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)
ObjectiveTo observe the blood perfusion of optic nerve and macular areas and investigate its relationship with visual field defect in nonarteritic anterior ischemic optic neuropathy (NAION).MethodsTwelve consecutive unilateral NAION patients (course of disease ＜3 months) and 12 healthy Chinese adults were enrolled in the study. The affected eyes and fellow eyes from 12 NAION patients were defined as group A and group B; 12 eyes from 12 healthy adults were defined as group C. Best corrected visual acuity (BCVA), intraocular pressure (IOP), indirect ophthalmoscope and computer optometry were performed on all of the three groups of patients. Visual field (VF) and optical coherence tomography (OCT) were performed on NAION patients. Logarithm of the minimum angle of resolution (logMAR) was used to calculate visual acuity. Compared to group B, logMAR BCVA, mean deviation (MD) and pattern standard deviation (PSD) in group A were significant decreased (t=3.278, −4.909, 4.130, P＜0.05). There was no significant difference in spherical equivalent, IOP, peripapillary retinal nerve fibre layer (pRNFL) between group A and group B (t=0.000, 0.890, 1.215; P＞0.05). OCT angiography (OCTA) was used to measure the flow area (FA) at optic disc, flow area at radial peripapillary capillaries (RCFA) and FA, non-perfusion area (NFA), parafoveal vessel density (PVD) and parafoveal vascular index (PVI) in macular area. Pearson correlations between the deficiency of optic blood flow and visual field were analyzed.ResultsThe differences of FA at optic disc and peripapillary RCFA among 3 groups were significant (F=4.162, 3.357; P＜0.050). Compared to group B (t=−5.822, −7.467; P＜0.001) and C (t=9.435, 4.615, P＜0.05), FA at optic disc and peripapillary RCFA in group A was significantly reduced. There is several NAION showed quadrantal FA decreased in optic nerve. However, there was no significant difference in optic disc FA and peripapillar RCFA between group B and C (F=0.004, 0.030; P＞0.050). There was no differences of FA, NFA, PVD and PVI among 3 groups (F=0.488, 1.107, 0.493, 1.086, 1.098, 0.093, 1.093, 1.221; P＞0.05). Positive correlation between optic disc FA, peripapillary RCFA and MD (r=0.542, 0.585; P＜0.05) were observed. However, there was no significant correlation between optic disc FA, peripapillary RCFA and PSD (r=−0.404, −0.430; P＞0.05), and negatively correlated to BCVA (r=−0.617, −0.596; P＜0.05). PRNFL was negatively correlated to optic disc FA (r=−0.643, P＜0.05), but not correlated to peripapillary RCFA (r=−0.377, P＞0.05).ConclusionsThe optic disc blood flow reduced in affected eyes of unilateral NAION whose disease course was less than 3 months, while the macular perfusion was normal. There was a positive correlation between optic disc flow and visual field.
ObjectiveTo observe the clinical profile and risk factors of non-arteritic anterior ischemic optic neuropathy (NAION). MethodsProspective study was conducted to consecutively recruit 73 patients with NAION from October 2013 through September 2015. A detailed history of previous systemic diseases, smoking and drinking was collected, and a comprehensive ophthalmic evaluation was performed. The prevalence of associated risk factors in NAION patients were compared to the 146 age-and gender-matched normal subjects, and assessed in logistic regression model. ResultsOf the 73 patients, 65.75% were males, 34.25% were females. The mean age was (55.18±9.89) years. 21.92% were bilateral and 78.08% were unilateral. Arcuate visual field defect (31.58%) was the most prevalent defect detected in unilateral NAION, and there were 8.93% fellow eyes with abnormal optic disc formation in incipient stage. Concentric visual field contraction (40.63%) was the most common in bilateral NAION. Obesity (OR=8.09, 95% CI: 2.94-22.23, P < 0.001) and diabetes (OR=4.72, 95% CI: 1.57-14.25, P=0.006) were significantly associated with NAION. While smoking was marginally associated with NAION (OR=2.76, 95% CI: 1.02-7.53, P=0.047). ConclusionsThe gender predisposition should be reconsidered in NAION. We should pay attention to the fellow eye in case of the incipient NAION patients. Diabetes and obesity are associated with NAION.
Objective To observe the expression of triggering receptor expressed on myeloid cells (TREM), Caspase-3 and interleukin (IL)-6 in optic nerve tissue of ischemic optic neuropathy (ION). Methods Twenty Sprague-Dawley rats were randomly divided into control group and model group, 10 rats in each group. The permanent ligation of bilateral internal carotid arteries (BICA) was performed for 14 days to establish sub-acute ION model as model group. The control group were separated BICA without ligation. The expressions of TREM-1, TREM-2, Caspase-3 and IL-6 in rat retina were detected by reverse transcription PCR and Western blot, respectively. ResultsCompared with the control group, the expressions of TREM-1, Caspase-3, IL-6 mRNA (t=6.058, 7.86, 6.055) and protein (t=9.671, 9.524, 14.501) in the optic nerve tissue of the model group were increased, while the expression of TREM-2 mRNA and protein (t=9.283) was decreased, and the difference was statistically significant (P＜0.05). Conclusion In ischemic optic nerve tissue, TREM-1 mRNA and protein were significantly expressed, the expressions of TREM-2 mRNA and protein decreased significantly.
ObjectiveTo investigate the application of critical flicker fusion frequency (CFF) in non-arteritic anterior ischemic optic neuropathy (NAION). MethodsA cross-sectional study. From January 2021 to September 2021, a total of 58 NAION patients (105 eyes) (NAION group) and 33 cases (63 eyes) in the healthy control (HC) group were included from Department of Ophthalmology of First Medical Center, PLA General Hospital. Patients underwent best-corrected visual acuity (BCVA), optical coherence tomography (OCT), visual field, CFF and flash visual evoked potential (F-VEP) examinations. BCVA examination was performed using a Snellen decimal visual acuity chart and was converted to logarithm of the minimum angle of resolution visual acuity. In the affected eyes group, there were 56 cases (72 eyes), 31 cases (43 eyes) male and 25 cases (29 eyes) female, with an average age of 49.28±11.42 years old. And the affected eyes were divided into 4 groups: ＜1, 1-＜3, 3-＜6 and ＞6 months according to the time interval from onset to CFF examination, which were 20 (27.8%), 26 (36.1%), 17 (23.6%) and 9 (12.5%) eyes, respectively. According to the BCVA ≥0.5, 0.1-0.5, ＜0.1 in CFF examination, the affected eyes were divided into a mild, moderate, and severe degree, 33 (45.8%), 32 (44.4%) and 7 (9.8%) eyes, respectively. Sixty-three eyes of 33 cases were in the HC group. There were 17 cases (31 eyes) males and 16 cases (32 eyes) females, with an average age of 35.18±10.96 years. Hand-held CFF detector type 2 (Japan, NEITZ company) was used for the CFF examination. The thickness of peripheral retinal nerve fiber layer (pRNFL), macular inner limiting membrane retinal pigment epithelium (mILM-RPE), F-VEP peak time and peak value and mean visual field defect (MD) values were recorded within 1 week of CFF examination. The CFF value of the above subgroups was analyzed in order using one-way ANOVA. Pearson correlation analysis was used for the correlation between CFF and F-VEP peak time, peak value, BCVA and MD. The correlations between BCVA, visual field, F-VEP, and CFF were analyzed. ResultsThe trichromatic values of red, green and yellow in NAION affected eyes were 22.56±10.30, 24.10±11.51, 24.81±11.41 Hz, respectively, which was significantly reduced compared with the HC group (t=－10.53,－11.11,－11.36; P＜0.05). There was no significant difference in CFF-red, green, and yellow values at different time points after the onset of the disease (F=2.075, 1.893, 2.073; P＞0.05). Compared CFF-red, green, and yellow values in NAION-affected eyes with different degrees, the difference was statistically significant (F=31.579, 27.332, 32.055; P＜0.05). The results of correlation analysis showed that the peak time of F-VEP (r=－0.362, －0.379,－0.357; P＜0.05), BCVA (r=－0.705,－0.695,－0.714; P＜0.05), and which was negatively correlated with CFF three color. MD and CFF were positively correlated (r=0.486, 0.435, 0.450; P＜0.05). ConclusionThe CFF value of the affected eye is decreased significantly in NAION-affected eyes, and CFF is more sensitive than F-VEP in reflecting visual impairment, and has a good correlation with visual function and latency of F-VEP.
ObjectiveTo analyze retrospectively the risk factors of nonarteritic anterior ischemic optic neuropathy (NAION). MethodsThe complete clinical data of 116 patients (134 eyes) were collected. All patients were asked in detail about the disease history and symptoms and were examined for the visual acuity, intraocular pressure, fundus, visual field and fundus fluorescein angiography (FFA), blood pressure, blood glucose, blood fat and head MRI or CT. Suspicious cases and patients with incomplete clinical data were excluded. The relationship between NAION and age, visual field, FFA, systemic and ocular factors, onset seasons were retrospectively analyzed. Results80 patients (68.97%) were 55 to 70 years old. 97 patients (83.7%) had systemic diseases, including 38 patients (39.2) with diabetes mellitus, 32 patients (32.9%) with hypertension (8 patients had low blood pressure at night), 28 patients (28.9%) with hyperlipidemia, 16 patients (16.5%) with cerebrovascular diseases (mainly lacunar cerebral infarction), 6 patients (6.2%) with coronary heart disease. There were 8 patients with ocular factors, including 3 patients (2.6%) with cataract surgery history, 5 patients (4.2%) with small optic discs. The difference of percentage of with or without diabetes mellitus and hypertension was significant (χ2=362, 259; P < 0.05). There were 27.6% patients with disease onset at March to April, 24.1% patients with disease onset at September to October, much higher than other months (χ2=580, P < 0.05). Visual field test results showed that 49 eyes (36.5%) had inferior visual field defect, 12 eyes (9.0%) had superior visual field defect. FFA showed that in the early stage 103 eyes (76.9%) had optic weak fluorescence, 13 eyes (9.7%) had strong fluorescence; in the late stage, 110 eyes (82.1%) had strong fluorescence, 8 eyes (6.0%) had weak fluorescence. ConclusionsDiabetes mellitus, hypertension may be the system risk factors of NAION. The seasonal variation from spring to summer and from autumn to winter may also be another risk factor for the onset of NAION.
Non-arteritic anterior ischemic optic neuropathy (NAION) is one of the most common acute optic neuropathy in adult characterized with impaired visual acuity and visual fields. The pathogenesis of NAION mostly result from the interactions between the systemic risk factors (such as diabetes mellitus, night hypotension, hereditary) and the local ocular risk factors (such as small optic disc and vitreo-papillary traction). A fully promoted diagnosis and treatment of NAION are based on the higher levels of clinical evidence, as well as the comprehensive assessment of relationship between the systemic and ocular risk factors in the pathogenesis of NAION. Secondary optic neuropathy of NAION and the early diagnosis with effective treatment of the fellow eye would be highly emphasized.
ObjectiveTo observe the morphological characteristics of internal carotid artery (ICA) siphon and ophthalmic artery (OA) in patients with non-arteritic anterior ischemic optic neuropathy (NAION) based on CT angiography (CTA) three-dimensional reconstruction of ICA siphon and OA models. MethodsA retrospective cohort study. From January 2017 to January 2019, 26 patients with 31 eyes (NAION group) who were diagnosed with NAION by ophthalmic examination at Beijing Friendship Hospital, Capital Medical Universitywere included in the study. Among them, there were 11 males with 13 eyes, and 15 females with 18 eyes; the age was 67.52±6.30 years old. Nineteen eyes of 19 non-affected contralateral eyes were selected as the contralateral eye group. Among them, there were 9 males with 9 eyes and 10 females with 10 eyes; the age was 65.95±5.66 years old. Twenty-six eyes of 26 age- and sex-matched subjects with normal fundus examination during the same period were selected as the normal control group. All subjects underwent best corrected visual acuity (BCVA), intraocular pressure, fundus photography and CTA examination. The data obtained from CT scans were reconstructed by 3D model, and the anatomical morphology of ICA siphon was divided into U-shape, V-shape, C-shape and S-shape; the diameter of ICA siphon portion and the diameter at the beginning of OA were measured. One-way analysis of variance was used to compare the diameter of the OA at the beginning of the OA and the diameter of the ICA siphon between the three groups of eyes. ResultsThe diameters at the beginning of OA in the NAION group, the contralateral eye group, and the normal control group were 1.17±0.20, 1.34±0.17, and 1.39±0.15 mm, respectively, and the differences among the three groups were statistically significant (F=12.325, P<0.05); there was no significant difference between the contralateral eye group and the normal control group (P=0.310). In the NAION group, the anatomical morphology of the ICA siphon was U-shaped and V-shaped in 20 (64.52%) and 8 (25.81%) eyes respectively, and S and C-shaped in 3 eyes (9.67%); in the contralateral eye group, in the control group, the ICA siphon shape of the eyes examined was U-shaped and V-shaped, and S-shaped and C-shaped were rare. The diameters of the ICA siphons in the NAION group, the contralateral eye group, and the normal control group were 3.50±0.69, 3.22±0.59, and 3.55±0.54 mm, respectively. There was no significant difference between the three groups (F=1.860, P=0.163). ConclusionU-shaped and V-shaped ICA siphons are more common in NAION-affected eyes; the diameter of the starting point of OA is significantly reduced.
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.
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.