyes. The average age was 53.62±6.67 years old. The affected eye underwent routine eye examination and visual field, optic cohenrence tomography angiography (OCTA) examination. Visual field inspection was performed to obtain the average visual mean defect (MD) value. OCTA was used to measure the thickness of the peripapillary retinal nerve flayer (pRNFL) around the optic disc, the whole en face image vessel density (wiVD), intro disc vessel density (diVD), RPC blood flow density around the optic disc, and macular ganglion cell complex (GCC). The course of disease ≤3 weeks was defined as the acute phase; 4-12 weeks was defined as the subacute phase; ＞12 weeks was defined as the chronic phase. The changes of visual field MD, optic disc RPC blood flow density, pRNFL thickness and macular GCC thickness were observed in the acute, subacute and chronic phases (12-24, ＞24 weeks). A completely randomized design of variance analysis was used to compare the differences in visual field MD, RPC blood flow density, GCC, and pRNFL thickness in different courses. Pearson correlation analysis was used to analyze the correlation between pRNFL thickness, macular GCC thickness, visual field MD changes and RPC blood flow density around the optic disc sex. ResultsThe wiVD of the eyes in the acute phase, subacute phase, and chronic phase (12-24 weeks, ＞24 weeks) were (44.96±2.76)%, (41.50±3.49)%, (39.08±5.43)%, (38.56±6.48)%. There was a statistically significant difference in wiVD of eyes with different disease courses (F=8.939, P＜0.001). The average difference of wiVD between 12-24 weeks and ＞24 weeks in the chronic phase was －0.984, and the difference was not statistically significant (P＞0.05). There was no statistically significant difference in diVD of patients with different courses of disease (F=1.079, P=0.365). The blood flow density of RPC around the optic disc of the affected eye, except for the lower part, the blood flow density of the nasal side, the temporal side, and the upper quadrant, decreased significantly with the progression of the disease, and the difference was statistically significant (F=8.816, 6.069, 8.943; P＜0.05). In the chronic phase, the average difference of blood flow density between the nasal, temporal, and upper sides of the eyes between 12-24 weeks and more than 24 weeks in the chronic phase was －0.984, －0.230, －0.198, and the difference was not statistically significant (P＞0.05). There was no statistically significant difference in the visual field MD of patients with different courses of disease (F=0.277, P=0.842); the overall pRNFL thickness and average macular GCC thickness were compared with statistical significance (F=47.122, 14.954; P＜0.001, ＜0.001), all became significantly thinner with the progression of the disease. The results of Pearson correlation analysis showed that the blood flow density of the entire optic disc wiVD, the blood flow density of RPC in the temporal quadrant around the optic disc and the visual field MD (r=－0.225, －0.268; P＜0.05), and the average thickness of GCC (r=0.480, 0.436; P＜0.01) were all related. ConclusionThe blood flow density of RPC in the entire optic disc and around the optic disc (except the lower quadrant) of NAION eyes gradually decrease with the progression of the disease, and stabilize after 12 weeks of the disease.
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.
ObjectiveTo analyze the protein expression changes in the retina of non-arteritic anterior ischemic optic neuropathy (NAION) in rats.MethodsThe rat NAION (rNAION) model was established by Rose Bengal and laser. Twenty Sprague-Dawley rats were randomly divided into 4 groups, the normal control group, the laser control group, the RB injection control group, and the rNAION model group, with 5 rats in each group. The right eye was used as the experimental eye. The retina was dissected at the third day after modeling. Enzyme digestion method was used for sample preparation and data collection was performed in a non-dependent collection mode. The data were quantitatively analyzed by SWATH quantitative mass spectrometry, searching for differential proteins and performing function and pathway analysis.ResultsCompared with the other three control groups, a total of 184 differential proteins were detected in the rNAION group (expression fold greater than 1.5 times and P＜0.05), including 99 up-regulated proteins and 85 down-regulated proteins. The expressions of glial fibrillary acidic protein, guanine nucleotide binding protein 4, laminin 1, 14-3-3γ protein YWHAG were increased. Whereas the expressions of Leucine-rich glioma-inactivated protein 1, secretory carrier-associated membrane protein 5, and Clathrin coat assembly protein AP180 were decreased. The differential proteins are mainly involved in biological processes such as nerve growth, energy metabolism, vesicle-mediated transport, the regulation of synaptic plasticity, apoptosis and inflammation. Pathway enrichment analysis showed that PI3K-Akt signaling pathway and complement and thrombin reaction pathway was related to the disease.ConclusionThe protein expressions of energy metabolism, nerve growth, synaptic vesicle transport and PI3K-Akt signaling pathway can regulate the neuronal regeneration and apoptosis in NAION.
ObjectiveTo observe the blood perfusion changes of peripapillary and macular vessels in patients with nonarteritic anterior ischaemic optic neuropathy (NAION).MethodsRetrospective cohort study. Thirty-six eyes (19 affected eyes and 17 fellow eyes) of 19 patients with NAION diagnosed in People’s Hospital of Wuhan University from November 2017 to January 2019 were included in this study. There were 10 males and 9 females, with the mean age of 55.05±7.11 years. Forty eyes of 20 normal subjects matched with NAION patients were included as controls. BCVA, fundus color photography, SD-OCT and OCT angiography were performed in normal controls and repeated in NAION affected eyes at 1-2 weeks, 1-2 months, 3-5 months intervals. OCT quantitative measurements: average retinal nerve fiber layer thickness (aRNFL) of the disc and its superior values (sRNFL) and the inferior values (iRNFL), average ganglion cell complex thickness (aGCC) in macular region and its superior values (sGCC) and the inferior values (iGCC). OCTA quantitative measurements: average radial peripapillary capillary density (aRPC) and its superior values (sRPC) and the inferior values (iRPC), average vascular density of superficial retina (aSVD) in macular region and its superior values (sSVD) and the inferior values (iSVD), average vascular density of deep layer retina (aDVD), areas of foveal avascular zone (FAZ). The differences of OCT and OCTA quantitative measurements between NAION eyes and the fellow eyes and normal controls were comparatively analyzed. Independent sample t test, paired sample t test or nonparametric rank sum test were performed for comparison among three groups. Pearson or Spearman correlation analysis were used to analyze the correlation between RNFL and RPC, GCC and SVD, RNFL and GCC, RPC and SVD.ResultsAt baseline, the aRNFL, aRPC and aDVD of NAION patients were significantly higher than those of normal controls. Compared with the fellow eyes, the aRNFL increased significantly and the aRPC decreased significantly in NAION affected eyes. The overall differences of aRNFL, aRPC, aGCC and aSVD at four intervals within NAION affected eyes were statistically significant (P＜0.05). The average sRNFL, sRPC, sGCC and sSVD at 1-2 months interval were significantly lower than the average iRNFL, iRPC, iGCC and iSVD (P＜0.05). Correlation analysis: at 1-2 months interval, aGCC was positively correlated with aSVD (r=0.482, P=0.037); at 3-5 months interval, aRNFL was positively correlated with aRPC (r=0.631, P=0.037).ConclusionThere is a sectorial reduction of vascular density of peripapillary RPC and macular SVD with the disease progression of NAION.
ObjectiveTo determine the correlation between obstructive sleep apnea syndrome (OSAS) and nonarteritic ischemic optic neuropathy (NAION).MethodsIt was a perspective study. A total of 41 consecutive patients with NAION (NAION group) and 41 age- and sex-matched physical examination subjects (control group) in Xi’an No.3 Hospital from December 2016 to December 2018 were enrolled in this study. The apnea hypopnea index (AHI, the number of sleep apneas per hour) was monitored using a polysomnography for patients in NAION group and control group. At the same time, the blood oxygen saturation was continuously recorded. The OSAS can be diagnosed if the AHI value was ≥5. OSAS severity was graded as mild: 5≤AHI＜15; moderate: 15≤AHI＜30; severe: AHI ≥30. The grading of OSAS severity between two groups was compared by Fisher's exact test. The AHI and minimum blood oxygen saturation were compared between NAION group and control group using the Mann-Whitney U test. Spearman correlation analysis was performed on the correlation between OSAS and NAION.ResultsAmong the patients in the NAION group, 31 patients (75.61%) were diagnosed with OSAS. Among them, 6 patients (14.63%) were mild, 9 patients (21.95%) were moderate, and 16 patients (39.03%) were severe. In the control group, 19 patients (46.34%) were diagnosed with OSAS. Among them, 10 patients (24.39%) were mild, 5 patients (12.20%) were moderate, and 4 patients (9.75%) were severe. The difference of OSAS patients of mild, moderate and severe between two groups were statistically significant (Z=0.235, 0.245, 0.312; P=0.012, 0.014, 0.032). The average AHI of patients in the NAION group was 20.25±7.74, and the mean minimum oxygen saturation at night was (87.38±5.53)%. The average AHI of the control group was 18.67±11.67, and the mean minimum oxygen saturation at night was (85.06+4.25)%. The differences of the mean AHI and mean minimum oxygen saturation between two groups were statistically significant (Z=1.124, 2.317, P=0.003, 0.020). There was a positive correlation between OSAS and NAION (Spearman correlation coefficient=0.229, P=0.030).ConclusionThere is a positive correlation between OSAS and NAION.
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.
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.