Optic Nerve In Patients Research Articles

Multi-Parametric Diffusion Tensor Imaging of The Optic Nerve for Detection of Dysthyroid Optic Neuropathy in Patients With Thyroid-Associated Ophthalmopathy.

ObjectiveTo evaluate the microstructural changes of the orbital optic nerve in thyroid-associated ophthalmopathy (TAO) patients with or without dysthyroid optic neuropathy (DON) using diffusion tensor imaging (DTI) and investigate whether DTI can be used to detect DON.Materials and Methods59 bilateral TAO patients with (n= 23) and without DON (non-DON, n= 36) who underwent pretreatment DTI were included and 118 orbits were analyzed. The clinical features of all patients were collected. DTI parameters, including mean, axial, and radial diffusivity (MD, AD, and RD, respectively) and fractional anisotropy (FA) of the intra-orbital optic nerve for each orbit were calculated and compared between the DON and non-DON groups. ROC curves were generated to evaluate the diagnostic performance of single or combined DTI parameters. Correlations between DTI parameters and ophthalmological characteristics were analyzed using correlation analysis.ResultsCompared with non-DON, the DON group showed decreased FA and increased MD, RD, and AD (P < 0.01). In the differentiation of DON from non-DON, the MD was optimal individually, and the combination of the four parameters had the best diagnostic performance. There were significant correlations between the optic nerve’s four DTI metrics and the visual acuity and clinical active score (P < 0.05). In addition, optic nerve FA was significantly associated with the amplitude of visual evoked potentials (P = 0.022).ConclusionsDTI is a promising technique in assessing microstructural changes of optic nerve in patients with DON, and it facilitates differentiation of DON from non-DON eyes in patients with TAO.

Quantitative assessment of the intraorbital segment of the optic nerve in patients with thyroid orbitopathy using diffusion tensor imaging.

It is difficult to detect optic nerve changes in patients with thyroid-associated ophthalmopathy (TAO) before the development of optic neuropathy. To detect changes in the intraorbital segment of the optic nerve in patients with TAO using diffusion tensor imaging (DTI) and determine any correlations with disease severity. A total of 74 participants (17 normal, 22 mild, and 35 moderate-severe TAO) were organized to be given 3-T DTI to measure fractional anisotropy (FA) and mean diffusivity (MD) for the orbital segments of their optic nerves. All underwent ophthalmological examinations for visual acuity, intraocular pressure, exophthalmos, and fundoscopy, and were assessed based on the Clinical Activity Score (CAS). Univariate analysis of variance and Pearson's correlation coefficients were carried out. Patients with moderate-to-severe TAO had significantly lower FA values and higher MD values (P < 0.05). FA values were negatively correlated with CAS but had no obvious correlations with the degree of exophthalmos. MD values had no obvious correlations with CAS or the degree of exophthalmos. DTI parameters of the intraorbital optic nerves were significantly altered in moderate-to-severe patients before onset of clinical optic nerve dysfunction and may, therefore, be used as an imaging biomarker for assessing the disease.

Special Cerebral and Cerebrospinal Features in Primary Open Angle Glaucoma and Normal Tension Glaucoma.

In addition to aqueous humour and blood, cerebrospinal fluid also plays an important part in the pathophysiology of primary open-angle glaucoma (POAG) and, in particular, normal-tension glaucoma (NTG). Apart from the important role of CSF pressure in papillary congestion, the composition of the CSF and its flow rate are relevant. CSF is in contact with the brain, the spinal canal and the optic nerve. In neurodegenerative disease, one potential pathophysiological factor, apart from an altered composition of the CSF, is a decrease in flow rate. Changes in CSF composition and flow rate have also been described in the perioptic subarachnoid space of the optic nerve in patients with normal tension glaucoma. Such findings indicate that primary open angle glaucoma and normal tension glaucoma especially, might be due to a neurodegenerative process.

Cases with IgG4-related ophthalmic disease with mass lesions surrounding the optic nerve

PurposeIgG4-related ophthalmic disease (IgG4-ROD) is a lymphoproliferative disorder with representative symptoms including lacrimal gland enlargement (Mikulicz disease), masses around the trigeminal nerves, and extraocular muscle swelling. Herein, we describe cases of IgG4-ROD with lesions surrounding the optic nerve. MethodsOf the 56 consecutive patients (35 men and 21 women) with a “definite case” of IgG4-ROD diagnosed from November 2004 through December 2019 at Kanazawa University hospital, seven patients presented with mass lesions around the optic nerve based on magnetic resonance imaging, and four patients showed symptoms of optic neuropathy. The clinical courses of these seven cases were reviewed. ResultsAmong the 56 cases of IgG4-ROD, seven cases had lesions surrounding the optic nerve and all of these patients were male. The male dominance in the patient group with lesions surrounding the optic nerve was statistically significant based on a Chi-squared test (p < 0.001). Lacrimal gland swelling was also present in all seven cases, extraocular muscle enlargement in six cases, and trigeminal (infraorbital and supraorbital) nerve enlargement in six cases. Four patients showed deteriorated visual acuity compatible with optic neuropathy. These seven patients were treated by systemic steroid administration. Overall, in cases with optic neuropathy, visual function responded well to steroid therapy; however, recovery was limited in the worst case. Conclusions and importanceAttention should be paid for mass lesions surrounding the optic nerve in patients with IgG4-related disease, especially in cases with high serum IgG4 levels.

Electrophysiological and psychophysical studies in assessment of visual functions in patients with hereditary optic neuropathy

To study the capabilities of electrophysiological and psychophysical examination methods for assessment of the functional state of ganglion cells, retina and optic nerve in patients with hereditary optic neuropathy (HON). The study included 60 patients (118 eyes) with a genetically confirmed diagnosis of HON. All study patients underwent visual field test (VFT), spectral optical coherence tomography (OCT), flash and pattern visual evoked potentials (VEP) (Flash-VEP, FVEP; Pattern-VEP, PVEP), photopic electroretinography with photonegative response (PhNR) registration and the color vision test. In 24 patients (46 eyes), these parameters were assessed before the start of treatment and one year later. The treatment involved the mitochondria-targeted antioxidant SkQ1 - plastoquinonyl-decyl-triphenylphosphonium bromide (PDTP) in the form of eye drops. The main PVEP components for 1.0° and 0.3° were registered in 20% and in 14% of patient eyes with HON and high visual functions, respectively. After one year of PDTP use, a significant decrease in P100 peak latency was found only in the group with disease duration of ≤1.5 years as of the time of treatment start (p<0.05). Significant differences were observed in the PhNR amplitude (p<0.004) between patients of the main and the control groups, as well as in the PhNR amplitude between patients with visual acuity of ≤0.1 and ≥0.13 (p<0.01). Patients with high visual functions were found to have a correlation between the PhNR amplitude, GCC thickness and the global loss index (GLV). Along with VFT, OCT and color vision tests, electrophysiological studies are one of the main methods of examining patients with HON. After one year of PDTP use, there was a significant decrease in the FVEP P2 peak latency in the group with a disease duration of ≤1.5 years as of the time of treatment start. The PhNR amplitude in patients with high visual functions was found to correlate with structural changes in the ganglion cell layer and the retinal nerve fiber layer.

Multiparametric quantitative MRI for the evaluation of dysthyroid optic neuropathy.

To evaluate the ability of quantitative MRI parameters for predicting dysthyroid optic neuropathy (DON). We retrospectively collected and analyzed the clinical features and 3.0T MRI data of 59 patients with Graves orbitopathy (GO), with (n = 26) and without DON (n = 33). We compared MRI quantitative parameters, including the modified muscle index (mMI), proptosis, volume of intra-orbital fat, mean apparent diffusion coefficient value, and T2 value of the optic nerve among patients with and without DON. A logistic regression analysis was performed to identify the risk factors associated with DON. Moreover, we performed a receiver operating characteristic curve analysis and decision curve analysis to evaluate the diagnostic performance of the identified parameters for DON. We studied 118 orbits (43 and 75 with and without DON, respectively). The mMI and mean T2 value of the optic nerve were significantly greater in orbits with DON (p < 0.001). A greater mMI at 21mm (odds ratio (OR), 1.039; 95% confidence interval (CI): 1.019, 1.058) and higher mean T2 value of the optic nerve (OR, 1.035; 95% CI: 1.017, 1.054) were associated with a higher risk of DON. A model combining the mMI at 21mm and mean T2 values for the optic nerve effectively predicted DON in patients with GO, with a sensitivity and specificity of 95.3% and 76%, respectively. A quantitative MRI parameter combining the mMI at 21mm and mean T2 value of the optic nerve can be an effective imaging marker for identifying DON. • Patients with GO and DON had greater mMI than those without DON. • Optic nerves in patients with DON demonstrated an increased T2 value. • The quantitative MRI parameter combining the mMI at 21mm and mean T2 value of the optic nerve is the most effective method for diagnosing DON.

Sonographic and ophthalmic assessment of optic nerve in patients with idiopathic intracranial hypertension: A longitudinal study

BackgroundTo assess the validity of neurosonological parameters (transorbital sonography (TOS)) for detection and monitoring of patients with idiopathic intracranial hypertension (IIH). MethodsProspective, single-center, case-controlled study in 25 patients with IIH and 19 controls. Visual parameters of papilledema, visual acuity, computerized static threshold perimetry, fundus examination, and neurosonological parameters of papilledema/optic disc elevation (ODE), optic nerve sheath diameter (ONSD) and optic nerve diameter (OND) were recorded at baseline and only for patients with IIH again within 6 months. ResultsONSD was significantly enlarged among individuals with IIH (6.2 ± 0.73 mm) compared to controls (4.99 ± 0.54 mm; p < 0.001). Bilateral ODE was found in 36/50 eyes in patients at their initial visit and in none of the controls. Re-evaluation 6 months later showed a significant reduction of ONSD (6.0 ± 0.7 mm; p = 0.024) and ODE (0.2 (0–1) mm; p ≤0.001). Best corrected visual acuity (BCVA) and square root of lost variance (sLV) remained stable. Headache intensity (Numeric rating scale, NRS) improved significantly p < 0.001. When compared to patients with first diagnosed IIH (n = 18), the subset of patients with preexisting IIH with acute relapse (n = 7) showed persistent but reduced levels of ICP increase. They also presented significant decrease of BVCA (p = 0.01) and mean defect (MD) (p = 0.012). Re-evaluation 6 months later showed significant change in ODE in both groups. ConclusionsOur study confirmed that TOS and ophthalmological parameters are a valuable and non-invasive method to detect and monitor elevated ICP in IIH.

English

This study was conducted to demonstrate whether puerarin regulates glutamine synthetase (GS) activity following intraocular hypertension and has therapeutic potential in ophthalmology for the protection of optic nerves in patients with glaucoma. This study used a Wistar rat model of acute closed-angle glaucoma to investigate the effect of puerarin on GS activity in rat retina following intraocular hypertension. Acute intraocular hypertension was induced by increasing anterior chamber pressure to 110 mmHg for 30 min in the left eyes of 50 Wistar rats, while 5 additional Wistar rats lacking intraocular hypertension were used as a control group. Retinal GS activity was measured at 4, 12, 24, 36 and 72 h after induction of acute intraocular hypertension with/without puerarin treatment. Compared to the control group that lacked intraocular hypertension, GS activity in the intraocular hypertension group significantly decreased at 4 and 12 h (P&lt;0.01), before increasing at 24 to 36 h and restoring to a level similar to the control group at 72 h. However, puerarin significantly (P&lt;0.05) prevented the loss of GS activity seen in the intraocular hypertension group at 4 and 12 h, with no significant (P&lt;0.05) difference in GS activity noted between the control group and rats treated with puerarin at these early time points. GS activity significantly (P&lt;0.05) increased above control values at 24 and 36 h in the puerarin-treated group before eventually restoring to control levels at 72 h. These findings suggest puerarin protects GS activity in the early stages of retinal acute intraocular hypertension and may be of potential therapeutic benefit in acute closed-angle glaucoma. Key words: Puerarin, acute intraocular hypertension, glutathione synthetase.

Comparison of the Structure and Function of the Retina and the Optic Nerve in Patients with a History of Multiple Sclerosis-Related Demyelinating Retrobulbar Optic Neuritis Treated and Not Treated with Systemic Steroid Therapy.

PurposeTo compare the structure and function of the retina and the optic nerve in patients with a history of multiple sclerosis (MS)-related demyelinating retrobulbar optic neuritis treated and not treated with systemic steroid therapy.Patients and MethodsThirty-two eyes of 32 MS patients with a past single episode of MS-related demyelinating retrobulbar ON were divided into 2 groups: S(+) consisting of 16 patients treated with intravenous methylprednisolone at a dose of 1g/day for 3 days during the acute stage of ON and S(-) consisting of 16 patients who did not receive any treatment. The following examinations were performed: distance best-corrected visual acuity (DBCVA) (Snellen), slit-lamp examination of the anterior and posterior segment of the eye (90D Volk lens), visual field analysis (Carl Zeiss Humphrey 750 Visual Field Analyzer, 24-2, W-W), macular thickness in the foveal (RT1) and parafoveal region (RT2), as well as peripapillary retinal nerve fiber layer thickness (RNFL) in the temporal, superior, nasal and inferior quadrants (Carl Zeiss Cirrus HD-OCT), assessment of the bioelectrical function of the visual pathway with an emphasis on the optic nerve – pattern visual evoked potentials (PVEP) and of macular ganglion cells and cone photoreceptors – pattern electroretinogram (PERG) (Roland Consult).ResultsNo statistically significant differences were observed between the investigated groups in terms of DBCVA, mean deviation of visual field macular (RT1, RT2) and RNFL thickness in the temporal, superior, nasal and inferior quadrants, as well as of the bioelectrical function (PVEP, PERG).ConclusionThe application of steroid therapy should be considered on an individual basis and not as a routine treatment for each patient.

Combined accuracy of optic nerve sheath diameter, strain ratio, and shear wave elastography of the optic nerve in patients with idiopathic intracranial hypertension.

PurposeThis study assessed the combined accuracy of optic nerve sheath diameter (ONSD), strain ratio (SR), and shear wave elastography (SWE) of the optic nerve (ON) in patients with idiopathic intracranial hypertension (IIH).MethodsThis prospective study was carried out on both ONs of 34 consecutive patients diagnosed with IIH and 16 age- and sex-matched healthy volunteers. All of the study participants were women. The ONSD, SR, and SWE of the ON were measured. The severity of papilledema of IIH patients was sub-classified into mild papilledema and moderate/severe papilledema.ResultsThe mean ONSD (5.6±1.1 mm), SR (0.7±0.1), and SWE (30.1±16.7 kPa) of the IIH patients were significantly different (P=0.001) from the ONSD (4.1±0.5 mm), SR (0.9±0.1), and SWE (8.2±3.4 kPa) of controls. The cutoff values of ONSD, SR, and SWE of the ON for differentiating IIH patients from controls were 5.45 mm, 0.8, and 10.3 kPa with areas under the curve (AUCs) of 0.91, 0.86, and 0.96 and accuracy values of 91%, 81%, and 93%, respectively. Combined SWE and ONSD and combined SWE, ONSD, and SR for differentiating IIH patients from controls revealed AUCs of 0.98 and 0.99 and accuracy values of 96% and 96%, respectively. ONSD, SR, and SWE showed significant differences between mild and moderate/severe papilledema (P=0.001). Papilledema was correlated with SWE (r=0.8, P=0.001), ONSD (r=0.4, P=0.001), and SR (r=-0.4, P=0.001).ConclusionThe combination of ONSD, SR, and SWE may be helpful for diagnosing IIH, and a good indicator of the degree of papilledema.

Detection of SARS-CoV-2 genomic and subgenomic RNA in retina and optic nerve of patients with COVID-19

PurposePresence of SARS-CoV-2 RNA in human retinal biopsies (RBs) was previously reported by us. In this consecutive study, we analysed RB and optic nerve biopsies (ONBs) in deceased patients with...

Editors' Note: Optical Coherence Tomography for Detection of Asymptomatic Optic Nerve Lesions in Clinically Isolated Syndrome

In the article “Optical Coherence Tomography for Detection of Asymptomatic Optic Nerve Lesions in Clinically Isolated Syndrome,” Dr. Outteryck et al. evaluated the ability of intereye retinal thickness difference (IETD) measured by optical coherence tomography (OCT) to detect asymptomatic optic nerve involvement in 130 patients who had presented with clinically isolated syndrome (CIS) within 4.5 months of enrollment. They found that detection of asymptomatic optic nerve lesions in CIS required lower ganglion cell–inner plexiform layer (GC-IPL) IETD thresholds than previously reported and concluded that GC-IPL IETD represents an alternative biomarker to MRI for the detection of such lesions. Although lowering the IETD thresholds may improve the sensitivity of detecting an optic nerve lesion, it comes at the expense of lowering the specificity and this will potentially increase the risk of a false diagnosis of an optic nerve lesion. In response, Dr. Shubhakaran suggests that such a biomarker could help in early intervention to improve the prognosis of patients with multiple sclerosis (MS) and also highlights the utility of OCT in diagnosing macular lesions that may differentiate MS from other disorders. Dr. Shubhakaran notes that OCT is more readily available in certain practice regions than MRI, oligoclonal band testing, and evoked potentials. Responding to these comments, Dr. Outteryck agrees with the utility of OCT in the evaluation of demyelinating diseases, and with the disparate accessibility to OCT and MRI in different parts of the world, but cautions that optic nerve involvement is still not part of the diagnostic criteria for MS for dissemination in space. Noting that optic nerve involvement in patients with CIS is associated with the presence of asymptomatic gadolinium enhancing lesions, Dr. Outteryck argues that optic nerve involvement should be accommodated in future iterations of the MS diagnostic criteria. This exchange illuminates the potential role that OCT can play in the evaluation of the optic nerves in patients with suspected demyelinating disease, even in the absence of ocular symptoms, and also highlights the enduring debate about how optic nerve involvement could be incorporated in the diagnostic criteria for MS. In the article “Optical Coherence Tomography for Detection of Asymptomatic Optic Nerve Lesions in Clinically Isolated Syndrome,” Dr. Outteryck et al. evaluated the ability of intereye retinal thickness difference (IETD) measured by optical coherence tomography (OCT) to detect asymptomatic optic nerve involvement in 130 patients who had presented with clinically isolated syndrome (CIS) within 4.5 months of enrollment. They found that detection of asymptomatic optic nerve lesions in CIS required lower ganglion cell–inner plexiform layer (GC-IPL) IETD thresholds than previously reported and concluded that GC-IPL IETD represents an alternative biomarker to MRI for the detection of such lesions. Although lowering the IETD thresholds may improve the sensitivity of detecting an optic nerve lesion, it comes at the expense of lowering the specificity and this will potentially increase the risk of a false diagnosis of an optic nerve lesion. In response, Dr. Shubhakaran suggests that such a biomarker could help in early intervention to improve the prognosis of patients with multiple sclerosis (MS) and also highlights the utility of OCT in diagnosing macular lesions that may differentiate MS from other disorders. Dr. Shubhakaran notes that OCT is more readily available in certain practice regions than MRI, oligoclonal band testing, and evoked potentials. Responding to these comments, Dr. Outteryck agrees with the utility of OCT in the evaluation of demyelinating diseases, and with the disparate accessibility to OCT and MRI in different parts of the world, but cautions that optic nerve involvement is still not part of the diagnostic criteria for MS for dissemination in space. Noting that optic nerve involvement in patients with CIS is associated with the presence of asymptomatic gadolinium enhancing lesions, Dr. Outteryck argues that optic nerve involvement should be accommodated in future iterations of the MS diagnostic criteria. This exchange illuminates the potential role that OCT can play in the evaluation of the optic nerves in patients with suspected demyelinating disease, even in the absence of ocular symptoms, and also highlights the enduring debate about how optic nerve involvement could be incorporated in the diagnostic criteria for MS.

Restricted Diffusion of the Optic Nerves in Patients with Acute Optic Neuritis: A Diagnostic Accuracy Study

Objective: To evaluate the diagnostic accuracy of restricted diffusion of the optic nerves in patients with acute optic neuritis (ON). Materials and Methods: The present study was a diagnostic accuracy study, including all acute ON patients, admitted to Ramathibodi Hospital in Thailand, between January 2014 and December 2018 (ID 075739). Patients were divided into acute ON and non-optic neuritis condition (non-ON) groups. The acute ON group was divided further into neuromyelitis optica spectrum disorder-associated optic neuritis (NMOSD-ON) group and other types of ON (other-ON) group. Patients’ clinical information and MRI scans were reviewed retrospectively. Restricted diffusion of the optic nerves was present if hyperintense signals were observed on diffusion-weighted imaging (DWI) and hypointense signals were observed on the apparent diffusion coefficient (ADC) map. Results: A total of 102 patients were included in the present study (141 optic nerves). Of all patients, 78 had acute ON (76.5%), and 24 had non-ON (23.5%). Of all optic nerves, there were 95 optic nerves in the acute ON group (67.4%) and 46 in the non-ON group (32.6%). Of 95 optic nerves in the acute ON group, there were 52 optic nerves in the NMOSD-ON group (54.7%) and 43 in the other-ON group (45.3%). Restricted diffusion of the optic nerves demonstrated a sensitivity of 77.9%, specificity of 95.7%, positive predictive value of 97.4%, and negative predictive value of 67.7% in identifying acute ON. It had a sensitivity of 86.5%, specificity of 32.6%, positive predictive value of 60.8%, and negative predictive value of 66.7% in differentiating NMOSD-ON from other-ON. Conclusion: The diffusion MRI can be a marker of acute ON. The test is most useful for ruling in acute ON when restricted diffusion is positive. However, further investigations might be required in negative tests. Restricted diffusion is positive in several types of ON. It is difficult to differentiate NMOSD-ON from other ON types using diffusion MRI alone. Keywords: Neuromyelitis optica spectrum disorders, Optic neuritis, Diffusion-weighted imaging, Apparent diffusion coefficient, Restricted diffusion

Cerebrospinal fluid dynamics along the optic nerve in patients with spontaneous cerebrospinal fluid rhinorrhea: a retrospective computed tomographic cisternography study.

Spontaneous cerebrospinal fluid (CSF) rhinorrhea is related to intracranial pressure (ICP) and dynamic changes. This study investigated CSF dynamics along the optic nerve (ON) in patients with spontaneous CSF rhinorrhea. The computed tomographic (CT) cisternographies of 66 patients (132 eyes) with spontaneous CSF rhinorrhea were analysed. The contrast-loaded CSF (CLCSF) density was measured in Hounsfield units (HU) at three regions of interest (ROIs) along the ON and adjusted by the basal cistern density. The CLCSF density and ON sheath diameter (ONSD) were analysed between both sides in the different ICP groups. When comparing the density of CLCSF along the ON, no significant differences were found between the ipsilateral and contralateral sides of the leakage. The distribution of CLCSF along the ON showed a highly significant density reduction from the canalicular segment to the bulbar segment on both sides. The CLCSF density significantly decreased on the ipsilateral ON in the canalicular segment and tended to decrease on the ipsilateral ON in thebulbar and canal segments compared with that on the contralateral ON in the low-ICP group. The ONSD tended to decrease on the ipsilateral side of leakage. According to the CLCSF density on CT cisternography, CSF dynamics along the ON may bilaterally decrease from the optic canal to the retrobulbar segment. Cerebrospinal fluid (CSF) dynamics are possibly influenced by differences in ICP, and a lower ICP may cause more obvious differences or impairments in CSF dynamics along the ipsilateral ON.

Results of optical coherence tomography of the retina and optic nerve in keratoconus

The article reviews the results of optical coherence tomography (OCT) of the retina and optic nerve in patients with keratoconus (KC). This research direction is premised by the possibility that changes in the retina and optic nerve are associated with KC, as well as the potential influence of significant changes in axial eye length, disorders of corneal refraction and increased level of aberrations on the quality of visualization of these ocular structures. Results of the conducted studies were conflicting, but in all they indicated a possibility of OCT findings to be altered in KC patients. Therefore, the question of changing the parameters for OCT of the retina and optic nerve requires further investigation. The main problem that needs solving with evidence based medical research can be phrased as follows: are the changes in OCT findings observed in KC patients the consequence of changes in the retina and optic nerve associated with this disorder, or potential effect of aberrations and irregular astigmatism on the quality of visualization of the studied structures?

Transorbital Endoscopic Medial Orbitotomy and Decompression of the Optic Nerve in Patients with Endocrine Ophthalmopathy Complicated by Optical Neuropathy

AIM OF STUDY: to improve the results of surgical treatment of patients with endocrine ophthalmopathy complicated by optical neuropathy. For this, medial orbitotomy and decompression of the optic nerve were performed for a patient with endocrine ophthalmopathy, CAS&lt;3, OD=18 mm, OS=23 mm and visual acuity OD=1.0 OS=0.2, using transorbital transconjunctival endoscopic access. The first step was a retro caruncular incision. After that, we defined an access to the medial wall of the orbit with its subsequent resection. Then, we performed ethmoidectomy and approach to the optic nerve canal. Upon completion of bone decompression, we opened periorbitis.RESULTS. The postoperative period was uneventful. In the early postoperative period, regression of exophthalmos was observed OD=18 mm, OS=20 mm, improvement in visual acuity OD=1.0 OS=0.5 . No complications were recorded. A satisfactory result was obtained.CONCLUSION. Transorbital endoscopic medial orbitotomy and optic decompression can be effectively used in the treatment of patients with endocrine ophthalmopathy complicated by optic neuropathy, refractory to conservative therapy. The technique is promising and requires further randomized studies.

Standard Diffusion-weighted MRI for the Diagnosis of Central Retinal Artery Occlusion

PurposeTo evaluate diffusion abnormalities of the retina and optic nerve in patients with central retinal artery occlusion (CRAO) using standard stroke diffusion-weighted magnetic resonance imaging (DWI).MethodsIn this case-control study, DWI scans of patients with nonarteritic CRAO were retrospectively assessed for acute ischemia of the retina and optic nerve. Two neuroradiologists, blinded for patient diagnosis, randomly evaluated DWI of CRAO patients and controls (a collective of stroke and transient ischemic attack [TIA] patients) for restrictions of the retina and optic nerve. We calculated statistical quality criteria and analyzed inter-rater reliability using unweighted Kappa statistics.Results20 CRAO patients (60,6 ± 17 years) and 20 controls (60,7 ± 17 years) were included in the study. Sensitivity, specificity, positive and negative predictive values for retinal DWI restrictions were 75%/80%/79%/76% (reader 1) and 75%/100%/100%/80% (reader 2), respectively. Unweighted Kappa was κ = 0,70 (95% CI 0,48‑0,92), indicating “substantial” interrater reliability. In comparison, sensitivity, specificity, PPV and NPV (positive and negative predictive values) for restrictions of the optic nerve in CRAO were 55%/70%/65%/61% (reader 1) and 25%/100%/100%/57% (reader 2). Inter-rater reliability was “fair” with unweighted Kappa κ = 0,32 (95% CI 0,09‑0,56).ConclusionsRetinal diffusion restrictions were present in a majority of CRAO patients and detectable with reasonable sensitivity, high specificity and substantial inter-rater reliability. Further studies are necessary to study time dependency of retinal diffusion restrictions, improve image quality and investigate the reliability of retinal DWI to discern CRAO from other causes of acute loss of vision.

Structural assessment of the optic nerve in patients with obstructive sleep apnea syndrome: Case-control study.

Obstructive sleep apnea syndrome has been identified as a possible risk factor for optic nerve pathology such as glaucoma, nonarteritic ischemic optic neuropathy, and optic disk edema. Accordingly, we aimed to evaluate structural changes of the apparently normal optic nerve in obstructive sleep apnea syndrome patients with effects of its severity. In this prospective case-control study, 47 eyes of 47 obstructive sleep apnea syndrome patients diagnosed with polysomnography and 40 eyes of 40 healthy subjects were included. Spectral-domain optical coherence tomography was used to evaluate the peripapillary retinal nerve fiber layer thickness, optic nerve head topographic parameters, and retinal ganglion cell-inner plexiform layer thickness. The average peripapillary nerve fiber layer thickness was lower in obstructive sleep apnea syndrome patients than in controls (90.74±7.98 vs 94.93±6.13μm; p = 0.008). The average cup/disk ratio and the vertical cup/disk ratio in patients with OSAS were significantly higher compared to the controls (both p < 0.001). However, no significant difference in retinal ganglion cell-inner plexiform layer thickness was found. Even if the retinal ganglion cell-inner plexiform layer thicknesses did not significantly differ between the obstructive sleep apnea syndrome and control groups, obstructive sleep apnea syndrome patients showed a decreased peripapillary nerve fiber layer thickness and increased optic nerve head parameters. These findings can be used as an indicator of optic nerve damage in the early diagnosis of obstructive sleep apnea syndrome patients.

Chronic demyelination exacerbates neuroaxonal loss in patients with MS with unilateral optic neuritis.

ObjectiveTo examine the effect of chronic demyelination in the optic nerve of patients with MS on progressive loss of retinal ganglion cell (RGC) axons.MethodsProgressive retinal nerve fiber layer (RNFL) loss, as measured by optical coherence tomography, was longitudinally examined in 51 patients with MS with a history of unilateral optic neuritis (ON) and 25 normal controls. Patients were examined annually with a median of 4-year follow-up. Pairwise intereye comparison was performed between ON and fellow non-ON (NON) eyes of patients with MS using the linear mixed-effects model and survival analysis. The latency asymmetry of multifocal visual evoked potential (mfVEP) was used to determine the level of demyelination in the optic nerve.ResultsAlthough both ON and NON eyes demonstrate significantly faster loss of RGC axons compared with normal subjects, ON eyes with severe chronic demyelination show accelerated thinning in the RNFL in the temporal sector of the optic disc (temporal RNFL [tRNFL]) compared with fellow eyes (evidenced by both the linear mixed-effects model and survival analysis). Furthermore, progressive tRNFL thinning is associated with the degree of optic nerve demyelination and reflects the topography of pathology in the optic nerve. More rapid axonal loss in ON eyes is also functionally evidenced by mfVEP amplitude reduction, which correlates with the level of optic nerve demyelination.ConclusionsAlthough the effect of demyelination on axonal survival has been demonstrated in experimental studies, our results provide first clinically meaningful evidence that chronic demyelination is associated with progressive axonal loss in human MS.

Magnetic resonance imaging evaluation of retro-bulbar optic nerve in patients with optic disc pit maculopathy

Background: Optic disc pit (ODP) is a congenital anomaly characterized by indented area of the optic nerve head most likely originating from the incomplete closure of the superior edge of the embryonic fissure. Maculopathy can occasionally complicate this anomaly as intra-retinal and sub-retinal fluid at the macula. In result, maculopathy is associated with a poor visual prognosis due to a serous macular detachment, formation of macular hole, or atrophy of the retinal pigmented epithelium. In this case series, we report of three patients with unilateral ODP. Case report: We attempted to analyze the morphologic changes seen in the ODP and evaluate patients with a complete ophthalmologic evaluation, fundus color photography, spectral-domain optical coherence tomography (SD-OCT) scanning, and magnetic resonance imaging (MRI) of globe and orbit. Magnetic resonance imaging scan was done for optic disc diameter (ODD) and optic nerve sheath diameter (ONSD). Conclusion: We noticed that in the patient who presented with neurosensory detachment in the macula, the ONSD is larger than in the fellow eye and is larger than the remaining two patients with ODP and without neurosensory detachment of the retina.