Journal of Neuro-Ophthalmology最新文献

Background: The rarity of optic nerve sheath meningiomas (ONSMs) complicates the guidelines surrounding optimal treatment strategies and prognostic factors. There are limited data on the visual outcomes of those treated with radiotherapy versus those observed without treatment. This study aimed to characterize the clinical and radiographic presentations of patients diagnosed with ONSMs and to identify factors predicting improvement in visual function after treatment.

Methods: This is a retrospective case series of 26 patients who presented to 2 tertiary neuro-ophthalmology practices for 10 years with the presumptive diagnosis of ONSM. Demographic, clinical, investigative, radiologic, treatment, and outcome data were collected. Visual improvement was defined as improvement in visual acuity (VA) by ≥2 Snellen lines or visual field (VF) mean deviation (MD) improvement by ≥2 dB. Statistical analyses were performed to compare patients who experienced improvement in visual function with those who did not poststereotactic radiotherapy to identify pretreatment predictors of visual recovery.

Results: Seventeen patients underwent radiotherapy (16 received 54 Gy in 30 fractions and 1 received 50 Gy in 25 fractions) and 4 elected observation. Five were lost to follow-up. Visual function improvement was seen in 10 patients who underwent radiotherapy. Pretreatment VA (logMAR 0.492 vs 1.42, P = 0.025), tumor size (8.50 vs 18.3 mm, P = 0.028), and a decrease in tumor size postradiotherapy (P = 0.009 for VA and 0.035 for VF MD improvement) were significantly associated with objective visual improvement.

Conclusions: Pretreatment VA and tumor size may predict improvement in visual function in patients with ONSMs treated with radiotherapy. Future larger scale studies that include these data may be able to draw more definite conclusions.

Background: The prevalence of idiopathic intracranial hypertension (IIH) is rising with the global obesity epidemic. Carbonic anhydrase inhibitors (CAIs), such as acetazolamide, have been shown to be effective in IIH but can also lead to kidney stone formation. This study evaluates the risk of kidney stone development in patients with IIH treated with CAIs.

Methods: A retrospective cohort study using the TriNetX database was performed to compare patients with IIH treated with CAIs vs. untreated controls. Propensity score matching (PSM) balanced demographic and clinical variables. The primary outcome was kidney stone incidence for 3 time intervals: 1 year, 1-2 years, and 2-3 years, identified using International Classification of Diseases-10 codes. Risk ratios (RRs) with 95% confidence intervals (CIs) assessed the association between CAI treatment and kidney stone formation.

Results: The study evaluated 23,182 patients with IIH treated with CAIs compared with 50,080 untreated controls. After applying PSM, each group was balanced to include 22,464 patients. The treated group had a significantly higher risk of developing kidney stones than the control group, with an RR of 1.49 (95% CI: 1.22-1.84) at 1 year, 2.24 (95% CI: 1.61-3.12) at 1-2 years, and 1.51 (95% CI: 1.05-2.18) at 2-3 years. Sensitivity analysis of patients treated with at least 500 mg of acetazolamide shared this elevated trend, and the risk remained persistently high at 2-3 years (RR: 2.18, 95% CI: 1.13-4.20). Subgroup analysis revealed higher risks in males, while Black or African American patients had a lower risk.

Conclusions: Carbonic anhydrase inhibitor use in patients with IIH may increase kidney stone risk, particularly in certain populations. Further research is needed to understand the mechanisms behind this risk and to optimize treatment strategies.

Background: Most of the data on visual functions in Leber hereditary optic neuropathy (LHON) is based on patient questionnaires. Our study assessed the impact of LHON on visual function by testing facial recognition and execution of purposeful actions.

Methods: Twelve participants with LHON with central scotoma ranging from 5° to 20° and 12 unaffected age-matched controls were involved in our study. In the face recognition test, participants were asked to recognize the sex and the facial expression of photographs of faces increasing in size to simulate approaching faces. In the purposeful action test, they were asked to manipulate real objects while their eye movements were recorded.

Results: Although most patients were able to recognize the correct sex of a face at a size corresponding to a 1-m viewing distance, recognition of facial expressions was severely impaired. Patients were slower than control subjects in executing purposeful tasks. A dynamic strategy to sample information needed for the execution of a task was documented in a longer scanpath and in higher frequency of saccades and fixation eye movements in patients than in control subjects.

Conclusions: Face perception is strongly impaired in patients with LHON. In addition, although the selection and manipulation of real objects to execute a task are slowed, they can be performed efficiently using peripheral vision.