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Clinical Pathways in Neuro-Ophthalmology (An Evidence-Based Approach) || 3 Optic Disc Edema with a Macular Star and Neuroretinitis
摘要： Optic disc edema associated with macular exudates in a star pattern occurs with a variety of conditions. When optic disc edema with a macular star occurs in the setting of retinitis, particularly due to an infectious etiology, it is termed neuroretinitis. This chapter discusses the clinical pathway for evaluating and diagnosing patients with optic disc edema with a macular star, and includes a detailed review of the literature and reported cases.
关键词： optic disc edema,neuroretinitis,Bartonella henselae,macular star,optic neuropathy
更新于2025-09-23 15:22:29
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The role of optical coherence tomography in the evaluation of compressive optic neuropathies
摘要： Purpose of review Optical coherence tomography (OCT) is a noninvasive imaging tool routinely used in ophthalmology that provides cross-sectional images of the retina. Compression of the anterior visual pathways results in progressive thinning of the retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) and this review will highlight the utility of OCT in evaluating patients with this condition. Recent findings The RNFL and macular GCC have been found to highly correlate with visual function in patients with compressive optic neuropathies. Preoperative RNFL and macular GCC thickness have emerged as the most reliable and consistent prognostic factors for visual recovery after surgery. Patients with an otherwise normal neuroophthalmic examination, including automated perimetry, may have macular GCC or RNFL thinning as the only manifestation of compression, enabling compressive optic neuropathies to be diagnosed at an earlier stage and managed accordingly. Summary Recent findings indicate that OCT is an important tool in the evaluation of patients with compressive optic neuropathies, particularly for prognosis in patients with visual field defects and diagnosis in patients with preserved or mildly reduced visual function. Anatomical changes detected by OCT may precede visual loss and allow for earlier diagnosis and presumably better visual outcomes.
关键词： optic neuropathy,anterior visual pathways,pituitary adenoma,optical coherence tomography
更新于2025-09-23 15:22:29
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Polybenzyl Glutamate Biocompatible Scaffold Promotes the Efficiency of Retinal Differentiation toward Retinal Ganglion Cell Lineage from Human-Induced Pluripotent Stem Cells
摘要： Optic neuropathy is one of the leading causes of irreversible blindness caused by retinal ganglion cell (RGC) degeneration. The development of induced pluripotent stem cell (iPSC)-based therapy opens a therapeutic window for RGC degeneration, and tissue engineering may further promote the efficiency of differentiation process of iPSCs. The present study was designed to evaluate the effects of a novel biomimetic polybenzyl glutamate (PBG) scaffold on culturing iPSC-derived RGC progenitors. The iPSC-derived neural spheres cultured on PBG scaffold increased the differentiated retinal neurons and promoted the neurite outgrowth in the RGC progenitor layer. Additionally, iPSCs cultured on PBG scaffold formed the organoid-like structures compared to that of iPSCs cultured on cover glass within the same culture period. With RNA-seq, we found that cells of the PBG group were differentiated toward retinal lineage and may be related to the glutamate signaling pathway. Further ontological analysis and the gene network analysis showed that the differentially expressed genes between cells of the PBG group and the control group were mainly associated with neuronal differentiation, neuronal maturation, and more specifically, retinal differentiation and maturation. The novel electrospinning PBG scaffold is beneficial for culturing iPSC-derived RGC progenitors as well as retinal organoids. Cells cultured on PBG scaffold differentiate effectively and shorten the process of RGC differentiation compared to that of cells cultured on coverslip. The new culture system may be helpful in future disease modeling, pharmacological screening, autologous transplantation, as well as narrowing the gap to clinical application.
关键词： induced pluripotent stem cells,retinal ganglion cells,tissue engineering,glaucoma,optic neuropathy,polybenzyl glutamate,electrospinning scaffold
更新于2025-09-23 15:22:29
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Medicine in ophthalmology
摘要： Ophthalmology is often a branch of medicine that is viewed as minor in relation to other specialities. However, there are numerous ophthalmic manifestations of neurological, rheumatological and general medical conditions. Some of these are considered emergencies (see pages xx of this chapter), but often signs are found within the eye that lead to systemic diagnoses requiring further intervention.
关键词： papilloedema,optic neuropathy,Diabetic retinopathy,thyroid eye disease,uveitis,MRCP
更新于2025-09-23 15:21:21
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Automatic Computer-Aided Diagnosis of Retinal Nerve Fiber Layer Defects Using Fundus Photographs in Optic Neuropathy
摘要： PURPOSE. To evaluate the validity of an automatic computer-aided diagnosis (CAD) system for detection of retinal nerve fiber layer (RNFL) defects on fundus photographs of glaucomatous and nonglaucomatous optic neuropathy. METHODS. We have proposed an automatic detection method for RNFL defects on fundus photographs in various cases of glaucomatous and nonglaucomatous optic neuropathy. In order to detect the vertical dark bands as candidate RNFL defects, the nonuniform illumination of the fundus image was corrected, the blood vessels were removed, and the images were converted to polar coordinates with the center of the optic disc. False positives (FPs) were reduced by using knowledge-based rules. The sensitivity and FP rates for all images were calculated. RESULTS. We tested 98 fundus photographs with 140 RNFL defects and 100 fundus photographs of healthy normal subjects. The proposed method achieved a sensitivity of 90% and a 0.67 FP rate per image and worked well with RNFL defects with variable depths and widths, with uniformly high detection rates regardless of the angular widths of the RNFL defects. The average detection accuracy was approximately 0.94. The overall diagnostic accuracy of the proposed algorithm for detecting RNFL defects among 98 patients and 100 healthy individuals was 86% sensitivity and 75% specificity. CONCLUSIONS. The proposed CAD system successfully detected RNFL defects in optic neuropathies. Thus, the proposed algorithm is useful for the detection of RNFL defects.
关键词： computer-aided diagnosis,glaucoma,optic neuropathy,fundus photographs,retinal nerve fiber layer
更新于2025-09-19 17:15:36
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Optical Coherence Tomography Study of Retinal Changes in Normal Aging and After Ischemia
摘要： PURPOSE. Age-related thinning of the retinal ganglion cell axons in the nerve ?ber layer has been measured in humans using optical coherence tomography (OCT). In this study, we used OCT to measure inner retinal changes in 3-month-, 1-year-, and 2-year-old mice and after experimental anterior ischemic optic neuropathy (AION). METHODS. We used OCT to quantify retinal thickness in over 200 eyes at different ages before and after a photochemical thrombosis model of AION. The scans were manually or automatically segmented. RESULTS. In normal aging, there was 1.3-lm thinning of the ganglion cell complex (GCC) between 3 months and 1 year (P < 0.0001) and no further thinning at 2 years. In studying age-related inner retinal changes, measurement of the GCC (circular scan) was superior to that of the total retinal thickness (posterior pole scan) despite the need for manual segmentation because it was not contaminated by outer retinal changes. Three weeks after AION, there was 8.9-lm thinning of the GCC (circular scan; P < 0.0001), 50-lm thinning of the optic disc (posterior pole scan; P < 0.0001), and 17-lm thinning of the retina (posterior pole scan; P < 0.0001) in the 3-month-old group. Changes in the older eyes after AION were similar to those of the 3-month-old group. CONCLUSIONS. Optical coherence tomography imaging of a large number of eyes showed that, like humans, mice exhibited small, age-related inner retinal thinning. Measurement of the GCC was superior to total retinal thickness in quantifying age-related changes, and both circular and posterior pole scans were useful to track short-term changes after AION.
关键词： vision loss,optic neuropathy,aging,retinal ganglion cell,optical coherence tomography,animal model,anterior ischemic optic neuropathy
更新于2025-09-11 14:15:04
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Microvascular blood flow velocities measured with a retinal function imager: inter-eye correlations in healthy controls and an exploration in multiple sclerosis
摘要： Background: The retinal microcirculation has been studied in various diseases including multiple sclerosis (MS). However, inter-eye correlations and potential differences of the retinal blood flow velocity (BFV) remain largely unstudied but may be important in guiding eye selection as well as the design and interpretation of studies assessing or utilizing retinal BFV. The primary aim of this study was to determine inter-eye correlations in BFVs in healthy controls (HCs). Since prior studies raise the possibility of reduced BFV in MS eyes, a secondary aim was to compare retinal BFVs between MS eyes, grouped based on optic neuritis (ON) history and HC eyes. Methods: Macular arteriole and venule BFVs were determined using a retinal function imager (RFI) in both eyes of 20 HCs. One eye from a total of 38 MS patients comprising 13 eyes with ON (MSON) and 25 eyes without ON (MSNON) history were similarly imaged with RFI. Results: OD (right) and OS (left) BFVs were not significantly different in arterioles (OD: 3.95 ± 0.59 mm/s; OS: 4.08 ± 0.60 mm/s, P = 0.10) or venules (OD: 3.11 ± 0.46 mm/s; OS: 3.23 ± 0.52 mm/s, P = 0.06) in HCs. Very strong inter-eye correlations were also found between arteriolar (r = 0.84, P < 0.001) and venular (r = 0.87, P < 0.001) BFVs in HCs. Arteriolar (3.48 ± 0.88 mm/s) and venular (2.75 ± 0.53 mm/s) BFVs in MSNON eyes were significantly lower than in HC eyes (P = 0.009 and P = 0.005, respectively). Similarly, arteriolar (3.59 ± 0.69 mm/s) and venular (2.80 ± 0.45 mm/s) BFVs in MSON eyes were also significantly lower than in HC eyes (P = 0.046 and P = 0.048, respectively). Arteriolar and venular BFVs in MSON and MSNON eyes did not differ from each other (P = 0.42 and P = 0.48, respectively). Conclusions: Inter-eye arteriolar and venular BFVs do not differ significantly in HCs and are strongly correlated. Our findings support prior observations that arteriolar and venular BFVs may be reduced in MS eyes. Moreover, this seems to be the case in both MS eyes with and without a history of ON, raising the possibility of global blood flow alterations in MS. Future larger studies are needed to assess differences in BFVs between MSON and MSNON eyes.
关键词： Blood flow velocity,Neurology,Multiple sclerosis,Optic neuropathy,Inter-eye correlation,Retinal function imager
更新于2025-09-11 14:15:04
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The Pattern of Visual Fixation Eccentricity and Instability in Optic Neuropathy and Its Spatial Relationship to Retinal Ganglion Cell Layer Thickness
摘要： The purpose of this study was to assess whether clinically useful measures of fixation instability and eccentricity can be derived from retinal tracking data obtained during optical coherence tomography (OCT) in patients with optic neuropathy (ON) and to develop a method for relating fixation to the retinal ganglion cell complex (GCC) thickness. Twenty-nine patients with ON underwent macular volume OCT with 30 seconds of confocal scanning laser ophthalmoscope (cSLO)-based eye tracking during fixation. Kernel density estimation quantified fixation instability and fixation eccentricity from the distribution of fixation points on the retina. Preferred ganglion cell layer loci (PGCL) and their relationship to the GCC thickness map were derived, accounting for radial displacement of retinal ganglion cell soma from their corresponding cones. Fixation instability was increased in ON eyes (0.21 deg2) compared with normal eyes (0.06982 deg2; P < 0.001), and fixation eccentricity was increased in ON eyes (0.488) compared with normal eyes (0.248; P ? 0.03). Fixation instability and eccentricity each correlated moderately with logMAR acuity and were highly predictive of central visual field loss. Twenty-six of 35 ON eyes had PGCL skewed toward local maxima of the GCC thickness map. Patients with bilateral dense central scotomas had PGCL in homonymous retinal locations with respect to the fovea. Fixation instability and eccentricity measures obtained during cSLO-OCT assess the function of perifoveal retinal elements and predict central visual field loss in patients with ON. A model relating fixation to the GCC thickness map offers a method to assess the structure–function relationship between fixation and areas of preserved GCC in patients with ON.
关键词： optic neuropathy,fixation,ganglion cell,OCT
更新于2025-09-10 09:29:36
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Optic nerve head width and retinal nerve fiber layer changes are good indexes for validating the successful induction of experimental anterior ischemic optic neuropathy
摘要： Reproducible skills are essential for successful induction of a rat model of anterior ischemic optic neuropathy (rAION). We established an in vivo validation index by measuring the natural course of optic nerve head (ONH) width and retinal nerve fiber layer (RNFL) thickness in the rAION model using optical coherence tomography (OCT). The rAION model was induced by photodynamic operations. We measured the ONH width and RNFL thickness in the acute stage (<3 days), subacute stage (day 7 and day 14) and later stage (day 28) post-infarct by OCT. RNFL were measured by hematoxylin and eosin stain (HE) to confirm the OCT findings. The RGCs survival rate was determined by retrograde Fluoro-gold labeling, and the visual function was assessed with flash visual-evoked potentials (FVEPs) 4 weeks post-infarct. The ONH showed significant swelling in the acute stage, which also correlated with RNFL swelling. The swelling was reduced to normal within one-week post-infarct. The rAION group (0.51± 0.12 mm2) showed a significant RNFL thinning when compared with sham groups (0.92±0.15 mm2, p<0.05) on day-28 post-infarct. And HE-stained retina cross sections also showed RNFL thinning, which further confirmed our OCT Findings. The RGC density and P1-N2 amplitude were significantly reduced in rAION. Swelling, reduction of swelling, and atrophy of RNFL in acute, sub-acute, and later stage, respectively, are important events for confirming the successful induction of rAION. They suggest that the longitudinal OCT data provides a reliable index for validating the reproducibility and correct order of rAION.
关键词： optic nerve head (ONH),retinal ganglion cells (RGCs),optical coherence tomography (OCT),anterior ischemic optic neuropathy in rats (rAION),retina nerve fiber layer (RNFL)
更新于2025-09-04 15:30:14
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Influence of <i>Opa1</i> Mutation on Survival and Function of Retinal Ganglion Cells
摘要： PURPOSE. Mutations in the OPA1 gene cause autosomal dominant optic atrophy (ADOA), a visual disorder associated with degeneration of retinal ganglion cells (RGCs). Here, we characterized the disease progression in a homologous mouse model B6;C3-Opa1329-355del and asked whether the pronounced cell death affects certain RGC types more than others. METHODS. The in?uence of the Opa1 mutation was assessed by morphologic (retina and optic nerve histology) and functional (multielectrode array) methods. RESULTS. The RGC loss of approximately 50% within 18 months was signi?cantly more pronounced in RGCs with small-caliber axons. Small-caliber axon RGCs comprise a variety of functional RGC types. Accordingly, electrophysiological analyses of RGCs did not show a dropout of distinct functional RGC subgroups. However, the response properties of RGCs were affected signi?cantly by the mutation. Surprisingly, these functional changes were different under different luminance conditions (scotopic, mesopic, and photopic). Finally, melanopsin cells are known to be less susceptible to retinal insults. We found that these cells are also spared in the Opa1 mouse model, and demonstrated for the ?rst time that this resistance persisted even when the melanopsin gene had been knocked-out. CONCLUSIONS. Small-caliber axons show a higher vulnerability to the Opa1 mutation in our mouse model for ADOA. Luminance-dependent functional changes suggest an in?uence of the Opa1 mutation on the retinal circuitry upstream of RGCs. Photoresponsive RGCs are protected against cell death due to the Opa1 mutation, but not by melanopsin expression itself.
关键词： retinal ganglion cells,optic nerve,melanopsin,MEA recordings,optic neuropathy
更新于2025-09-04 15:30:14