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Nonarteritic anterior ischemic optic neuropathy (NA-AION) is the most common form of acute painless, usually unilateral, optic neuropathy in the elderly population. Systemic risk factors include diabetes mellitus, arterial hypertension, sleep apnea syndrome, and cardiovascular disease. Α 52-year-old man developed sequential, bilateral NA-AION, involving a worsening, severe vision compromising attack in the secondly affected eye. Thrombophilia testing revealed compound heterozygosity for the C6777T mutation of the MTHFR gene and the prothrombin G20210A (FII mutation). Oral anticoagulation treatment was initiated. A thorough systemic and family history, especially in the absence of major vasculopathic disease, should alert toward investigation for thrombophilia in middle-aged patients with atypical forms of NA-AION and initiation of anticoagulant treatment should be considered. [ABSTRACT FROM AUTHOR]

Calciphylaxis resulting in ischemic optic neuropathy secondary to calcification of the central retinal artery is a rare occurrence. Only 12 reports of calciphylaxis resulting in optic neuropathy have been published. While it is important to consider giant cell arteritis (GCA) in cases of acute vision loss with pallid disc swelling, clinicians must also maintain a high index of suspicion of calciphylaxis in a patient with risk factors of hypercalcaemia. We present a 56-year-old lady with end-stage renal failure with acute onset painless right eye vision loss and ipsilateral pallid chalky white swollen optic disc. However, she did not have the other features typical of GCA. Temporal artery biopsy and subsequent skin biopsy of lower limb eschar and indurated dermal plaques found features consistent with calciphylaxis. [ABSTRACT FROM AUTHOR]

Ischemic optic neuropathy(ION)is a common eye disease that could cause blindness. ION can be classified as anterior ischemic optic neuropathy(AION)or posterior ischemic optic neuropathy(PION)according to the presence or absence of optic disc edema. AION is more prevalent(90%). Moreover, ION can be divided into arteritic ION and non-arteritic ION based on the presence or absence of vasculitis. While various forms of ION may present comparable clinical symptoms, they differ considerably in terms of etiology, prognosis, and treatment approaches.Arteritic ION has the potential to cause blindness, disability, and even mortality in a short period of time. Therefore, early detection of arteritis and determination of the need for corticosteroid therapy are essential for the treatment of ION. The positive significance of identifying and managing potential modifiable risk factors for ION lies in its ability to prevent recurrence in both the affected and contralateral eyes. This article reviews the etiology, risk factors, diagnosis, and management of various varieties of ION with the goal of reducing misdiagnosis and improper treatment, thereby enhancing the overall prognosis of this condition.

AIM: To explore the correlation between remnant cholesterol(RC)and anterior ischemic optic neuropathy(AION).METHODS: A total of 80 cases of AION patients hospitalized in the department of ophthalmology of Linyi People's Hospital from January 2020 to December 2023 were selected as the observation group, and 80 cases of those who had completed health checkups in Linyi People's Hospital during the same period(without ischemic optic neuropathy and other fundus vasculopathies)were selected as the control group. The general data and biochemical indexes of the two groups were compared to evaluate the correlation between RC and AION.RESULTS: Compared with the control group, the levels of RC, fasting blood glucose(FBG), triglyceride(TG), total cholesterol(TC), and low-density lipoprotein cholesterol(LDL-C)in patients with AION were significantly higher than those in the control group(all P

Background: Ischemic optic neuropathy (ION) is exceedingly rare in children on dialysis, resulting from poor perfusion of the optic nerve, and presents as sudden acute painless vision loss. Case–diagnosis/treatment: We report the case of a 3-year-old male with stage 5 chronic kidney disease (CKD 5) due to focal segmental glomerulosclerosis (FSGS) status post-bilateral nephrectomy on chronic hemodialysis who had acute loss of vision several hours after a hemodialysis session. Earlier that day, he had a drop in blood pressure intra-dialysis to 89/67 mmHg, with at home blood pressures ranging 90/60 to 150/100 mmHg. The patient was treated with tight blood pressure control to maintain blood flow and prevent blood pressure lability, received high-dose corticosteroids with a corticosteroid taper, and placed on high-dose erythropoietin for neuroprotective effect. He regained partial vision beginning approximately 1 month after presentation. Conclusions: The exact cause of our patient's simultaneous bilateral anterior and posterior ION, confirmed via MRI and fundoscopic examination, is unclear; however, is likely secondary to a combination of fluctuating blood pressure, anemia, anephric status, and hemodialysis. This highlights the need for close blood pressure monitoring, management of anemia, and more diligent ophthalmologic screening in pediatric patients on chronic hemodialysis. [ABSTRACT FROM AUTHOR]

目的 总结头面部美容填充物注射引起的眼动脉及其分支动脉阻塞的临床特征和视力预后影响因素。 方法 本研究为回顾性病例研究。共纳入头面部美容填充物注射后立即出现视力下降、视物重影或上睑下垂等眼科症状的患者26例，收集并分析所有患者的临床和影像学资料。 结果 26例患者中，注射透明质酸者23例，注射自体脂肪者2例，注射干细胞制剂者1例。注射点位于额部8例、额部+眉间4例、眉间3例、眉间+鼻根1例、鼻根4例、鼻翼1例、眼睑4例、颞侧头皮1例。临床表现：眼动脉阻塞2例，视网膜中央动脉阻塞（central retinal artery occlusion，CRAO）7例（其中不完全性CRAO 1例），睫状后短动脉阻塞12例[其中非动脉炎性前部缺血性视神经病变（non-arteritic anterior ischemic optic neuropathy，NAION）6例、非动脉炎性后部缺血性视神经病变3例、局限性脉络膜水肿3例]，眼外肌麻痹5例（其中眼动脉肌支阻塞4例，动眼神经麻痹1例），上睑下垂4例，瞳孔散大2例。其中6例患者同时发生2种眼部受累表现，包括CRAO+局限性脉络膜水肿2例，NAION+局限性脉络膜水肿1例，NAION+肌支阻塞1例，NAION+动眼神经麻痹1例，上睑下垂+肌支阻塞1例。头颅MRI检查显示新发性脑梗死灶3例。18例视网膜或视神经受累患者中，11例患者表现为完全性CRAO或弥漫性视神经缺血，治疗前后患者视力无改变；7例患者表现为不完全性CRAO或节段性视神经缺血，治疗后患者视力有明显改善。 结论 头面部美容填充物注射引起的眼动脉及其分支动脉阻塞视力预后差，不完全性CRAO、节段性视神经缺血和初诊时最佳矫正视力≥0.02的患者视力预后较好。 Abstract: Objective To evaluate the clinical characteristics and factors related to visual prognosis of ophthalmic artery and its branch occlusion caused by cosmetic facial filler injection. Methods In this retrospective case study, a total of 26 patients with ophthalmic symptoms including visual loss, diplopia, or ptosis immediately after cosmetic facial filler injection were included. Clinical and imaging data of all patients were collected and analyzed. Results Among 26 patients, hyaluronic acid, autologous fat, and stem cell preparation was injected in 23, 2, and 1 case, respectively. Injection point was located in the forehead, forehead combined with glabella, glabella, glabella combined with nasal root, nasal root, nasal ala, eyelid, and temporal scalp in 8, 4, 3, 1, 4, 1, 4, and 1 case, respectively. Clinical manifestations included ophthalmic artery occlusion (2 cases), central retinal artery occlusion (CRAO) (7 cases, including one case of incomplete CRAO), posterior ciliary short artery occlusion [12 cases, including 6 cases of non-arteritic anterior ischemic optic neuropathy (NAION), 3 cases of non-arteritic posterior ischemic optic neuropathy, and 3 cases of focal choroidal ischemia], external ophthalmoplegia (5 cases, including 4 cases of ophthalmic artery muscular branch occlusion, and one case of oculomotor nerve palsy), ptosis (4 cases), and mydriasis (2 cases). Among them, 6 patients had two ocular involvement manifestations at the same time, including CRAO + focal choroidal ischemia in 2 cases, NAION + focal choroidal ischemia in 1 case, NAION + muscular branch occlusion in 1 case, NAION + oculomotor nerve palsy in 1 case, ptosis + muscular branch occlusion in 1 case. Cranial MRI examination revealed new focal cerebral infarctions in 3 cases. Among 18 patients with retinal or optic nerve involvement, 11 cases showed complete CRAO or diffuse ischemic optic neuropathy, and no visual improvement after treatment; 7 patients showed incomplete CRAO or segmental ischemic optic neuropathy, and evident visual improvement after treatment. Conclusions Visual prognosis of ophthalmic artery and its branch occlusion caused by cosmetic facial filler injection is poor. Incomplete CRAO, segmental ischemic optic neuropathy, and best corrected visual acuity≥0.02 at baseline are main factors indicating a relatively good visual prognosis.

Yousef A Fouad, Mohamed Nabil Hamza, Moataz M Wessam Department of Ophthalmology, Ain Shams University Hospitals, Cairo, EgyptCorrespondence: Yousef A Fouad, Department of Ophthalmology, Ain Shams University Hospitals, Ramses st., Abbassiya, Cairo, 11517, Egypt, Tel +201063781237, Email yousef.a.fouad@gmail.comPurpose: To examine the prevalence and distribution of fluid within a cohort of eyes with acute central retinal artery occlusion (CRAO) and non-arteritic anterior ischemic optic neuropathy (AION) using optical coherence tomography (OCT).Methods: A retrospective analysis of patient records and OCT imaging. Patients presenting with acute CRAO or AION who had available macular OCT imaging and no co-morbidities known to cause macular fluid were included in the analysis. Baseline characteristics, visual acuity (VA), and fluid presence and distribution among the retinal layers were recorded.Results: In the 16 eyes with acute CRAO, fluid was noted in 5 eyes (31%), which was mainly subretinal (3 eyes) or intraretinal located within the outer retinal layers (3 eyes). Only one eye had inner retinal cysts. Of the 11 eyes with acute AION, fluid was present in 8 eyes (73%). Subretinal fluid was noted in 4 eyes and extended to the foveal area in 3 of them, and outer retinal versus inner retinal cysts were noted in 6 versus 3 eyes, respectively. None of the eyes showed hard exudate deposition. In the small subset of eyes with CRAO and macular fluid that were followed-up, VA improved, while in eyes with AION, VA remained stable.Conclusion: Macular fluid on OCT is not an uncommon feature of acute CRAO and AION and is mainly distributed within the outer retinal layers or subretinal space. Fluid is an understudied feature of retinal and optic nerve head infarction and may have a role in predicting neuronal damage extent and visual outcome.Keywords: anterior ischemic optic neuropathy, intraretinal fluid, optical coherence tomography, retinal artery occlusion, subretinal fluid

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Introduction: Anterior ischemic optic neuropathy (AION) can mimic glaucoma and consequently cause difficulties in differential diagnosis. The purpose of this paper was to summarize differences in diagnostic tests that can help perform a correct diagnosis. Methods: The search strategy was performed according to the PRISMA 2009 guidelines, and four databases were used: MEDLINE, Embase, Web of Science, and Cochrane. Totally, 772 references were eligible; 39 were included after screening with respect to inclusion criteria that included English language and published in the 20 years before search date. Results: Ninety percent (n = 35) of included studies used optical coherence tomography (OCT). Glaucomatous eyes had a significantly greater cup area, volume and depth, cup-to-disk ratio, a lower rim volume and area, and a thinner Bruch's membrane opening-minimum rim width. Retinal nerve fiber layer (RNFL) thinning in glaucomatous eyes occurred primarily at the superotemporal, inferotemporal, and inferonasal sectors, while AION eyes demonstrated mostly superonasal thinning. Glaucoma eyes showed greater macular ganglion cell layer thickness, except at the inferotemporal sector. OCT angiography measurements demonstrated a significant decrease in superficial and deep macular vessel density (VD) in glaucoma compared to AION with similar degree of visual field damage; the parapapillary choroidal VD was spared in AION eyes compared to glaucomatous eyes. Conclusion: By use of OCT imaging, optic nerve head parameters seem most informative to distinguish between glaucoma and AION. Although both diseases affect the RNFL thickness, it seems to do so in different sectors. Differences in structure and vascularity of the macula can also help in making the differential diagnosis. [ABSTRACT FROM AUTHOR]

The global pandemic impact of the COVID-19 infection included clinical manifestations that affected several organs and systems, with various neuro-ophthalmological manifestations associated with the infection. These are rare and occur either secondary to the presence of the virus or by an autoimmune mechanism secondary to viral antigens. The manifestations are atypical, being present even in the absence of the systemic symptoms typical of a SARS-CoV-2 infection. In this article, we introduce a series of three clinical cases with neuro-ophthalmological manifestations associated with COVID infection that were shown in Ophthalmology Clinic of St. Spiridon Emergency Hospital. Case 1 is that of a 45-year-old male patient with no personal history of general pathology or ophthalmology, with binocular diplopia, painful red eyes, and lacrimal hypersecretion with a sudden onset of about 4 days. Based on the evaluations, a positive diagnosis of orbital cellulitis in both eyes is made. Case 2 is that of a 52-year-old female patient with general PPA (personal pathological antecedents) of SARS-CoV-2 infection 1 month prior to presentation with decreased visual acuity in the right eye and a positive central scotoma, preceded by photopsia and vertigo with balance disorders. The diagnosis is made at the right eye for retrobulbar optic neuritis and post-SARS-CoV-2 infection status. The last clinical case is that of a 55-year-old male patient known to have high blood pressure (HBP) with a sudden, painless decrease in VARE approximately 3 weeks post-SARS-CoV-2 immunization (Pfizer vaccine first dose). The diagnosis is made after consulting all the RE results for central retinal vein thrombosis. Conclusions: Although the cases were quickly and efficiently investigated and the treatment was administered adequately by a multidisciplinary team (cases 1 and 3), the evolution was not favorable in all three situations. Atypical neuro-ophthalmological manifestations can also be present in the absence of systemic symptoms typical of SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Arteritic anterior ischemic optic neuropathy is a common ophthalmic manifestation of giant cell arteritis in elderly patients. Central retinal artery occlusion and anterior ischemic optic neuropathy are relatively rare presentations in Takayasu arteritis. Our report describes a young Indian woman with Takayasu disease who presented with central retinal artery occlusion in one eye followed by anterior ischemic optic neuropathy in the fellow eye leading to bilateral loss of vision. Prompt initiation of corticosteroid therapy resulted in visual recovery.

Introduction. Glaucoma and non-arteritic anterior ischemic optic neuropathy (NAION) are optic neuropathies that can both lead to irreversible blindness. Several studies have compared optical coherence tomography angiography (OCTA) findings in glaucoma and NAION in the presence of similar functional and structural damages with contradictory results. The goal of this study was to use a deep learning system to differentiate OCTA in glaucoma and NAION. Material and methods. Sixty eyes with glaucoma (including primary open angle glaucoma, angle-closure glaucoma, normal tension glaucoma, pigmentary glaucoma, pseudoexfoliative glaucoma and juvenile glaucoma), thirty eyes with atrophic NAION and forty control eyes (NC) were included. All patients underwent OCTA imaging and automatic segmentation was used to analyze the macular superficial capillary plexus (SCP) and the radial peripapillary capillary (RPC) plexus. We used the classic convolutional neural network (CNN) architecture of ResNet50. Attribution maps were obtained using the "Integrated Gradients" method. Results. The best performances were obtained with the SCP + RPC model achieving a mean area under the receiver operating characteristics curve (ROC AUC) of 0.94 (95% CI 0.92–0.96) for glaucoma, 0.90 (95% CI 0.86–0.94) for NAION and 0.96 (95% CI 0.96–0.97) for NC. Conclusion. This study shows that deep learning architecture can classify NAION, glaucoma and normal OCTA images with a good diagnostic performance and may outperform the specialist assessment. [ABSTRACT FROM AUTHOR]

A 57‐year‐old male known case of diabetes mellitus presented with gradually bilateral decreased vision accompanied by ocular pain two weeks after diagnosis of SARS‐CoV‐2 infection. The results of examination and imaging were indicative of bilateral anterior ischemic optic neuropathy (AION) and massive choroidal ischemia, which may be associated with SARS‐CoV‐2‐induced damages, including endothelial damage, hypercoagulable state, and hypoxia. [ABSTRACT FROM AUTHOR]

Abstract A 57‐year‐old male known case of diabetes mellitus presented with gradually bilateral decreased vision accompanied by ocular pain two weeks after diagnosis of SARS‐CoV‐2 infection. The results of examination and imaging were indicative of bilateral anterior ischemic optic neuropathy (AION) and massive choroidal ischemia, which may be associated with SARS‐CoV‐2‐induced damages, including endothelial damage, hypercoagulable state, and hypoxia.

AIM: To explore the therapeutic effects and safety of dexamethasone intravitreal implant(DEX)on non-arteritic anterior ischemic optic neuropathy(NAION), and responses to the different course of disease.METHODS: Totally 70 patients(70 eyes)in the First Affiliated Hospital of Zhengzhou University diagnosed with NAION from January 2018 to December 2020 were obtained retrospectively as combination treatment group and routine treatment group. 35 patients(35 eyes)in each group received usual care(methylprednisolne pluse therapy, microcirculation improvement and neurotrophic treatment), and combination treatment group also received a dexamethasone intravitreal implant. The best corrected visual acuity(BCVA), mean damage(MD)and pattern standard deviation(PSD)of the visual field, mean thickness of the retinal nerve fiber layer(RNFL)and intraocular pressure(IOP)were compared between the two groups, and two groups with a different course of disease before and 3mo after treatment.RESULTS: BCVA and MD improved in both groups at 3mo after treatment(P0.05). The PSD at 3mo after treatment in the routine treatment group was worse than before treatment(P0.05). BCVA, PSD and effective rate in the combination treatment group had better improvement than in the routine treatment group in disease course ≤ 15d at 3mo after treatment(P 15d(P>0.05). There was a mild and controllable increase in IOP in the combination treatment group compared to routine treatment group.CONCLUSION: Dexamethasone intravitreal implant can promote BCVA and the recovery of visual function for the long term. It is deemed safe and effective in treating NAION, with better therapeutic effects within 2wk after onset.

Urszula Szydełko-Paśko,1 Joanna Przeździecka-Dołyk,1,2 Rafał Małecki,3 Andrzej Szuba,3 Marta Misiuk-Hojło1 1Department of Ophthalmology, Wroclaw Medical University, Wrocław, Poland; 2Department of Optics and Photonics, Wroclaw University of Science and Technology, Wrocław, Poland; 3Department of Angiology, Systemic Hypertension and Diabetology, Wroclaw Medical University, Wrocław, PolandCorrespondence: Urszula Szydełko-Paśko, Department of Ophthalmology, Wroclaw Medical University, Borowska 213, Wrocław, 50-556, Poland, Tel +48 71 736 43 00, Email u.szydelko@gmail.comAbstract: Buerger’s disease, also known as thromboangiitis obliterans, is a disorder of primarily small and medium arteries and veins of the arms and legs. We have failed to find a comprehensive review discussing a possible link between the disease and the eyes. The aim of this study is to review current knowledge on the topic of ocular manifestations in the course of Buerger’s disease. The Medline and Web of Science databases were searched without a time or language limit. We have managed to review 13 articles, describing the involvement of the eyes in thromboangiitis obliterans. It appears that patients suffering from Buerger’s disease may develop non-arteritic anterior ischemic optic neuropathy (NAION), occlusive retinal vasculitis and periphlebitis, papillophlebitis, central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), normal tension glaucoma (NTG), uveitis, chorioretinal atrophy, retinitis, papillitis, optic atrophy, changes typical for hypertensive retinopathy. Additionally the abnormalities in electroretinography might be present. The treatment options and the possible outcome depend on the type of ocular manifestations, so it seems impossible to propose a universal therapy. We would like to raise awareness of the possible ocular manifestations in the course of Buerger’s disease.Keywords: Buerger’s disease, anterior ischemic optic neuropathy, central retinal artery occlusion, normal tension glaucoma, uveitis

Anterior ischemic optic neuropathy (AION) is infrequently complicated with Vogt-Koyanagi-Harada (VKH) disease. We quantitatively examined sequential changes in the morphology and circulation hemodynamics, using a C-scan of optical coherence tomography (OCT) and laser speckle flowgraphy (LSFG) in a patient with VKH disease accompanied by AION. A 65-year-old female complained of blurred vision in both of her eyes. The patient presented with optic disc swelling and remarkable choroidal thickening detected by OCT bilaterally. The diagnosis of VKH disease was established based on the presence of pleocytosis detected in the cerebrospinal fluid and hypofluorescent dark dots scattered all around the fundus, detected by indocyanine green angiography. Goldmann perimetry detected visual field defects, similar to superior altitudinal hemianopsia in the right eye and similar to inferior altitudinal hemianopsia in the left eye. The patient was suspected to have developed AION in both eyes. The patient received methylprednisolone pulse therapy, followed by oral prednisolone. With these treatments, the optic disc swelling disappeared. However, optic disc atrophy with visual field defects remained in both eyes. An OCT C-scan showed the ganglion cell complex (GCC) and circumpapillary retinal nerve fiber layer (cpRNFL) thickness getting thinner below the normal range, and LSFG showed the decrease in optic nerve head (ONH) tissue microcirculation. These results supported the occurrence of AION in this patient with VKH disease. The analysis of GCC and cpRNFL thickness and ONH microcirculation would be useful for supporting the occurrence of AION in a case of VKH disease.

After the revolutionary effect of optical coherence tomography (OCT) on ophthalmology practice, recent OCT-based technology OCT angiography (OCT-A) also has rapidly gained a wide clinical acceptance. OCT-A is a noninvasive, depth-resolved imaging tool for the evaluation of retinal vascular changes. Since its introduction, the understanding of retinal vascular diseases, pacychoroid spectrum diseases, and other diseases have been enriched in many ways. More importantly, OCT-A provides depth-resolved information that has never before been available. The whole spectrum of neuro-ophthalmological diseases shows consistent peripapillary and macular capillary changes with structural and functional correlation. The superficial and deeper retinal and choroidal vasculatures are affected depending on the nature of the disease process. Therefore, OCT-A play an important role in the diagnosis and management of optic nerve-related diseases as well. In this review, we summarized existing literature on the use of OCT-A in neuro-ophthalmological diseases such as arteritic anterior ischemic neuropathy, nonarteritic anterior ischemic neuropathy, papillitis, papilledema, multiple sclerosis. Currently, OCT-A has an important position as a useful, noninvasive tool in the evaluation of neuro-ophthalmologic diseases; however, OCT-A has several limitations regarding its technical capabilities in challenging neuro-ophthalmic cases. With the improvement in the technical capacity of OCT-A, it will have a more important place in the diagnosis and follow-up of neuro-ophthalmological diseases in future. [ABSTRACT FROM AUTHOR]

The global pandemic impact of the COVID-19 infection included clinical manifestations that affected several organs and systems, with various neuro-ophthalmological manifestations associated with the infection. These are rare and occur either secondary to the presence of the virus or by an autoimmune mechanism secondary to viral antigens. The manifestations are atypical, being present even in the absence of the systemic symptoms typical of a SARS-CoV-2 infection. In this article, we introduce a series of three clinical cases with neuro-ophthalmological manifestations associated with COVID infection that were shown in Ophthalmology Clinic of St. Spiridon Emergency Hospital. Case 1 is that of a 45-year-old male patient with no personal history of general pathology or ophthalmology, with binocular diplopia, painful red eyes, and lacrimal hypersecretion with a sudden onset of about 4 days. Based on the evaluations, a positive diagnosis of orbital cellulitis in both eyes is made. Case 2 is that of a 52-year-old female patient with general PPA (personal pathological antecedents) of SARS-CoV-2 infection 1 month prior to presentation with decreased visual acuity in the right eye and a positive central scotoma, preceded by photopsia and vertigo with balance disorders. The diagnosis is made at the right eye for retrobulbar optic neuritis and post-SARS-CoV-2 infection status. The last clinical case is that of a 55-year-old male patient known to have high blood pressure (HBP) with a sudden, painless decrease in VARE approximately 3 weeks post-SARS-CoV-2 immunization (Pfizer vaccine first dose). The diagnosis is made after consulting all the RE results for central retinal vein thrombosis. Conclusions: Although the cases were quickly and efficiently investigated and the treatment was administered adequately by a multidisciplinary team (cases 1 and 3), the evolution was not favorable in all three situations. Atypical neuro-ophthalmological manifestations can also be present in the absence of systemic symptoms typical of SARS-CoV-2 infection.

An ischemic insult at optic nerve (ON) is followed by detrimental neuroinflammation that results in progressive and long‐lasting retinal ganglion cell (RGC) death and vision loss. Icariin was reported to be a safe and effective natural anti‐inflammatory drug. Herein, we evaluated the long‐term therapeutic effects of a single intravitreal injection of poly(lactide‐co‐glycolide) PLGA–icariin in a rat model of anterior ischemic optic neuropathy (rAION). Treatment with PLGA microspheres of icariin preserved the visual function and RGC density for 1 month in the rAION model. In addition, ON edema and macrophage infiltration were inhibited by treating PLGA microspheres of icariin. We found that the binding complex of icariin and CCAAT enhancer binding protein beta (CEBP‐β) significantly induced endogenous granulocyte colony‐stimulating factor (G‐CSF) expression to activate noncanonical nuclear factor kappa B (NF‐κB) signaling pathway by promoting an alternative phosphorylation reaction of IKK‐β. Activation of noncanonical NF‐κB signaling pathway promoted the M2 microglia/macrophage polarization and AKT1 activation, which prevented neuroinflammation and RGC apoptosis after ON infarct. This study concluded that protective mechanism of icariin is a CEBP‐β/G‐CSF axis‐induced noncanonical NF‐κB activation, which provides the long‐term neuroprotective effects via anti‐inflammatory and antiapoptotic actions after ON ischemia. [ABSTRACT FROM AUTHOR]

Abstract An ischemic insult at optic nerve (ON) is followed by detrimental neuroinflammation that results in progressive and long‐lasting retinal ganglion cell (RGC) death and vision loss. Icariin was reported to be a safe and effective natural anti‐inflammatory drug. Herein, we evaluated the long‐term therapeutic effects of a single intravitreal injection of poly(lactide‐co‐glycolide) PLGA–icariin in a rat model of anterior ischemic optic neuropathy (rAION). Treatment with PLGA microspheres of icariin preserved the visual function and RGC density for 1 month in the rAION model. In addition, ON edema and macrophage infiltration were inhibited by treating PLGA microspheres of icariin. We found that the binding complex of icariin and CCAAT enhancer binding protein beta (CEBP‐β) significantly induced endogenous granulocyte colony‐stimulating factor (G‐CSF) expression to activate noncanonical nuclear factor kappa B (NF‐κB) signaling pathway by promoting an alternative phosphorylation reaction of IKK‐β. Activation of noncanonical NF‐κB signaling pathway promoted the M2 microglia/macrophage polarization and AKT1 activation, which prevented neuroinflammation and RGC apoptosis after ON infarct. This study concluded that protective mechanism of icariin is a CEBP‐β/G‐CSF axis‐induced noncanonical NF‐κB activation, which provides the long‐term neuroprotective effects via anti‐inflammatory and antiapoptotic actions after ON ischemia.

Giant cell arteritis (GCA) is the most important medical emergency in ophthalmology, because its most dreaded complication is visual loss, which is preventable if these patients are diagnosed early and treated immediately and aggressively. This is a brief review of GCA, its ophthalmic manifestations, and how to diagnose and manage them.

Introduction: Giant cell arteritis (GCA) is a systemic disease that may cause severe visual loss. Our purpose was to determine which factors contribute to ocular manifestations (OMs) in patients with temporal artery biopsy-proven GCA. Methods: This was a retrospective review of all cases diagnosed in our center from 2010 to 2021 (>6 months follow-up). We analyzed demographic data, comorbidities, type and duration of symptoms before diagnosis, ocular features, and systemic and laboratory findings. Results: Out of 51 patients (60.8% females, mean age 74.8 ± 13.5), 32 (63%) had OM, of whom 28% had transient visual loss, 69% had permanent visual loss, and 9% had diplopia. Apart from scalp tenderness (P = 0.039), OM did not correlate with other ischemic symptoms such as jaw claudication or headache and were even significantly associated with the absence of fever (P = 0.026). Patients with OM also showed lower values of C-reactive protein (CRP) (P = 0.045). Conclusion: In our sample, visual involvement was not significantly associated with any systemic symptom apart from scalp tenderness, which highlights the importance of having a high index of suspicion for GCA in an ophthalmology setting, especially in older patients with visual loss. Furthermore, OMs were significantly associated with the absence of fever and lower values of CRP which may suggest a lower inflammatory state may in these patients.

Introduction. Glaucoma and non-arteritic anterior ischemic optic neuropathy (NAION) are optic neuropathies that can both lead to irreversible blindness. Several studies have compared optical coherence tomography angiography (OCTA) findings in glaucoma and NAION in the presence of similar functional and structural damages with contradictory results. The goal of this study was to use a deep learning system to differentiate OCTA in glaucoma and NAION. Material and methods. Sixty eyes with glaucoma (including primary open angle glaucoma, angle-closure glaucoma, normal tension glaucoma, pigmentary glaucoma, pseudoexfoliative glaucoma and juvenile glaucoma), thirty eyes with atrophic NAION and forty control eyes (NC) were included. All patients underwent OCTA imaging and automatic segmentation was used to analyze the macular superficial capillary plexus (SCP) and the radial peripapillary capillary (RPC) plexus. We used the classic convolutional neural network (CNN) architecture of ResNet50. Attribution maps were obtained using the “Integrated Gradients” method. Results. The best performances were obtained with the SCP + RPC model achieving a mean area under the receiver operating characteristics curve (ROC AUC) of 0.94 (95% CI 0.92–0.96) for glaucoma, 0.90 (95% CI 0.86–0.94) for NAION and 0.96 (95% CI 0.96–0.97) for NC. Conclusion. This study shows that deep learning architecture can classify NAION, glaucoma and normal OCTA images with a good diagnostic performance and may outperform the specialist assessment.

Aim: A variety of manifestations in different organs could be associated with severe COVID-19; for example, ocular manifestations. Case report: A 52-year-old male complaining of sudden onset unilateral painless vision loss in the right eye for 1 month (started just 1 week after COVID-19 remission) came to the ophthalmology clinic. On further evaluations, he was diagnosed with anterior ischemic optic neuropathy (AION). Considering his past history and the result of evaluations, the hypothesis of association between AION and COVID-19 was proposed. Results & discussion: Ocular and neurologic manifestations of COVID-19 are more likely to happen in patients with more severe conditions. Complications occur secondary to two basic mechanisms including severe inflammatory response and hypercoagulable state. Conclusion: Our findings indicated that non-arteritic AION is another manifestation of microangiopathic/thrombotic events which may occur in the course of COVID-19. [ABSTRACT FROM AUTHOR]

Purpose To investigate the efficacy of intravitreal injection of granulocyte colony-stimulating factor (G-CSF) for the treatment of non-arteritic anterior ischemic optic neuropathy (NAION).Methods: Patients with acute NAION were enrolled in this prospective interventional case series. They received an intravitreal injection of 60 micrograms in 0.1 ml of G-CSF within 2 weeks of the onset of the disease. Visual acuity, visual field, intraocular pressure (IOP), corneal endothelial cell density, and peripapillary retinal nerve fiber layer (RNFL) thickness were recorded before injections and 1 week, 1 month, 3 months, 6 months, and one year after the injections. Full-field electroretinography (ERG) was obtained at the baseline, 1 month, and 12 months post- injections.Results: Fourteen eyes of 14 patients entered the study. Best-corrected visual acuity (BCVA) significantly improved in the first month following injections (p =.007), decreased subsequently, and the final BCVA showed no significant improvement (p =.278) compared to the baseline measurements. A significant decrease in RNFL thickness was observed in all quadrants compared to the baseline measurements. Also, no improvement in the visual field parameters was observed. From the toxicity aspect, no significant changes in the corneal endothelial cell density, IOP, and ERG recordings were observed.Conclusion: Intravitreal injection of G-CSF seems to be safe. The effect may last for one month and then decline. [ABSTRACT FROM AUTHOR]

Purpose: To assess the use of temporal artery biopsy (TAB) in diagnosing giant cell arteritis (GCA) and to evaluate patients' clinical and laboratory characteristics. Methods: We conducted a retrospective chart review of patients with suspected GCA who underwent TAB and had complete workup in a tertiary center in Iran between 2008 and 2017. The 2016 American College of Rheumatology (ACR) revised criteria for early diagnosis of GCA were used for each patient for inclusion in this study. Results: The mean age of the 114 patients in this study was 65.54 ± 10.17 years. The mean overall score according to the 2016 ACR revised criteria was 4.17 ± 1.39, with 5.82 ± 1.28 for positive biopsies and 3.88 ± 1.19 for negative biopsies (p

Anterior ischemic optic neuropathy (AION) is infrequently complicated with Vogt-Koyanagi-Harada (VKH) disease. We quantitatively examined sequential changes in the morphology and circulation hemodynamics, using a C-scan of optical coherence tomography (OCT) and laser speckle flowgraphy (LSFG) in a patient with VKH disease accompanied by AION. A 65-year-old female complained of blurred vision in both of her eyes. The patient presented with optic disc swelling and remarkable choroidal thickening detected by OCT bilaterally. The diagnosis of VKH disease was established based on the presence of pleocytosis detected in the cerebrospinal fluid and hypofluorescent dark dots scattered all around the fundus, detected by indocyanine green angiography. Goldmann perimetry detected visual field defects, similar to superior altitudinal hemianopsia in the right eye and similar to inferior altitudinal hemianopsia in the left eye. The patient was suspected to have developed AION in both eyes. The patient received methylprednisolone pulse therapy, followed by oral prednisolone. With these treatments, the optic disc swelling disappeared. However, optic disc atrophy with visual field defects remained in both eyes. An OCT C-scan showed the ganglion cell complex (GCC) and circumpapillary retinal nerve fiber layer (cpRNFL) thickness getting thinner below the normal range, and LSFG showed the decrease in optic nerve head (ONH) tissue microcirculation. These results supported the occurrence of AION in this patient with VKH disease. The analysis of GCC and cpRNFL thickness and ONH microcirculation would be useful for supporting the occurrence of AION in a case of VKH disease. [ABSTRACT FROM AUTHOR]

AIM: To investigate the relationship between serum homocysteine(Hcy)and anterior ischemic optic neuropathy(AION)in patients with type 2 diabetes mellitus.METHODS: One hundred patients with type 2 diabetes mellitus who treated in Hebei Eye Hospital from January 2016 to April 2019 were divided into two groups: group A(n=53)without AION, group B(n=47)with AION. Thirty-eight healthy volunteers were used as control group(group C). The serum levels of Hcy, triglyceride cholesterol(TG), low density lipoprotein cholesterol(LDL-C), creatinine(Cr), gycosylated hemoglobin(HbA1c), blood pressure, best corrected visual acuity were detected. To analyze the correlation between serum Hcy level and the clinical indicators in AION in patients with type 2 diabetes mellitus.RESULTS: The level of Hcy in group B was significantly higher than that in group A and group C \〖(13.87±5.02)μmol/L ratio(11.83±3.49)μmol/L, and(11.06±3.62)μmol/L, all Pr=0.517, P=0.001)and negatively correlated with BCVA(r=-0.353, P=0.026)after adjustment for age, TG, LDL-C, Cr, systolic blood pressure, diastolic blood pressure and course of diabetes mellitus.CONCLUSION: The level of Hcy in serum may be involved in the pathogenesis of AION in type 2 diabetic patients. Hcy may be a potential target for preventing and treating AION in type 2 diabetic patients.

Background and objectives: Although a lot of studies suggested the predisposition of many risk factors, non-arteritic anterior ischemic optic neuropathy was considered for a long time to be idiopathic. This study aimed to assess the relationship between different factors and anterior ischemic optic neuropathy among a sample of patients in Erbil city. Methods: A case-control study was conducted in Erbil city, Iraq from 2008 to 2011. A total of 36 cases of non-arteritic anterior ischemic optic neuropathy and 36 controls with other visual problems were included. Results: Eight percent of patients in this study had one or more risk factors (P = 0.001), in particular hypertension and diabetes were shown to have a significant relationship (P = 0.046 and 0.001, respectively). The absence of physiological cup over the optic disc has crucial importance both independently (P = 0.001) and in association with diabetes (P = 0.001). Old age and male gender were significant factors in relation to co-morbidities (P = 0.001 and 0.038, respectively). Conclusion: The study had concluded that hypertension, diabetes, age, male gender and absent physiological cup over the optic disc were important risk factors for anterior ischemic optic neuropathy.

Abstract Background A rodent model of photodynamic AION resulting from intravenous verteporfin is presented. The analysis of the morphological function, the pathological changes and the potential mechanism of action were further investigated. Methods Photodynamic treatment was conducted on the optic nerve head (ONH) following administration of the photosensitizer. The fellow eye was considered as sham control. Fundus Fluorescein angiography (FFA), spectral domain optical coherence tomography (SD-OCT) and Flash-visual evoked potential (F-VEP) recordings were conducted at different time points. Immunohistochemistry was used to observe apoptotic cell death (TUNEL) and macrophage infiltration (ED-1/Iba-1). Retrograde labeling of retinal ganglion cells (RGCs) was used to evaluate the loss of RGCs. Results After laser treatment, SD-OCT indicated optic nerve edema, while FFA indicated late leakage of the ONH. F-VEPs were distinctly reduced compared to control eyes. The number of apoptotic RGCs peaked on day 14 (5.71 ± 0.76, p

Abstract Background Giant cell arteritis (GCA) is a systemic vasculitis of medium and large-size vessels and can led to permanent visual loss in elderly patients. GCA is very rare among Asians. We report a Chinese patient presenting with acute bilateral anterior ischemic optic neuropathy, and the temporal artery biopsy proved the diagnose of GCA. Case presentation A 77-year-old Chinese man presented with sudden bilateral blindness for 5 days with a severe headache. Funduscopic examination revealed bilateral optic disc swollen with “chalky white” pallid appearance. The blood tests showed the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) elevated dramatically. The color duplex ultrasonography (CDUS) of the superficial temporal artery revealed the inflammation of the vessel wall as a “halo sign”. The temporal artery biopsy was perfumed and the pathology revealed luminal occlusion with multinuclear giant cell infiltration. The patient was treated with intravenous methylprednisolone for 3 days and oral prednisone weaning for 12 months. The visual acuity remained no light perception at one year follow-up. Conclusions Although very rare in Asian, GCA can led to permanent blindness in elderly Chinese caused by anterior ischemic optic neuropathy. The noninvasive CDUS might be a promising technique for diagnose GCA in highly suspected patients.

Anterior ischemic optic neuropathy( AION )is the most common acute optic neuropathy in people over 50 years old, which often causes unilateral acute painless visual loss. Non-arteritis anterior ischemic optic neuropathy(NAION)is the most common type and one of the main causes of blindness or severe visual impairment in the middle-aged and elderly. But at present, because of insufficient understanding of the pathogenesis of this disease, there is still no effective treatment method in clinic. Therefore, it is very important to find a standard and effective treatment method in order to control the disease development and reduce blindness.

Giant cell arteritis (GCA) is the most important medical emergency in ophthalmology, because its most dreaded complication is visual loss, which is preventable if these patients are diagnosed early and treated immediately and aggressively. This is a brief review of GCA, its ophthalmic manifestations, and how to diagnose and manage them. [ABSTRACT FROM AUTHOR]

Purpose of Review: Giant cell arteritis (GCA), a medium and large vessel vasculitis occurring in the aged, remains a formidable disease, capable of taking both vision and life, through a multitude of vascular complications. Our understanding of the spectrum of its manifestations has grown over the years, to include limb claudication, aortitis, and cardiac disease, in addition to the more classic visual complications resulting from of ischemia to branches of the external and internal carotid arteries. While a clinical presentation of headache, jaw claudication, scalp tenderness, fever and other systemic symptoms and serum markers are together highly suggestive of the disease, diagnosis can be challenging in those cases in which classic symptoms are lacking. The purpose of this review is to update the reader on advances in the diagnosis and treatment of giant cell arteritis and to review our evolving understanding of the immunological mechanism underlying the disease, which have helped guide our search for novel therapies. Recent Findings: There is increasing evidence supporting the use of Doppler ultrasound, dedicated post-contrast T1-weighted spin echo MRI of the scalp arteries and PET scan, which can together improve our diagnostic accuracy in cases in which temporal artery biopsy is either inconclusive or not feasible. Advances in our understanding of the immunological cascades underlying the disease have helped guide our search for steroid-sparing treatments for the GCA, the most important of which has been the IL-6 receptor antibody inhibitor tocilizumab, which has been shown to reduce cumulative steroid dose in a large multicenter, placebo-controlled prospective study. Other biologic agents, such as abatacept and ustekinumab have shown promise in smaller studies. Summary: GCA is no longer a disease whose diagnosis is based exclusively on temporal artery biopsy and whose complications are prevented solely with the use of corticosteroids. Modern vascular imaging techniques and targeted immunologic therapies are heralding a new era for the disease, in which practitioners will hopefully be able to diagnosis it with greater accuracy and treat it with less ischemic complications and iatrogenic side effects. [ABSTRACT FROM AUTHOR]

Background: To test the hypothesis that varicella-zoster virus (VZV) infection contributes to temporal arteritis pathogenesis, comprehensive in situ analysis was performed on temporal artery biopsies of 38 anterior ischemic optic neuropathy (AION) patients, including 14 (37%) with giant cell arteritis.Methods: Biopsies were completely sectioned, and, on average, 146 serial sections per patient were stained for VZV glycoprotein E.Results: Four of 38 AION patients showed VZV glycoprotein E staining, but VZV infection was not confirmed by staining for VZV IE63 protein and VZV-specific polymerase chain reaction on adjacent sections.Conclusions: This study refutes the premise that VZV is casually related to AION with and without giant cell arteritis. [ABSTRACT FROM AUTHOR]