MRI Histogram Texture Feature Analysis of the Optic Nerve in the Patients with Optic Neuritis.

Objective To evaluate the optic nerve impairment using MRI histogram texture analysis in the patients with optic neuritis.Methods The study included 60 patients with optic neuritis and 20 normal controls. The coronal T2 weighted imaging (T2WI) with fat saturation and enhanced T1 weighted imaging (T1WI) were performed to evaluate the optic nerve. MRI histogram texture features of the involved optic nerve were measured on the corresponding coronal T2WI images. The normal optic nerve (NON) was measured in the posterior 1/3 parts of the optic nerve. Kruskal-Wallis one-way ANOVA was used to compare the difference of texture features and receiver operating characteristic (ROC) curve were performed to evaluate the diagnostic value of texture features for the optic nerve impairment among the affected optic nerve with enhancement (ONwEN), affected optic nerve without enhancement (ONwoEN), contralateral normal appearing optic nerve (NAON) and NON.Results The histogram texture Energy and Entropy presented significant differences for ONwEN vs. ONwoEN (both P=0.000), ONwEN vs. NON (both P=0.000) and NAON vs. NON (both P<0.05). ROC analysis demonstrated that the area under the curve (AUC) of histogram texture Energy were 0.758, 0.795 and 0.701 for ONwEN vs. ONwoEN, ONwEN vs. NON and NAON vs. NON, AUC of Entropy were 0.758, 0.795 and 0.707 for ONwEN vs. ONwoEN, ONwEN vs. NON and NAON vs. NON.Conclusions The altered MRI histogram texture Energy and Entropy could be considered as a surrogate for MRI enhancement to evaluate the involved optic nerve and normal-appearing optic nerve in optic neuritis.

Research Advances in Biomarkers for Demyelinating Optic Neuritis.

Optic neuritis refers to all inflammatory diseases in the optic nerve. The most common type is demyelinating optic neuritis. Biomarkers can indicate its pathophysiological process and thus are useful in disease diagnosis and treatment. This article reviews the known biomarkers for demyelinating optic neuritis.

Intraoperative high-field magnetic resonance imaging combined with functional neuronavigation in resection of low-grade temporal lobe tumors.

BACKGROUND: The aim of this study is to investigate the role of intraoperative MR imaging in temporal lobe low-grade glioma (LGG) surgery and to report the surgical outcome in our series with regard to seizures, neurological defects, and quality of life. METHODS: Patients with temporal lobe contrast-nonenhancing gliomas who presented with seizures in the course of their disease were enrolled in our prospective study. We non-randomly assigned patients to undergo intraoperative magnetic resonance imaging (iMRI)-guided surgery or conventional surgery. Extent of resection (EOR) and surgical outcomes were compared between the two groups. RESULTS: Forty-one patients were allocated in the iMRI group, and 14 were in the conventional group. Comparable EOR was achieved for the two groups (p = 0.634) although preoperative tumor volumes were significantly larger for the iMRI group. Seizure outcome tended to be better for the iMRI group (Engel class I achieved for 89.7% (35/39) vs 75% (9/12)) although this difference was not statistically different. Newly developed neurological deficits were observed in four patients (10.3%) and two patients (16.7%), respectively (p = 0.928). Free of seizures and neurological morbidity led to a return-to-work or return-to-school rate of 84.6% (33/39) vs 75% (9/12), respectively (p = 0.741). CONCLUSIONS: Our study provided evidence that iMRI was a safe and useful tool in temporal lobe LGG surgery. Optimal extent of resection contributed to favorable seizure outcome in our series with low morbidity rate, which led to a high return-to-work rate.

The involvement of high mobility group 1 cytokine and phospholipases A2 in diabetic retinopathy.

BACKGROUND: Diabetic retinopathy, the main microvascular complications of diabetes and one of the leading causes of blindness worldwide. Interesting reports on the role of inflammatory/proangiogenic high mobility group 1 (HMGB-1) cytokine and phospholipases A2 (PLA2) in neovascularization have diverted our concentration to reveal whether HMGB-1 and PLA2 plays role in diabetic retinopathy. METHODS: We performed our study in streptozotocin (STZ)-induced diabetic rat model. The expression levels of the cytokines, chemokines, and cell adhesion molecules in retinal tissues were evaluated by quantitative RT-PCR. HMGB-1 and PLA2 protein levels along with VEGF, TNF-α, IL-1ß and ICAM-1 levels were also measured. RESULTS: We observed the retinal pericytes, endothelial injury/death and breakdown of blood-retinal barrier (BRB). The protein expression of HMGB-1, PLA2 and IL-1ß were significantly increased in micro vessels from retina of diabetic rats. Diabetic rats had also high retinal levels of VEGF, ICAM-1 and TNF-α. Further investigation revealed that pericyte death is mediated by HMGB-1-induced cytotoxic activity of glial cells, while HMGB-1 can directly mediate endothelial cell death. Similarly, increased expression of PLA2 represents the diabetic mediated alteration of BRB, perhaps up regulating the VEGF. CONCLUSIONS: Our data suggest that HMGB-1 and PLA2 involved in retinal pericyte and endothelial injury and cell death in diabetic retinopathy. From this study, we suggest that HMGB-1 and PLA2 may be interesting targets in managing diabetic retinopathy.

[Clinical characteristics of paraneoplastic retinopathy and optic neuropathy].

OBJECTIVE: To analyze the clinical characteristics of paraneoplastic retinopathy and optic neuropathy(PRON). METHODS: Case series study. Eight patients were enrolled from October 2006 to March 2012 visited in ophthalmology department, the People Liberation Army General Hospital. The patients were underwent a series of examinations, including fundus photography, visual electrophysiology, fundus fluorescein angiography, optic coherent tomography,fundus autofluorescent imaging, perimetry, ultrasonography, magnetic resonance imaging, spinal tap and cerebrospinal fluid test, paraneoplastic syndrome (PNS) antibody test. The patients were followed up in outpatient department and(or) by phone. The clinical manifestation,entity types, and treatment were analyzed. RESULTS: Of the eight patients, there were cancer associated retinopathy(CAR) 3 cases, bilateral diffuse uveal melanocytic proliferation (BDUMP) 2 cases and paraneoplastic optic neuropathy(PON) 3 cases. Five patients were detected the PNS antibodies and revealed three patients with positive results. As for the primary malignancy,four of the eight patients were lung carcinoma,others included invasive thymoma, kidney cancer, acute lymphocytic leukemia and cervical cancer, each for one case. All the patients complained vision blurring or progressive visual decrease. Other complaints included dark shadow in two patients, shimmering, dazzling, double vision and eye pain, each in one patient. One patient complained progressive decreased vision in both eyes prior to the diagnosis of lung cancer. Of the 16 eyes of the eight patients, there were six patients with no light perception vision, five from light perception to 0.05, and other five with no less than 0.4 vision, in the end of the follow up. Five patients were treated with steroid with unsatisfactory efficacy. CONCLUSIONS: Each entity of PRON has its own clinical characteristics. PRON especially BDUMP may be a pre-metastatic disease.

Protective Effects of Adeno-associated Virus Mediated Brain-derived Neurotrophic Factor Expression on Retinal Ganglion Cells in Diabetic Rats.

Adeno-associated virus vector plasmid carrying the expression cassette of brain-derived neurotrophic factor (BDNF), pAAV-BDNF, was constructed and packaged into recombinant adeno-associated virus (rAAV-BDNF). The rAAV-BDNF was intravitreally injected into streptzotocin (STZ)-induced diabetic Sprague-Dawley (SD) Rats. Data showed that over-expression of BDNF could increase alive retinal ganglion cell (RGC) number and improve its function in streptzotocin(STZ)-induced diabetic rats, which might be a new method to treat diabetic neuropathy and retinopathy.

[Comment on the therapeutic value of optic atrophy].

Optic disc pale is a typical sign of optic atrophy and is often improperly remarked an "totally visual function damaged and without any therapeutic value". However, increasing evidences showed that there is considerable potential for vision restoration and recovery by appropriately stimulating the undamaged visual pathway through different means, medications and low vision rehabilitation techniques. Correct recognition the therapeutic value of optic atrophy is undoubtedly valuable for visual function improvement. We encourage continuously developing new way or tool to rescues or preserve the residual vision of optic atrophy.

[Current research status on radiation retinopathy].

Radiation retinopathy (RR) and radiation optic neuropathy (RON) are vision-threatening complications of head and/or neck irradiation therapy. Clinical features are characterized by delayed-onset, slowly progressive, occlusive vasculopathy caused by endothelial damage. Compared with the optic nerve, retinal vessels are more sensitive and harmful to radioactive injury and cause RR, which may progress to eyeball atrophy ultimately. Thorough understanding of the incidence, pathogenesis, risk factors, clinical characteristics and treatment of RR is of practice significance. Ongoing basic laboratory and clinical research efforts have led to a better understanding of this disease. This article reviews the present research status of RR briefly.

Structural-visual functional relationships detected by optical coherence tomography in varying age-cohorts' patients with optic neuritis.

AIM: To assess the relationships of final best-corrected visual acuity (BCVA) and the optic nerve structural loss in varying age-cohorts of optic neuritis (ON) patients. METHODS: This is a retrospective, cross-sectional study. Totally 130 ON subjects (200 eyes) without ON onset within 6mo were included, who underwent BCVA assessment, peripapillary retinal nerve fibre layer (pRNFL) and macular segmented layers evaluation by optical coherence tomography (OCT). RESULTS: For the 0-18y cohort, the final BCVA (logMAR) was significantly better and less frequent recurrences than adult cohorts (P=0.000). The final BCVA (logMAR) in all age-cohorts of the ON patients had negative and linear correlations to the pRNFL thicknesses and macular retinal ganglion cell layer (mRGCL) volumes, when the pRNFL thicknesses were reduced to the thresholds of 57.2-67.5 µm or 0.691-0.737 mm3 in mRGCL volumes, respectively, with the strongest interdependence in the 19-40y cohort. The ON patients from varying age cohorts would be threatened by blindness when their pRNFL thicknesses dropped 36.7-48.3 µm or the mRGCL volumes dropped to 0.495-0.613 mm3. CONCLUSION: The paediatric ON has best prognosis and young adult ON exhibits perfectly linear correlations of final vision and structural loss. The pRNFL and the mRGCL could be potential structural markers to predict the vision prognosis for varying-age ON patients.

Leber's hereditary optic neuropathy companied with multiple-related diseases.

Objective: To elucidate the clinical, radiologic characteristics of Leber's hereditary optic neuropathy (LHON) associated with the other diseases. Materials and methods: Clinical data were retrospectively collected from hospitalized patients with LHON associated with the other diseases at the Neuro-Ophthalmology Department at the Chinese People's Liberation Army General Hospital (PLAGH) from December 2014 to October 2018. Results: A total of 13 patients, 24 eyes (10 men and 3 women; mean age, 30.69 ± 12.76 years) with LHON mitochondrial DNA (mtDNA) mutations, were included in the cohort. 14502(5)11778(4)11778 &11696(1)12811(1)11696(1)3460(1). One patient was positive for aquaporin-4 antibody (AQP4-Ab), and two were positive for myelin oligodendrocyte glycoprotein antibody (MOG-Ab). Three patients were associated with idiopathic optic neuritis (ON). Two patients were with compression optic neuropathy. Three patients were with the central nervous system (CNS) diseases. One patient was with proliferative diabetic retinopathy (PDR) and one with idiopathic orbital inflammatory syndrome (IOIS). At the onset, visual acuity (VA) in eighteen eyes was below 0.1, one eye was 0.5, five eyes were above 0.5, while VA in sixteen eyes was below a 0.1 outcome, three eyes experienced moderate vision loss. MRI images showed T2 lesions and enhancement in nine patients who received corticosteroids treatment; additional immune modulators treatment was performed on two patients. None of the patients had relapse during the follow-up time. Conclusion: Leber's hereditary optic neuropathy can be accompanied with multiple-related diseases, especially different subtypes of ON, which were also exhibited with IOIS and compression optic neuropathy for the first time in this cohort. This condition may be a distinct entity with an unusual clinical and therapeutic profile.

[Emphasize the importance of study on treatment and visual restoration related to impairment of retro-chiasmal visual pathway].

Homonymous visual field defect which is usually caused by stroke, brain tumor and trauma, is common. In spite of partial spontaneous recovery, homonymous hemianopia still causes serious disability. Visual restoration therapy (VRT) based on the residual visual capability and brain plasticity theory was reported effectively enlarged visual field caused by impairment of visual pathway. Controversy still exits on the efficacy of these procedures. However, due to the high prevalence and poor outcome of visual pathway impairment, it is important to initiate multiple disciplinary co-operative study on VRT and other procedures for visual function rehabilitation to improve life quality of patients with retro-chiasmal visual pathway impairment.

[Is it efficacy for the treatment of idiopathic optic neuritis with glucocorticosteroid].

Glucocorticosteroid (steroid) therapy is the major treatment for some important neuro-ophthalmological diseases. However, its efficacy, safety and abuse raise great controversy and debate for a long time, many clinical problems also remain to be solved. This paper discusses the issues relevant to the treatment of idiopathic optic neuritis by steroid and strongly advocate carrying out an evidence-based multicenter randomized clinical trial in China. It is suggested to establish a standard guideline or consensus for the treatment of neuro-ophthalmological diseases with steroid.

[Recent progress on genetics of optic neuritis].

Optic neuritis (ON) is a common disorder of the neuro-ophthalmology, which harms patients vision seriously. However, there are a lot of controversy and confusion about its etiology. While ON has familial characteristic and the tendency of heredity to some extent. Recently, association studies have made considerable progress with the rapid development of molecular biology techniques and statistical methods. In this article, the latest progresses in genetics of ON are reviewed.

Mitochondrial Mutations in Ethambutol-Induced Optic Neuropathy.

Background: Ethambutol-induced optic neuropathy (EON) is a well-recognized ocular complication in patients who take ethambutol as a tuberculosis treatment. The aim of the current study was to investigate the presence of mitochondrial mutations, including OPA1 and Leber's hereditary optic neuropathy (LHON)-mitochondrial DNA (mtDNA), in patients with EON and to determine their effect on clinical features of these patients. Methods: All 47 patients underwent clinical evaluations, including best-corrected visual acuity, fundus examination, and color fundus photography; 37 patients were then followed up over time. Molecular screening methods, including PCR-based sequencing of the OPA1 gene and LHON-mtDNA mutations, together with targeted exome sequencing, were used to detect mutations. Results: We detected 15 OPA1 mutations in 18 patients and two LHON-mtDNA mutations in four patients, for an overall mutation detection rate of 46.8%. The mean presentation age was significantly younger in the patients with the mitochondrial mutations (27.5 years) than in those without mutations (48 years). Fundus examination revealed a greater prevalence of optic disc hyperemia in the patients with mutations (70.5%) than without mutations (48%). Half of the patients with mutations and 91% of the patients without mutations had improved vision. After adjusting for confounders, the logistic regression revealed that the patients with optic disc pallor on the first visit (p = 0.004) or the patients with the mitochondrial mutations (p < 0.001) had a poorer vision prognosis. Conclusion: Our results indicated that carriers with OPA1 mutations might be more vulnerable for the toxicity of EMB to develop EON.

[Actively promote the development of neuro-ophthalmology in China].

Neuro-ophthalmology is a medical subspecialty concerned on the nervous system diseases with ocular manifestations, this could be both sensory and motor, including ocular movements, papillary responses, and the structure changes of the brain and nervous system with ocular manifestations. Although neuro-ophthalmology in China has achieved some progress, certain problems still exist, such as the professional neuro-ophthalmology team and related academic organization are still absent in China; neuro-ophthalmology knowledge has not been popularized; the new technologies for diagnosis and treatment in neuro-ophthalmology have not been absorbed and applied; the coordination and cooperation with other related disciplines are not enough. We should actively promote the development of neuro-ophthalmology in China, including organization of a professional team of neuro-ophthalmology, popularization of neuro-ophthalmology knowledge to the ophthalmologists, development of research work in neuro-ophthalmology and the collaboration with international neuro-ophthalmologists.

[Study on the association between IL-2R and IL-7R gene polymorphism and idiopathic demyelinating optic neuritis].

OBJECTIVE: To analyze the relationship between the gene polymorphism of IL-2R (rs2104286) and IL-7R (rs6897932) and the susceptibility to idiopathic demyelinating optic neuritis (IDON). METHODS: A case-control study was performed in 72 IDON patients and 81 healthy individuals as the control group. DNA was extracted from peripheral blood leukocytes. PCR was used to amplify the aim genes; the SNP of IL-2R were analyzed by restriction fragment length polymorphism (RFLP) assay and the SNP of IL-7R were analyzed by gene sequencing. The χ2 test was used to compare genotype and allele frequencies between the IDON and control populations. Odds ratio (OR) was calculated using the approximation of Woolf for the 95% confidence interval (CI). RESULTS: No significant difference of genotype (χ2=0.410, P=0.815) and allele frequency(χ2=0.413, P=0.520) of IL-2R gene existed in IDON group(AA:54/AG:15/GG:3;A:123/G:21) as compared with the control group (AA:57/AG:20/GG:4;A:134/G:28). No significant difference of genotype frequency (χ2=3.787, P=0.150) of IL-7R existed in IDON group (CC:56/CT:13/TT:3) as compared with the control group (CC:52/CT:21/TT:8). However, there was a significant difference in IL-7R allele (C/T) between IDON group (C:125/T:19) and the controls (C:125/T:37) (χ2=4.743, P=0.029), OR=1.95 (95%CI: 1.07-3.55). CONCLUSIONS: There is no significant difference in IL-2R rs2104286 polymorphism between IDON group and the controls; the frequencies of IL-7R rs6897932 C allele in IDON group was significantly greater than that of the controls. Polymorphism of IL-7R gene (rs6897932) may contribute to the risk of IDON.

[Clinical analysis of internal carotid artery aneurysm accompanied with ocular manifestations].

OBJECTIVE: To study the location and size of aneurysm of internal carotid artery (AICA) with ocular manifestations and the clinical characteristic of ocular changes. METHODS: Forty patients with ocular changes caused by AICA presented in Department of Ophthalmology of the General Hospital of PLA were collected and analyzed retrospectively. RESULTS: In 42 cases of AICA accompanied with ocular manifestations, AICA was located at paraclinoid aneurysms in 23 case and 23 cases were giant aneurysm. Visual acuity was decreased significantly in 25 cases. Oculomotor palsy was present in 21 cases. Abducens paralysis was present in 7 cases. Different degrees of visual field defects were present in 15 cases. CONCLUSIONS: Ocular changes in AICA include decrease of visual acuity, oculomotor palsy, abducens paralysis and various defects of visual field. Ocular changes mainly occur in paraclinoid aneurysms and giant aneurysms.

[Preliminary report of contrast sensitivity in idiopathic optic neuritis patients after recovery].

OBJECTIVE: To explore the changes of contrast sensitivity (CS) in patients recovered from idiopathic optic neuritis (ION). METHODS: It was a case-control study. We screened 22 idiopathic optic neuritis patients who underwent treatment and obtained normal visual acuity. No nervous system abnormalities were found in MRI scan. Twenty four healthy individuals were enrolled as the control group. OPTEC 6500 contrast sensitivity tester was used to examine near- and far-distance CS values on 1.5, 3.0, 6.0, 12 and 18 cycles/degree (c/d), separately. T-test or u-test was used to compare the mean of CS values between these two groups. ANOVA or H-test was adopted on CS values at the different frequencies in each group. Simple linear correlation was used to analyze the correlation between CS values and age, duration and gender, separately. RESULTS: The maximum CS values in both far- and near-distance appeared in 6.0 c/d in these two groups were 70.27 +/- 40.44, 53.32 +/- 29.50, 78.86 +/- 36.37 and 109.39 +/- 44.98, respectively. The minimum CS values in both far- and near-distance appeared in 18 c/d in these two groups were 8.27 +/- 6.11, 12.09 +/- 8.57, 15.67 +/- 9.02 and 22.22 +/- 14.56, respectively. Far- and near-distance CS values in ION group and control group had very significant differences at these five spatial frequencies (From 1.5 to 18.0 c/d, the test values on far-distance were 4.19, 5.59, 3.06, 2.50, 3.13, P values were 0.00, 0.00, 0.00, 0.01, 0.00. The test values on near-distance were 3.54, 3.98, 2.72, 3.20, 3.39, P values were 0.00, 0.00, 0.01, 0.00, 0.00). CS values had no relation to the duration of ION. Significant difference in CS values existed on most frequencies (In far- and near-distance, H values in ION group were 52.38 and 64.96, in control group were 64.77 and 60.53, P values were both less than 0.01). The maximum H value appeared on near-distance in ION group. The maximum H value was 64.96 of near-distance in ION group. Far- and near-distance CS values in ION group itself and control group itself had very significant differences at these 5 spatial frequencies (From low to high frequencies, F values were 6.36, 0.03, 2.52, 1.53, 2.90; P values were 0.02, 0.87, 0.12, 0.22, 0.10 in ION group. In control group, F values were 5.31, 5.69, 6.06, 0.61, 3.14; P values were 0.03, 0.02, 0.02, 0.44, 0.08 respectively). CONCLUSIONS: CS values at different frequencies in ION patients with normal visual acuity descend significantly. Contrast sensitivity examination can be an important technique to evaluate vision quality in patients after ION.

[Ocular manifestations of brainstem tumor].

OBJECTIVE: To investigate the ocular manifestations of brainstem tumors and to avoid misdiagnosis and missed diagnosis. METHODS: This is a retrospective case series study. The clinical data of 57 brainstem tumor in-patients were collected from 1993 to 2007. The clinical manifestations and the results of related examinations were analyzed. RESULTS: The present series included 51 cases of brainstem germinoma, 4 cases of cavernous hemangioma, 1 case of hemangioblastoma and 1 case of metastatic tumor. In 51 cases of brainstem germinoma, there were 37 males and 14 females. The first attack age varied from 5 to 55 years old and the median age was 23 years old. The high incident ages of brainstem germinoma were 10 - 35 years. Patients were presented with diplopia, ocular motility disturbance, nystagmus, anisocoria, and facial palsy. In 57 patients, diplopia was the initial symptom in 12.3% (7/57) cases. The incidence of oculomotor nerve paralysis was 17.5% (10/57); trochlear paralysis, 1.8% (1/57); trigeminal nerve paralysis, 5.3% (3/57); abducens nerve paralysis, 35.1% (20/57); facial palsy, 14.0% (8/57); optic disc edema, 19.3% (11/57); nystagmus, 21.1% (12/57) and anisocoria, 10.5% (6/57). CONCLUSIONS: Ocular manifestations occur frequently in brainstem tumor. Nuclear ophthalmoplegia, nystagmus and other neuro-ophthalmic signs provide helpful clues for the diagnosis of brainstem tumor.

[Clinical features of hypoperfusion retinopathy induced neovascular glaucoma].

OBJECTIVE: To analyze the clinical features of hypoperfusion retinopathy induced neovascular glaucoma METHODS: This retrospective case series included 18 cases (18 eyes) with hypoperfusion retinopathy induced neovascular glaucoma Among them, there were 15 male and 3 female; 10 right eye and 5 left eye. The average age was 40-year-old (ranged from 18- to 78-year-old). Visual acuity and fundus were examined using fundus fluorescein angiography (FFA), Color Doppler Flow Imaging (CDFI), magnetic resonance angiography (MRA), and Digital subtraction angiography (DSA) etc in all patients. RESULTS: The visual acuity was ranged from light perception to 0. 8 in all patients. The clinical features in hypoperfusion retinopathy induced neovascular glaucoma were characterized by midperipheral intraretinal hemorrhages, narrowed retinal arteries, dilated retinal veins, neovascularisation in iris and anterior chamber angle, ocular hypertension, excavation and atrophy of optic disk, and visual field defects when glaucoma progressed. All eyes have either ipsilateral common carotid artery obstruction or severe bilateral obstruction of the internal carotid arteries. CONCLUSIONS: Neovascular glaucoma is a rare and severe complication of hypoperfusion retinopathy associated with either ipsilateral common carotid artery obstruction or severe bilateral obstruction of the internal carotid arteries. Fundus degeneration is commonly involved in one eye. The characteristic clinical features are presented during the process of the disease.