Volume 50 · Issue 12 · 2014

Neuro-ophthalmology is a crossing discipline.Optic neuritis and ischemic optic neuropathy are the hot points of this field.Currently,studies of optic neuritis epidemiology,etiology and clinical features have already been done in china.And the expert consensus of optic neuritis therapy was published.The pathogenesis and treatment of ischemic optic neuropathy is another hot point.We have embarked on the epidemiological study of ischemic optic neuropathy in china.We also appeal the ophthalmologists to pay more attention on the therapy of posterior visual pathway.(Chin J Ophthalmol,2014,

Neuro-ophthalmology,as an interdisciplinary,covers at least three disciplinesophthalmology,neurology and neurosurgery.With limited knowledge in each discipline,doctors often make misdiagnoses for neuro-ophthalmology diseases.Therefore,it is imperative to abandon the distinction between disciplines and combine all the knowledge to diagnose and treat patients in patterns of holistic integrated medicine in order to effectively improve the diagnosis and treatment of neuro-ophthalmology.

Objective To investigate the clinical feature of the chronic compressive optic neuropathy without optic atrophy.Methods Retrospective cases series study.The clinical data of 25 patients (37 eyes) with chronic compressive optic neuropathy without optic atrophy,treated in Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,from October,2005 to March,2014,were collected.Those patients had been showing visual symptoms for 6 months or longer,but missed diagnosed or misdiagnosed as other eye diseases due to their normal or slightly changed fundi.The collected data including visual acuities,visual fields,neuroimaging and/or pathologic diagnosis were analyzed.Results Among the 25 patients,there were 5 males and 20 females,and their ages range from 9 to 74 years [average (47.5 ± 13.4) years].All patients suffered progressive impaired vision in single eye or both eyes,without exophthalmos or abnormal eye movements.Except one patient had a headache,other patients did not show systemic symptoms.The corrected visual acuities were between HM to 1.0,and their appearances of optic discs and colors of fundi were normal.After neuroimaging and/or pathological examination,it was proven that 14 patients suffered tuberculum sellae meningiomas,5 patients with hypophysoma,3 patient with optic nerve sheath meningioma in orbital apex,1 patient with cavernous hemangioma,1 patient with vascular malformation in orbital apex and 1 patient with optic nerve glioma.Among the 19 patients whose suffered occupied lesions of saddle area,14 patients underwent visual field examinations,and only 4 patients showed classic visual field defects caused by optic chiasmal lesions.Conclusion Occult progressive visual loss was the most important clinical feature of the disease.

Objective To evaluate the association between the ocular hemodynamic and the incidence of ischemic cerebral vascular diseases in carotid artery stenosis patients.Methods Case-control study.Seventy-two cases patients with carotid artery stenosis including 22 cases of cerebral infarction group,14 cases of lacunar cerebral infarction group and the control group of the other 36 patients without cerebral infarction were recruited.All patients were measured with hemodynamic parameters of the ophthalmic artery,central retinal artery and posterior ciliary artery.PSV,EDV,PI and RI were also measured.The other risk ischemic cerebral vascular factors were obtained through the questionnaire and venous blood sampling.The differences of 3 groups and the influences of the other risk factor of hemodynamic were calculated.Results PSV of ophthalmic artery was(25.96 ± 12.63) cm/s in cerebral infarction group,(32.63 ± 13.25) cm/s in lacunar infarction group and (39.46 ± 14.97) cm/s in control group.EDV of ophthalmic artery was(6.09 ± 3.10)cm/s in cerebral infarction group,(6.57 ± 2.85)cm/s in lacunar infarction group and (9.73 ± 5.02) cm/s in control group.PSV of central retinal artery was (8.06 ± 2.98) cm/s in cerebral infarction group,(8.91 ± 2.76)cm/s in lacunar infarction group and (9.71 ± 2.60)cm/s in control group.The differences were statistically significant (F =13.393,12.609,5.027,P ＜ 0.01).EDV of central retinal artery was (2.46 ± 0.77) cm/s in cerebral infarction group,(2.35 ± 0.89) cm/s in lacunar infarction group and (2.73 ±0.86)cm/s in control group.There was no statistical difference of EDV of CRA in three group (F=2.405,P =0.094).Conclusions There was association between the ocular hemodynamic parameters and the incidence of ischemic cerebrovascular disease in the carotid artery stenosis patients.Increased level of PSV and EDV of the ophthalmic artery raised the risk of the incidence of ischemic cerebrovascular disease.

Objective To evaluate the impairment of optic nerve of different types of multiple sclerosis (MS) by optic coherence tomography (OCT).Methods Cross-sectional study.52 eyes of 30 patients who diagnosed as MS up to the 2010 Mcdonald criteria were included.13 eyes of 13 healthy people matched with sex and age were set as the control group.Patients with MS were divided into 3 subgroups based on the history of optic neuritis (ON):22 eyes of MS patients with the history of ON were in MS-ON group,16 eyes of MS patients without ON were in MS-NON group and 14 contralateral eyes of MS-ON patients were in MS-ON Contra group.Fourier domain OCT was used to examine.The protocol included macula scanning,retinal nerve fiber layer (RNFL) analysis and ganglion cell complex (GCC) and optic nerve head (ONH) scanning.Visual acuity (VA) and visual field (VF) were also compared.The major measurements were RNFL and GCC thickness.ANOVA was used to compare the overall difference of RNFL and GCC thickness among all the groups.LSD method was used to compare the difference between every two groups.Results The thickness of average GCC,superior GCC and inferior GCC of MS-ON group is (80.65 ± 16.03) μm,(81.50 ± 14.56) μm,(79.83 ± 17.65) μm.Compared with the MS-NON group which is(99.65 ± 9.35) μm,(99.26 ± 9.73) μm,(100.06 ± 9.31) μm correspondingly,MS-ON contra group (99.36 ± 8.25) μm,(100.39 ± 8.97) μm,(98.34 ± 7.88) μm correspondingly and the control group (104.87 ± 8.71) μm,(105.36 ± 8.21) μm,(103.96 ± 10.33) μm correspondingly,they decreased significantly (P ＜ O.05).While the GCC thickness has no significantly difference among the MS-NON,MSON Contra and the control group.The average RNFL thickness and nasal inferior quadrant RNFL thickness in MS-ON group was (83.68 ±29.91) μm,(92.26 ±35.97) μm.And they were significantly thinner than that in the MS-NON group which was (108.83 ± 15.33) μm,(120.85 ± 35.96) μm correspondingly and that in the control group which was (111.60 ± 14.90) μm,(139.95 ±7.77) μm correspondingly (P ＜ 0.05).The RNFL thickness in temporal inferior quadrant in MS-ON group was (109.63 ± 44.54) μm and it was (60.47 ± 26.94) μm in the temporal quadrant.And they decreased significantly compared with that in the MS-NON which was (149.92 ± 18.51) μm,(90.64 ± 16.15) μm correspondingly,and in the MSON Contra group which was (135.70± 28.66) μm,(77.30± 23.40) μm correspondingly and in the control group which was (172.72 ± 15.29) μm,(90.90 ± 6.15) μm correspondingly (P ＜ 0.05).The RNFL thickness in nasal inferior,temporal inferior and temporal quadrant in the MS-ON Contra group was (106.60 ±44.07) μm,(135.70 ±28.66) μm,(77.30 ±23.40) μm respectively which was significantly thinner than that in the control group which was (139.95 ±7.77) μm,(172.72 ± 15.29) μm,(90.90 ± 6.15) μm correspondingly (P ＜ 0.05).Conclusions GCC and RNFL thickness of OCT test can be used to evaluate the impairment of optic nerve of MS patients,and the RNFL scanning can reflect the early and latent lesion of optic nerve in MS.(Chin J Ophthalmol,2014,50:900-905)

Objective To characterize the literature associated with the ocular ischemic syndrome (OIS) field from January 1,2000 to December 1,2013.Methods Literature analysis.Articles related to OIS between January 1,2000 and December 1,2013 were found by advanced search using Google Scholar.All results underwent visual inspection to ensure that the final results included only literature associated with OIS in some way.All the results including the publication year,authors,organizations,nations and the source journals were listed and analyzed.Results There were 322 literatures which cited 2 798 times totally.The h-index of literature associated with OIS was 28.There were only 6 articles published in 2000,while 54 articles in 2013 which was significant different.The largest number of author is from US,then China and Japan.The most frequent cited article was a review which summarized retinal vascular occlusive disorders written by Sohan Singh Hayreh.And the other top 10 articles talked about intravitreal injection,hemodynamics and its pathogenesis.The hightest h-index of author,orgnization,country,and source title was Sohan Singh Hayreh,University of Iowa and Utrecht University,United States,and Investigative Ophthalmology and Visual Science respectively.Conclusions The quantity of the articles about OIS growed every year.OIS research is getting more attention gradually,particularly in intravitreal injection,hemodynamics and its pathogenesis.(Chin J Ophthalmol,2014,50:906-910)

Objective To explore the radiographic characteristics of nasolacrimal canals in congenital nasolacrimal canal agenesis.Methods Retrospective case series study.The images of Computed Tomography of 18 children with unilateral congenital nasolacrimal canal agenesis who were treated in Beijing Children's Hospital from January 2009 to June 2013 were studied.The common features of abnormal lacrimal canals were analyzed.The heights of bilateral lacrimal canals,anterioposterior and transverse diameters at the original level of lacrimal canal were measured.The traverse diameters,anteroposterior diameters,heights of bony nasolacrimal duct between affected side and normal side were compared using paired t tests.Results The initial segment of abnormal nasolacrimal canal showed no obvious abnormalities,but it became significant stenosis or even atresia at the middle and terminal segments.The transverse (4.72 ± 0.79) mm and anterioposterior diameters (5.45 ± 1.07) mm of affected sides were larger than the values of normal sides (3.42 ±0.67) mm,(4.35 ± 1.01) mm at the original level of nasolacrimal canal with statistically significance (t =5.665,P =0.000 ; t =6.610,P =0.000).However,the height of nasolacrimal canal of normal sides were larger than the affected sides (t =5.931,P =0.000).Conclusions Atresia position of congenital nasolacrimal canal agenesis always located in the terminal segment.High pressure in the nasolacrimal duct caused by bony obstruction leaded to the enlargement of nasolacrimal canal in affected side.(Chin J Ophthalmol,2014,50:911-914)

Ten researches that represent the most advanced neuro-ophthalmology related studies in china were voted by specialists from Chinese Neuro-ophthalmology Society.These researches were concentrated in the following fields:clinical and basic researches of optic neuritis,studies of ischemic optic neuropathy,and clinical present of Leber's hereditary optic neuropathy.These researches represented the level of neuro-ophthalmology in China and also showed the focus of our Chinese neuro-ophthalmologists in recent years.(Chin J Ophthalmol,2014,50:915-917)

The patient is a 40-year-old female, a civil servant. Due to acute left eyelid ptosis with diplopia for 1 month, she came to the Department of Neuroophthalmology, Eye, Ear, Nose and Throat Hospital of Fudan University in April 2014. The patient denied headache and facial and neck pain; There is no phenomenon of light morning and heavy evening; Not accompanied by numbness and weakness of limbs. In the past, in September 2012, he underwent transsphenoidal fiberscopic surgery for "pituitary tumor", and postoperative gamma knife treatment with a dose of 20 Gy. The patient had no history of hypertension and diabetes. Neuroophthalmic examination: clear consciousness, fluent speech and cooperation. The best corrected visual acuity of both eyes was 1.0. The border of the bilateral optic papilla of the fundus was clear and red, and there were no abnormalities in the retina and macula. The left eyelid was completely drooped; The bilateral pupils were unequal in size, 3 mm on the right side; Left side 7 mm. The direct and indirect light response of the left pupil disappeared; The right side light reflection is sensitive, and the left eyeball turns up, down and adduction are completely limited; The abduction of the left eye and the right eye movement were normal (Figure 1). No abnormalities were found in the examination of the remaining cranial nerve, and the muscle strength, muscle tone and tendon reflex of the limbs were normal.

The patient, a 24-year-old Uyghur male, went to the 474th Hospital of the People's Liberation Army for treatment due to visual acuity decrease and visual field defect after right eye trauma for 3 days. On April 11, 2014, when the patient tapped an iron tool, an iron chip foreign body splashed and injured his right eye. On April 15, 2013, he was admitted to the hospital with a foreign body in his right orbit. He was in good health. After admission, the patient had an irregular wound (white arrow) on the skin of the medial eyebrow arch of his right eye, with an oblique length of about 0.5mm, which had been closed (Figure 1). Visual acuity, right eye: 0.6, left eye: 1.0; Subconjunctival congestion on the medial side of the right eye, no wound on the ocular surface, and the pupils were equal in size and round on both sides, 3 mm under natural light. He was directly and indirectly sensitive to light, and no abnormalities were found in fundus examination. CT examination showed that the deep orbit was in contact with a foreign body of the optic nerve (Figure 2), and the visual field was missing in the upper half of the visual field and the temporal part of the visual field (Figure 3). Diagnosis: foreign body in the deep right orbit; Contusion of the optic nerve in the right eye.

The patient, a 64-year-old man, came to the Department of Ophthalmology of Tianjin First Central Hospital on March 11, 2013 due to malignant lymphoma of left orbit 3 years after operation and swelling of left eye for 1 1/2 years. The patient was operated in the Second Affiliated Hospital of Tianjin Medical University 25 years ago due to exophthalmos of left eye with inflammation. The postoperative pathological results suggested reactive tissue hyperplasia, and was diagnosed as inflammatory pseudotumor of left eye. Three years ago, the main cause of left orbital mass with exophthalmos was operated in Tianjin Eye Hospital, and the pathological diagnosis was non-Hodgkin's B small lymphocytic lymphoma in left orbit; No radiotherapy or chemotherapy was performed after operation; One and a half years ago, the patient felt swollen left eye, and found a mass above the orbit. The eyeball was protruding and displaced outward and downward, accompanied by vision loss, diplopia, numbness on the left forehead, and an enlarged lymph node palpable under the left mandible. On February 25, 2013, an orbital CT examination was performed in Tianjin Eye Hospital, which showed irregular medium-high density shadows in the left orbit with unclear boundaries, closely related to the medial rectus and superior rectus muscles, and the CT value was about 46 HU (Figure 1). The outpatient clinic was admitted to the hospital with "recurrence of malignant lymphoma in the left orbit?". No abnormalities were found in the rest of the body examination, and no obvious abnormalities were found in the abdominal B-ultrasound.

The patient was a male, 7 years old and 8 months old. Because of the physical examination in kindergarten, it was found that the visual acuity in both eyes decreased for more than 3 months, and he was diagnosed as "optic neuroretinopathy in the right eye, and the cause of poor visual acuity in the left eye to be investigated". He was given dexamethasone intravenously, and then changed to prednisolone orally. TROCH examination (T: toxoplasma, R: rubella virus, C: cytomegalovirus, H: herpes simplex virus): cytomegalovirus (CMV) -IgG (+), herpes simplex virus (HSV) 1-IgG (+), HSV1-IgM (+), HSV2-IgM (+), and rubella virus (RV) -IgG1 14.66 U/ml.

The patient was a 45-year-old female who went to Tianjin Eye Hospital because the tumor in the lateral canthus of the right upper eyelid had grown for more than 10 years, the growth was accelerated, the visual field was occluded and the eyelid was heavy for 1 year. The patient denied the history of right eye trauma, tumor treatment and surgery. The patient underwent double eyelid surgery in both eyes 30 years ago, uterine fibroids and bilateral breast fibroids resection 4 years ago. There were no obvious abnormalities in the whole body examination, and the calcium and phosphorus metabolism was normal in the biochemical examination. Ocular examination: the visual acuity was 1.0 in both eyes, and the anterior segment and fundus examination were normal. The upper eyelid of the right eye was slightly swollen, the lateral canthus was slightly drooped, and a hard nodule with a vertical oval shape of about 3 mm ×6 mm could be palpable on the lateral orbital margin, without obvious tenderness, it could be pushed subcutaneously, with moderate mobility, and no obvious adhesion to the skin (Figure 1). Orbital CT examination showed that there were multiple irregular dense shadows in the subcutaneous soft tissue of the right eyelid on the temporal side, with a CT value of about 334 Hu, and the adjacent soft tissue was slightly swollen. Small dot-like density increased shadows could also be seen in the soft tissue of the left eyelid, and the shape of the bilateral eyeballs was normal (Figure 2).

Ocular trauma is the main cause of monocular blindness worldwide, which seriously affects the working ability and quality of life of the injured [1-5]. In Beijing alone, the 5-year incidence rate of ocular trauma over 40 years old is nearly 3%, and it is concentrated in young and middle-aged low-income males, and the blindness rate of ocular trauma is 2.3% [6]. Since China's ocular trauma registration system is in the preparatory stage, there is no exact data on the incidence or prevalence of ocular trauma in the national or regional scope. Besides, China is a developing country with a large population base, many migrant workers, unreasonable distribution of medical resources and low medical level in most areas, it is estimated that China has a high incidence rate of ocular trauma [7].

A 26-year-old male was seen in Changchun Aier Eye Hospital on June 29, 2014 due to left eye pain accompanied by ipsilateral headache for 3 days. He had a history of left eye trauma for 7 years. Eye examination: visual acuity was 1.0 in the right eye, light sensing in the left eye, and intraocular pressure was 16 mmHg (1 mmHg =0.133 kPa) in the right eye and 56 mmHg in the left eye. Right eye normal; The essence picture 1 is seen in the anterior segment of the left eye, but the fundus of the left eye is invisible. The essence picture 2 is seen in the orbital CT examination image. Clinical diagnosis: rust disease in the left eye; Secondary glaucoma of left eye; Complicated cataract in left eye; Foreign body in left eyeball.

A 60-year-old male was seen in Tianjin Eye Hospital due to the accidental discovery of a mass under the left orbit for 1 year and the curvature of vision for 3 months. Ocular examination showed that the visual acuity was 1.0 in the right eye and 0.6 in the left eye, and there was no abnormality in the external eye and anterior segment of the right eye; The lower eyelid of the left eye is slightly bulged, nodular mass can be palpable, which can be pushed, and hard mass can be palpable in the deep layer, which is immobile, tender and not smooth; Eye movement was acceptable, and there was no abnormality in the anterior segment of the eye; The foveal light reaction in the macular area of the right eye disappeared, and the pigment disorder; Bloody subretinal exudation in the macular area of the left eye; IOP was normal in both eyes.

Pediatric optic neuritis (ON) is different from its adult counterpart in terms of epidemiology,etiology,clinical manifestations,and prognosis.Although adult optic neuritis was well described in treatments by the Optic Neuritis Treatment Trial (ONTT),there is no universal agreement on the treatments in a pediatric population.Since there is an inadequate knowledge about pediatric ON in our nation,we compared the clinical manifestations of pediatric ON with its adult population,reviewed the existing understanding of the relationship between pediatric ON and various diseases of CNS,and summarized the current treatments,expecting to provide useful reference in clinic.(Chin J Ophthalmol,2014,50:941-945)

Reduction of intraocular pressure (IOP) by drugs is a major treatment for glaucoma.Clinically,diverse antiglaucoma drugs take effect to decrease the IOP through different mechanisms.However,due to limitations of traditional form of eye drops,the bioavailability of the drug and the patient compliance is lowered,the clinical efficacy is not good and also some toxic and side-effects come out.Otherwise,traditional medication is not suitable for neuroprotective drugs to work on both retina and optic nerve.Drug delivery system has the potential to improve the bioavailability of the drug,prolong the time of drug action,decrease the dosage and frequency of drugs,reduce the side-effects,and improve the patient compliance and efficacy.It is one of the most important studies in glaucoma medication development because it is valuable for patients' neuroprotection.Nowadays,several novel delivery systems have been designed.This review will focus on the progressions of some of the sustained-release antiglaucoma eye drops,polymeric gels,colloidal systems,membrane-controlled drug delivery system,ocular implants,and transscleral drug delivery systems.(Chin J Ophthalmol,2014,50:946-951)

Tip cells are one kind of vascular endothelial cells.Migration and sprouting of tip cells is the first step of angiogenesis.In recent years,researchers found a large number of tip endothelial cells in new blood vessels of diabetic retinopathy patients and animal models.Vascular endothelial growth factor (VEGF) regulates the migration and budding of tip cells and dissolves the extracellular matrix.Pericyte recruitment guided by the VEGF-DLL-Notch signal pathway is necessary for neovascularization.The change of miRNA in tip cells is also involved in the regulation of angiogenesis.This paper focuses on the mechanism of endothelial tip cells in diabetic retinopathy and prospects for the future research of anti-angiogenesis drug targets.(Chin J Ophthalmol,2014,50:952-958)

With the rapid development of perinatal medicine and neonatology in China, and the general establishment of neonatal intensive care unit (NICU), the survival rate of premature infants and low birth weight infants has obviously improved. The incidence of retinopathy of prematurity (ROP), which has appeared in the early stage of developed countries, is on the rise in China. ROP can lead to blindness when it is severe, which is the first cause of childhood blindness at present, causing a heavy burden on families and society. The causes of ROP are many, which are related to premature birth and immature retinal vascular development. Oxygen is an important rescue measure and a common risk factor for disease [1-2]. The smaller the gestational age and weight at birth, the higher the incidence rate [3]. In 2004, the Ministry of Health promulgated the Guidelines for Oxygen Treatment and retinopathy Prevention and Treatment of Premature Infants formulated by the Chinese Medical Association [4], which actively promoted the process of premature infant treatment and ROP prevention and treatment in China. However, the task of prevention and treatment of ROP is still very serious at present [5]. ROP first appeared in the correction of gestational age (gestational age at birth Early screening and correct treatment can prevent the development of retinopathy. In order to further solve this problem which seriously affects the quality of life of premature infants, do a good job in the prevention and treatment of ROP, and reduce the blindness rate caused by ROP, the Ophthalmology Group of Ophthalmology Branch of Chinese Medical Association revised the screening guidelines for retinopathy of premature infants in China for clinical application.

Glaucoma is the most common irreversible blinding eye disease in the world.Recent studies have shown that the pressure difference between the transsieve plate (the pressure difference between intraocular pressure and the cerebrospinal fluid of the retrobulbar optic nerve), rather than the abnormal increase of intraocular pressure, is an important risk factor.To obtain the pressure difference between the transsieve plate, it is necessary to detect the pressure of the subarachnoid cerebrospinal fluid around the retrobulbar optic nerve [1-7]. Up to now, the detection methods used in relevant research in the world are lumbar puncture or optic nerve subarachnoid puncture.However, as an invasive examination method, these two methods limit their clinical implementation. Beijing Tongren Ophthalmology Center, Imaging Department and Neurology Department of Beijing Tongren Hospital affiliated to Capital Medical University cooperated in a hospital-based cross-sectional study to explore the method of non-invasive intracranial pressure and transsieve plate pressure difference detection by 3.0T magnetic resonance imaging (MRI) technology.The research results are summarized as follows and discussed with ophthalmologists.

Functional neurosurgery is a branch of neurosurgery that interferes with the central nervous system and changes its physiological activities. As the subspecialty with the most rapid development in the field of neurosurgery, functional neurosurgery has made great progress in recent years. Functional neurosurgery treats a wide range of diseases, covering many functional diseases in other clinical disciplines such as neurology, neurosurgery, psychiatry, etc., mainly including cranial nerve diseases, epilepsy, pain, movement disorders, spasticity, etc. Among the diseases of cranial nerve, such as idiopathic hemifacial spasm (HFS), Bell's palsy, primary trigeminal neuralgia (TN) and other symptoms and signs involve the head and face, and have a variety of ocular manifestations, so they are closely related to ophthalmology related diseases. This article expounds this aspect, in order to play a certain helpful role in the diagnosis, differential diagnosis and treatment of related diseases.