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Effects of Stimulus Luminance, Stimulus Color and Intra-Stimulus Color Contrast on Visual Field Mapping in Neurologically Impaired Adults Using Flicker Pupil Perimetry. 刺激亮度、刺激颜色和刺激内颜色对比对使用闪烁瞳孔周边测量的神经损伤成人视野映射的影响。
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2023-01-01 DOI: 10.2147/EB.S409905
Brendan L Portengen, Giorgio L Porro, Douwe Bergsma, Evert J Veldman, Saskia M Imhof, Marnix Naber

Purpose: We improve pupillary responses and diagnostic performance of flicker pupil perimetry through alterations in global and local color contrast and luminance contrast in adult patients suffering from visual field defects due to cerebral visual impairment (CVI).

Methods: Two experiments were conducted on patients with CVI (Experiment 1: 19 subjects, age M and SD 57.9 ± 14.0; Experiment 2: 16 subjects, age M and SD 57.3 ± 14.7) suffering from absolute homonymous visual field (VF) defects. We altered global color contrast (stimuli consisted of white, yellow, cyan and yellow-equiluminant-to-cyan colored wedges) in Experiment 1, and we manipulated luminance and local color contrast with bright and dark yellow and multicolor wedges in a 2-by-2 design in Experiment 2. Stimuli consecutively flickered across 44 stimulus locations within the inner 60 degrees of the VF and were offset to a contrasting (opponency colored) dark background. Pupil perimetry results were compared to standard automated perimetry (SAP) to assess diagnostic accuracy.

Results: A bright stimulus with global color contrast using yellow (p= 0.009) or white (p= 0.006) evoked strongest pupillary responses as opposed to stimuli containing local color contrast and lower brightness. Diagnostic accuracy, however, was similar across global color contrast conditions in Experiment 1 (p= 0.27) and decreased when local color contrast and less luminance contrast was introduced in Experiment 2 (p= 0.02). The bright yellow condition resulted in highest performance (AUC M = 0.85 ± 0.10, Mdn = 0.85).

Conclusion: Pupillary responses and pupil perimetry's diagnostic accuracy both benefit from high luminance contrast and global but not local color contrast.

目的:通过改变脑性视觉障碍(CVI)所致视野缺损的成人患者的整体和局部颜色对比和亮度对比,改善闪烁瞳孔周边测量的瞳孔反应和诊断性能。方法:对CVI患者进行2项实验(实验1:19例,年龄M, SD 57.9±14.0;实验2:16例患者,年龄M, SD(57.3±14.7),患有完全同位视野缺损。在实验1中,我们改变了整体颜色对比度(刺激由白色、黄色、青色和黄-蓝等色楔组成),在实验2中,我们用2 × 2设计的明黄色和暗黄色和多色楔来操纵亮度和局部颜色对比度。在视场内60度的44个刺激位置上,刺激连续闪烁,并被抵消到一个对比色的暗背景上。瞳孔周边检查结果与标准自动周边检查(SAP)进行比较,以评估诊断准确性。结果:与含有局部颜色对比和较低亮度的刺激相比,黄色(p= 0.009)或白色(p= 0.006)具有全局颜色对比的明亮刺激引起了最强的瞳孔反应。然而,在实验1中,诊断准确性在全局色彩对比条件下是相似的(p= 0.27),而在实验2中,当引入局部色彩对比和较低亮度对比时,诊断准确性下降(p= 0.02)。在亮黄色条件下表现最佳(AUC M = 0.85±0.10,Mdn = 0.85)。结论:高亮度对比和全局色彩对比有利于瞳孔反应和瞳孔周边检查的诊断准确性。
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引用次数: 0
Meridional Attentional Asymmetries in Astigmatic Eyes. 散光眼的经向注意不对称。
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2023-01-01 DOI: 10.2147/EB.S407481
Elie de Lestrange-Anginieur

Purpose: To investigate the impact of attention orientation in young myopic adults with astigmatism.

Methods: The effect of attention on foveal meridional performance and anisotropy was measured in corrected myopes with various levels of astigmatism (with-the-rule astigmatism ≤ -0.75D, Axis: 180 ± 20) using orientation-based attention. Attention was manipulated by instructing subjects to attend to either the horizontal or the vertical line of a central pre-stimulus (a pulsed cross) along separate blocks of trials. For each attention condition, meridional acuity and reaction times were measured via an annulus Gabor target situated remotely from the cross and presented at random horizontally and vertically in a two-alternative forced-choice employing two interleaved staircase procedures (one-up/one-down). Attention modulations were estimated by the difference in performance between horizontal and vertical attention.

Results: Foveal meridional performance and anisotropy were strongly affected by the orientation of attention, which appeared critical for the enhancement of reaction times and resolution. Under congruent orienting of attention, foveal meridional anisotropy was correlated with the amount of defocus for both reaction time and resolution, demonstrating greater vertical performance than horizontal performance as myopia increased. Compatible with an attentional compensation of blur through optimal orienting of attention, vertical attention enhanced reaction times compared to horizontal attention and was accompanied by an increase in overall acuity when myopia increased. Increased astigmatism was associated with smaller attention effects and asymmetry, suggesting potential deficits in the compensation of blur in astigmatic eyes.

Conclusion: Collectively, attention to orientation plays a significant role in horizontal-vertical foveal meridional anisotropy and can modulate the asymmetry of foveal perception imposed by the optics of the eye in episodes of uncorrected vision. Further work is necessary to understand how attention and refractive errors interact during visual development. These results may have practical implications for methods to enhance vision with attention training in myopic astigmats.

目的:探讨青少年近视散光对注意定向的影响。方法:采用定向注意法对不同散光程度矫正近视(视距散光≤-0.75D,轴距:180±20)的中央凹经络性能和各向异性的影响进行测量。通过指示受试者注意中央预刺激的水平线或垂直线(脉冲交叉)沿不同的试验块来操纵注意力。对于每个注意条件,经向锐度和反应时间是通过一个远离十字架的环形Gabor靶来测量的,并在水平和垂直方向随机呈现,采用两个交错的楼梯程序(一上一下)。注意调节是通过水平和垂直注意的表现差异来估计的。结果:中央凹经向性能和各向异性受到注意方向的强烈影响,这对提高反应时间和分辨率至关重要。在相同的注意取向下,中央凹经向各向异性与反应时间和分辨率的离焦量相关,随着近视的增加,垂直表现大于水平表现。当近视增加时,垂直注意力比水平注意力更能提高反应时间,这与通过最佳注意力定向对模糊的注意补偿相一致。散光的增加与注意力效应和不对称性的减小有关,表明散光眼的模糊补偿存在潜在缺陷。结论:总的来说,定向注意在水平-垂直中央凹经向各向异性中起着重要作用,并可以调节未矫正视力时眼睛光学施加的中央凹感知的不对称性。需要进一步的工作来了解在视觉发育过程中注意力和屈光不正是如何相互作用的。这些结果可能对近视散光的注意训练增强视力的方法具有实际意义。
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引用次数: 0
Does Long-Duration Exposure to Microgravity Lead to Dysregulation of the Brain and Ocular Glymphatic Systems? 长时间暴露在微重力环境下会导致脑和眼淋巴系统失调吗?
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2022-05-01 DOI: 10.2147/EB.S354710
P. Wostyn, T. Mader, C. Gibson, M. Nedergaard
Abstract Spaceflight-associated neuro-ocular syndrome (SANS) has been well documented in astronauts both during and after long-duration spaceflight and is characterized by the development of optic disc edema, globe flattening, choroidal folds, and hyperopic refractive error shifts. The exact mechanisms underlying these ophthalmic abnormalities remain unclear. New findings regarding spaceflight-associated alterations in cerebrospinal fluid spaces, specifically perivascular spaces, may shed more light on the pathophysiology of SANS. The preliminary results of a recent brain magnetic resonance imaging study show that perivascular spaces enlarge under prolonged microgravity conditions, and that the amount of fluid in perivascular spaces is linked to SANS. The exact pathophysiological mechanisms underlying enlargement of perivascular spaces in space crews are currently unclear. Here, we speculate that the dilation of perivascular spaces observed in long-duration space travelers may result from impaired cerebral venous outflow and compromised cerebrospinal fluid resorption, leading to obstruction of glymphatic perivenous outflow and increased periarterial cerebrospinal fluid inflow, respectively. Further, we provide a possible explanation for how dilated perivascular spaces can be associated with SANS. Given that enlarged perivascular spaces in space crews may be a marker of altered venous hemodynamics and reduced cerebrospinal fluid outflow, at the level of the optic nerve and eye, these disturbances may contribute to SANS. If confirmed by further studies, brain glymphatic dysfunction in space crews could potentially be considered a risk factor for the development of neurodegenerative diseases, such as Alzheimer’s disease. Furthermore, long-duration exposure to microgravity might contribute to SANS through dysregulation of the ocular glymphatic system. If prolonged spaceflight exposure causes disruption of the glymphatic systems, this might affect the ability to conduct future exploration missions, for example, to Mars. The considerations outlined in the present paper further stress the crucial need to develop effective long-term countermeasures to mitigate SANS-related physiologic changes during long-duration spaceflight.
摘要太空飞行相关的神经眼综合征(SANS)在宇航员长期太空飞行期间和之后都有很好的记录,其特征是视盘水肿、眼球扁平、脉络膜折叠和远视屈光不正移位。这些眼科异常的确切机制尚不清楚。关于太空飞行相关脑脊液空间,特别是血管周围空间改变的新发现,可能会为SANS的病理生理学提供更多的线索。最近一项脑磁共振成像研究的初步结果表明,在长时间的微重力条件下,血管周围空间会扩大,并且血管周围空间中的液体量与SANS有关。太空工作人员血管周围间隙扩大的确切病理生理机制目前尚不清楚。在此,我们推测,在长期太空旅行者中观察到的血管周围空间扩张可能是由于脑静脉流出受损和脑脊液吸收受损,分别导致淋巴管周围静脉流出受阻和动脉周围脑脊液流入增加。此外,我们为扩张的血管周围间隙如何与SANS相关提供了可能的解释。鉴于太空工作人员血管周围空间增大可能是视神经和眼睛水平静脉血流动力学改变和脑脊液流出减少的标志,这些干扰可能导致SANS。如果得到进一步研究的证实,太空工作人员的大脑交感神经功能障碍可能被认为是神经退行性疾病(如阿尔茨海默病)发展的风险因素。此外,长期暴露在微重力环境中可能会导致眼部免疫系统失调,从而导致SANS。如果长时间的太空飞行暴露导致glymphatic系统中断,这可能会影响未来执行探测任务的能力,例如火星探测任务。本文中概述的考虑因素进一步强调,迫切需要制定有效的长期对策,以缓解长期太空飞行中与SANS相关的生理变化。
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引用次数: 4
Comparative Evaluation of Two SD-OCT Macular Parameters (GCC, GCL) and RNFL in Chiasmal Compression SD-OCT两种黄斑参数(GCC, GCL)和RNFL在交叉压迫中的比较评价
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2022-03-01 DOI: 10.2147/EB.S337333
M. Santorini, T. Ferreira de Moura, S. Barraud, C. Litré, C. Brugniart, A. Denoyer, Z. Djerada, C. Arndt
Purpose To evaluate the relationship between different macular thickness parameters analyzed by SD-OCT and the central visual field (VF) evaluated with automated kinetic perimetry in a cohort of patients with pituitary tumors. Methods Data from patients with pituitary adenoma treated at Reims University Hospital between October 1st, 2017, and May 31st, 2018 were collected. All patients underwent an automated kinetic perimetry and a SD-OCT to map the ganglion cell complex (GCC), the ganglion cell layer (GCL) thickness and the retinal nerve fiber layer (RNFL) using devices from two different manufacturers. Univariate and multivariate analysis were used to evaluate the correlation between the area of central VF in square degrees (deg2) and the SD-OCT parameters (μm). Results Eighty-eight eyes were included in the analysis. All the thickness parameters measured in SD-OCT decreased with the visual field alteration. The best correlation was observed between superior thickness parameters (GCC, GCL) and the inferior central visual field. The most pertinent predictive factors for visual field loss were the inferior central GCL and the nasal RNFL (both AUC=0.775) with a sensitivity respectively of 86% and 70%. Conclusion This study suggests that both GCC, GCL thickness parameters could be reliable predictors of central visual field impairment in patients with pituitary tumors. There was no significative difference between both devices.
目的探讨SD-OCT分析的不同黄斑厚度参数与自动动态视野测量的中心视野(VF)之间的关系。方法收集2017年10月1日至2018年5月31日在兰斯大学医院治疗的垂体腺瘤患者的资料。所有患者都使用两家不同制造商的设备进行了自动动力学视野测量和SD-OCT,以绘制神经节细胞复合物(GCC)、神经节细胞层(GCL)厚度和视网膜神经纤维层(RNFL)。采用单因素和多因素分析评价中央VF面积平方度(deg2)与SD-OCT参数(μm)之间的相关性。结果共纳入88只眼。SD-OCT测得的厚度参数均随视野改变而降低。高厚度参数(GCC、GCL)与低中央视野的相关性最好。视野丧失最相关的预测因素为下中央GCL和鼻腔RNFL (AUC均为0.775),敏感性分别为86%和70%。结论GCC、GCL厚度参数均可作为垂体肿瘤患者中央视野损害的可靠预测指标。两种设备之间无显著差异。
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引用次数: 2
Neuroplasticity of the Lateral Geniculate Nucleus in Response to Retinal Gene Therapy in a Group of Patients with RPE65 Mutations. 一组RPE65突变患者视网膜基因治疗对外侧膝状核神经可塑性的影响。
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2022-01-01 DOI: 10.2147/EB.S377275
Manzar Ashtari, Mikhail Lipin, Michelle Duong, Gui-Shuang Ying, Yinxi Yu, Albert Maguire, Jean Bennett

Introduction: Previous works on experience-dependent brain plasticity have been limited to the cortical structures, overlooking subcortical visual structures such as the lateral geniculate nucleus (LGN). Animal studies have shown substantial experience dependent plasticity and using fMRI, human studies have demonstrated similar properties in patients with cataract surgery. However, in neither animal nor human studies LGN has not been directly assessed, mainly due to its small size, tissue heterogeneity, low contrast/noise ratio, and low spatial resolution.

Methods: Utilizing a new algorithm that markedly improves the LGN visibility, LGN was evaluated in a group of low vision patients before and after retinal intervention to reinstate vision and normal sighted matched controls.

Results: Between and within groups comparisons showed that patients had significantly smaller left (p< 0.0001) and right (p < 0.00002) LGN volumes at baseline as compared to the one-year follow-up volumes. The same baseline and one year comparison in controls was not significant. Significant positive correlations were observed between the incremental volume increase after gene therapy of the left LGN and the incremental increase in the right (r = 0.71, p < 0.02) and left (r = 0.72, p = 0.018) visual fields. Incremental volume increase of the right LGN also showed a similar positive slope but did not reach significance.

Discussion: These results show that despite significantly less volume at baseline, retinal gene therapy promotes robust expansion and increase in LGN volume. Reinstating vision may have facilitated the establishment of new connections between the retina and the LGN and/or unmasking of the dormant connections. The exact trajectory of the structural changes taking place in LGN is unclear but our data shows that even after years of low vision, the LGN in RPE65 patients has the potential for plasticity and expansion to a nearly normal volume one year after gene therapy administration.

以往关于经验依赖大脑可塑性的研究仅限于皮层结构,忽视了皮层下的视觉结构,如外侧膝状核(LGN)。动物研究已经显示了大量的经验依赖可塑性,使用功能磁共振成像,人类研究已经在白内障手术患者中证明了类似的特性。然而,在动物和人类研究中,LGN都没有被直接评估,主要是由于其体积小、组织异质性、低对比度/噪声比和低空间分辨率。方法:采用一种明显提高LGN可见度的新算法,对一组低视力患者进行视网膜干预恢复视力前后的LGN进行评估,并与正常视力对照进行比较。结果:组间和组内比较显示,基线时患者左侧LGN体积(p< 0.0001)和右侧LGN体积(p< 0.00002)明显小于1年随访时的体积。相同的基线和对照组的一年比较无显著性。左侧LGN基因治疗后体积增量与右侧视野(r = 0.71, p < 0.02)、左侧视野(r = 0.72, p = 0.018)体积增量呈显著正相关。右侧LGN的增量体积增加也呈现类似的正斜率,但没有达到显著性。讨论:这些结果表明,尽管在基线时体积明显减少,视网膜基因治疗促进了LGN的强劲扩张和体积的增加。恢复视力可能有助于在视网膜和LGN之间建立新的连接和/或揭开休眠连接的面纱。LGN发生结构变化的确切轨迹尚不清楚,但我们的数据显示,即使经过多年的低视力,RPE65患者的LGN在接受基因治疗一年后仍具有可塑性和扩大到接近正常体积的潜力。
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引用次数: 0
Involvement of High Mobility Group Box 1 Protein in Optic Nerve Damage in Diabetes. 高迁移率组1蛋白在糖尿病视神经损伤中的作用
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2022-01-01 DOI: 10.2147/EB.S352730
Ghulam Mohammad, Renu A Kowluru

Introduction: Diabetic patients routinely have high levels of high mobility group box 1 (HMGB1) protein in their plasma, vitreous and ocular membranes, which is strongly correlated with subclinical chronic inflammation in the eye. Our previous work has suggested that high HMGB1 in diabetes plays a role in retinal inflammation and angiogenesis, but its role in the optic nerve damage is unclear. Therefore, our goal is to examine the role of HMGB1 in optic nerve damage in diabetes.

Methods: Gene expression of HMGB1 was quantified in the optic nerve from streptozotocin-induced diabetic mice by qRT-PCR, and their protein expressions by Western blot analysis and immunofluorescence staining. Using immunohistochemical technique, expression of reactive astrogliosis (indicator of neuroinflammation) and nerve demyelination/damage were determined by quantifying glial fibrillary acid protein (GFAP) and myelin basic protein (MBP), respectively. The role of HMGB1 in the optic nerve damage and alteration visual pathways was confirmed in mice receiving glycyrrhizin, a HMGB1 inhibitor. Similar parameters were measured in the optic nerve from human donors with diabetes.

Results: Compared to normal mice, diabetic mice exhibited increased levels of HMGB1, higher GFAP expression, and decreased MBP in the optic nerve. Double immunofluorescence microscopy revealed that diabetes induced increased HMGB1 immunoreactivities were significantly colocalized with GFAP in the optic nerve. Glycyrrhizin supplementation effectively reduced HMGB1 and maintained normal axonal myelination and visual conduction. Results from mice optic nerve confirmed the results obtained from human donors with diabetes.

Discussions: Thus, diabetes-induced HMGB1 upregulation promotes optic nerve demyelination and inflammation. The regulation of HMGB1 activation has potential to protect optic nerve damage and the abnormalities of visual pathways in diabetic patients.

导语:糖尿病患者血浆、玻璃体和眼膜中HMGB1蛋白水平普遍偏高,与眼部亚临床慢性炎症密切相关。我们之前的研究表明,糖尿病患者高HMGB1在视网膜炎症和血管生成中起作用,但其在视神经损伤中的作用尚不清楚。因此,我们的目标是研究HMGB1在糖尿病视神经损伤中的作用。方法:采用qRT-PCR法测定链脲霉素诱导的糖尿病小鼠视神经中HMGB1基因的表达,采用Western blot和免疫荧光染色法测定其蛋白表达。采用免疫组化技术,分别定量测定神经胶质原纤维酸蛋白(GFAP)和髓鞘碱性蛋白(MBP),检测反应性星形胶质增生(神经炎症指标)和神经脱髓鞘/损伤的表达。HMGB1抑制剂甘草酸在小鼠视神经损伤和视觉通路改变中的作用得到证实。在糖尿病患者的视神经中也测量了类似的参数。结果:与正常小鼠相比,糖尿病小鼠视神经HMGB1水平升高,GFAP表达升高,MBP降低。双免疫荧光显微镜显示,糖尿病引起的HMGB1免疫反应性升高与GFAP在视神经中明显共定位。补充甘草酸能有效降低HMGB1,维持正常的轴突髓鞘形成和视觉传导。小鼠视神经的结果证实了从糖尿病患者供体获得的结果。讨论:因此,糖尿病诱导的HMGB1上调可促进视神经脱髓鞘和炎症。调节HMGB1激活对糖尿病患者视神经损伤和视觉通路异常具有保护作用。
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引用次数: 0
Neuro-Ophthalmological Optic Nerve Cupping: An Overview. 神经眼科视神经拔火罐:综述。
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2021-12-14 eCollection Date: 2021-01-01 DOI: 10.2147/EB.S272343
Ethan Waisberg, Jonathan A Micieli

Optic nerve cupping or enlargement of the cup-to-disc ratio is widely recognized as a feature of glaucoma, however it may also occur in non-glaucomatous optic neuropathies. The most well-recognized non-glaucomatous optic neuropathies that cause cupping include compressive optic neuropathies, arteritic anterior ischemic optic neuropathies, hereditary optic neuropathies, and optic neuritis. Cupping is thought to consist of two main components: prelaminar and laminar thinning. The former is a shallow form of cupping and related to loss of retinal ganglion cells, whereas the latter involves damage to the lamina cribrosa and peripapillary scleral connective tissue. Differentiating glaucomatous and non-glaucomatous optic nerve cupping remains challenging even for experienced observers. Classically, the optic nerve in non-glaucomatous causes has pallor of the neuroretinal rim, but the optic nerve should not be examined in isolation. The patient's medical history, history of presenting illness, visual function (visual acuity, color vision and visual field testing) and ocular examination also need to be considered. Ancillary testing such as optical coherence tomography of the retinal nerve fiber layer and ganglion cell layer-inner plexiform layer may also be helpful in localizing the disease. In this review, we review the non-glaucomatous causes of cupping and provide an approach to evaluating a patient that presents with an enlarged cup-to-disc ratio.

视神经拔火罐或杯盘比增大被广泛认为是青光眼的一个特征,但它也可能发生在非青光眼视神经病变中。引起拔罐的最常见的非青光眼性视神经病变包括压缩性视神经病变、动脉前缺血性视神经病变、遗传性视神经病变和视神经炎。拔火罐被认为包括两个主要组成部分:层前和层减薄。前者是一种浅层拔火罐,与视网膜神经节细胞的丧失有关,而后者涉及到网层和乳头周围巩膜结缔组织的损伤。鉴别青光眼和非青光眼视神经拔火罐仍然具有挑战性,即使是有经验的观察者。典型地,视神经在非青光眼的原因有神经视网膜边缘苍白,但视神经不应单独检查。还需要考虑患者的病史、病史、视觉功能(视力、色觉和视野测试)和眼部检查。辅助检查如视网膜神经纤维层和神经节细胞层-内丛状层的光学相干断层扫描也可能有助于疾病的定位。在这篇综述中,我们回顾了拔罐的非青光眼原因,并提供了一种评估出现杯盘比增大的患者的方法。
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引用次数: 7
Neuro-Ophthalmic Complications of Vestibular Schwannoma Resection: Current Perspectives. 前庭神经鞘瘤切除术的神经眼科并发症:目前的观点。
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2021-10-01 eCollection Date: 2021-01-01 DOI: 10.2147/EB.S272326
Stephanie J Chiu, Simon J Hickman, Irene M Pepper, Jennifer H Y Tan, John Yianni, Joanna M Jefferis

Vestibular schwannomas (VSs), also called acoustic neuromas, are benign intracranial neoplasms of the vestibulocochlear (VIII) cranial nerve. Management options include "wait-and-scan," stereotactic radiosurgery and surgical resection. Due to the proximity of the VIII nerve to the facial (VII) nerve in the cerebello-pontine angle, the VII nerve is particularly vulnerable to the effects of surgical resection. This can result in poor eye closure, lagophthalmos and resultant corneal exposure post VS resection. Additionally, compression from the tumor or resection can cause trigeminal (V) nerve damage and a desensate cornea. The combination of an exposed and desensate cornea puts the eye at risk of serious ocular complications including persistent epithelial defects, corneal ulceration, corneal vascularization, corneal melting and potential perforation. The abducens (VI) nerve can be affected by a large intracranial VS causing raised intracranial pressure (a false localizing sign) or as a result of damage to the VI nerve at the time of resection. Other types of neurogenic strabismus are rare and typically transient. Contralaterally beating nystagmus as a consequence of vestibular dysfunction is common post-operatively. This generally settles to pre-operative levels as central compensation occurs. Ipsilaterally beating nystagmus post-operatively should prompt investigation for post-operative cerebrovascular complications. Papilledema (and subsequent optic atrophy) can occur as a result of a large VS causing raised intracranial pressure. Where papilledema follows surgical resection of a VS, it can indicate that cerebral venous sinus thrombosis has occurred. Poor visual function following VS resection can result as a combination of all these potential complications and is more likely with larger tumors.

前庭神经鞘瘤(VSs),也称为听神经瘤,是前庭耳蜗(VIII)颅神经的良性颅内肿瘤。治疗方案包括“等待扫描”、立体定向放射手术和手术切除。由于VII神经在小脑-桥脑角与面神经(VII)神经接近,因此VII神经特别容易受到手术切除的影响。这可能导致闭眼不良,眼球lagophthalmos和最终角膜暴露后VS切除术。此外,肿瘤压迫或切除可引起三叉神经(V)损伤和角膜致密。暴露和致密的角膜会使眼睛面临严重的眼部并发症的风险,包括持续的上皮缺陷、角膜溃疡、角膜血管化、角膜融化和潜在的穿孔。外展神经(VI)可受到较大的颅内VS的影响,导致颅内压升高(一种错误的定位征象),或由于VI神经在切除时受损。其他类型的神经源性斜视是罕见的,通常是短暂的。对侧跳动性眼球震颤作为前庭功能障碍的后果是常见的术后。随着中枢代偿的发生,这通常会稳定到术前水平。术后同侧跳动性眼球震颤应提示术后脑血管并发症的调查。视神经乳头水肿(以及随后的视神经萎缩)可由于大VS引起颅内压升高而发生。如果手术切除VS后出现乳头水肿,则表明发生了脑静脉窦血栓形成。切除VS后的视觉功能差可能是所有这些潜在并发症的综合结果,更有可能是较大的肿瘤。
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引用次数: 0
Studies Utilizing Current Estimated CSF Pressure Equations Should Not Be Conducted and Published [Letter]. 利用目前估计的脑脊液压力方程的研究不应进行和发表[信]。
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2021-09-24 eCollection Date: 2021-01-01 DOI: 10.2147/EB.S338935
David Fleischman, Hanspeter E Killer
1Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2Department of Ophthalmology, Kantonsspital Aarau, Aarau, Switzerland Dear editor We took interest in the recent article by Qian Wang and colleagues, “Prevalence of Retinal Vein Occlusions and Estimated Cerebrospinal Fluid Pressure: The Kailuan Eye Study.” We agree with the authors that CSF pressure, in particular the perioptic subarachnoid space pressure, is likely important in the development of many cases of retinal vein occlusions. However, we were troubled by the methodology employed by the study team. While we appreciate the mention of our study that had found that formulae used to predict CSFP derived from clinical data were unable to accurately estimate CSF pressures, we were surprised that this formula was nonetheless used in the current study. Even more troubling is that the reference given for the justification of the formula, “eCSFP [mm Hg] = 0.44 * BMI [kg/m2] + 0.16 * DBP [mm Hg] – 0.18 * Age [years],” does not in fact explain its derivation. The Xie study from Critical Care used patientspecific anatomic measurements derived from MRI data in order to estimate CSFP, an important factor that has been excluded from the current study’s equation. CSF pressure is not static. It varies over time as a function of the production and resorption rate of CSF and body posture. A formula that is derived top down from preexisting data (such as BMI and DBP) is far from representing the complexity of CSF dynamics, including CSF pressure. Neither is CSF pressure and composition homogeneous throughout all CSF-containing spaces. Further, even if it could reflect the appropriate CSF pressure in the lumbar spine region, it is purely speculative to assume that this measurement could be extrapolated to the pressure within the subarachnoid space of the optic nerve. Several studies in patients with papilledema as well as normal tension glaucoma demonstrated “comparted” optic nerve sheaths, a finding that cautions even the assumption that the pressure measured at the lumber site reflects the pressure in the perioptic space. Thus, to assume that all CSF spaces connect via a linear continuum can be quite misleading. In conclusion, we are strongly supportive of research that will further the understanding of the cerebrospinal fluid’s role in ophthalmic disease. However, bad data are worse than no data. We would have expected that the limitations of such a study should have been clearly explained to the reader who may not be familiar with this complex topic, and we discourage the use of unvalidated formulae for CSF and ophthalmic research. Correspondence: David Fleischman Department of Ophthalmology, University of North Carolina at Chapel Hill, 5126 Bioinformatics Bldg #7040, Chapel Hill, NC, 27599-7040, USA Tel +1 919 259-9336 Fax +1 919 966-1908 Email david8fleischman@gmail.com
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引用次数: 0
Sensitivity and Specificity of New Visual Field Screening Software for Diagnosing Hemianopia. 新型视野筛查软件诊断偏视的敏感性和特异性。
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2021-08-29 eCollection Date: 2021-01-01 DOI: 10.2147/EB.S315403
Supharat Jariyakosol, Patcharaporn Jaru-Ampornpan, Anita Manassakorn, Rath Itthipanichpong, Parima Hirunwiwatkul, Visanee Tantisevi, Thanapong Somkijrungroj, Prin Rojanapongpun

Purpose: To assess the diagnostic accuracy of visual field results generated by the newly developed software (CU-VF) and the standard automated perimetry (SAP) for detecting hemianopia.

Patients and methods: Forty-three subjects with hemianopia and 33 controls were tested with the CU-VF software on a personal computer and SAP. Hemianopia was defined as the presence of a hemianopic field respecting the vertical meridian on SAP with the corresponding neuroimaging pathology as evaluated by 2 neuro-ophthalmologists. Results of CU-VF were independently evaluated by 2 neuro-ophthalmologists, 1 general ophthalmologist, and 1 general practitioner in terms of the presence of hemianopia. Sensitivity, specificity, and kappa coefficient for inter-observer reliability were calculated. Satisfaction and ease of use were evaluated with a visual analog-scale questionnaire and analyzed using paired t-test.

Results: The sensitivity (95% CI) and specificity (95% CI) of the CU-VF to detect hemianopia was 74.42% (58.53-85.96) and 93.94% (78.38-99.94). Kappa coefficient between neuro-ophthalmologists versus general ophthalmologist and general practitioner were 0.71 and 0.84, respectively. The mean (SD) test duration was 2.25 (0.002) minutes for the CU-VF and 5.38 (1.34) minutes for SAP (p < 0.001). Subjects reported significantly higher satisfaction and comfort using the CU-VF software compared to SAP.

Conclusion: The CU-VF screening software showed good validity and reliability to detect hemianopia, with shorter test duration and higher subject satisfaction compared to SAP.

目的:评价新开发的软件(CU-VF)和标准自动视距仪(SAP)对偏视的诊断准确性。患者和方法:43名偏视患者和33名对照者使用个人电脑上的CU-VF软件和SAP进行测试。由2名神经眼科医生评估,在SAP上出现偏视视场并伴有相应的神经影像学病理,即为偏视。CU-VF的结果由2名神经眼科医生、1名普通眼科医生和1名全科医生独立评估是否存在偏视。计算观察者间信度的敏感性、特异性和kappa系数。使用视觉模拟量表评估满意度和易用性,并使用配对t检验进行分析。结果:CU-VF检测偏视的灵敏度(95% CI)和特异性(95% CI)分别为74.42%(58.53 ~ 85.96)和93.94%(78.38 ~ 99.94)。神经眼科医生与普通眼科医生和全科医生的Kappa系数分别为0.71和0.84。CU-VF的平均(SD)测试时间为2.25(0.002)分钟,SAP的平均(SD)测试时间为5.38(1.34)分钟(p < 0.001)。结论:与SAP相比,CU-VF筛选软件检测偏视具有较好的效度和信度,测试时间短,受试者满意度高。
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引用次数: 1
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Eye and Brain
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