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Optic nerve sheath meningiomas: prevalence, impact, and management strategies. 视神经鞘脑膜瘤:患病率,影响和管理策略。
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2018-10-24 eCollection Date: 2018-01-01 DOI: 10.2147/EB.S144345
Richard T Parker, Christopher A Ovens, Clare L Fraser, Chameen Samarawickrama

Optic nerve sheath meningiomas are rare benign neoplasms of the meninges surrounding the optic nerve. They are a significant cause of morbidity. While the mortality rate is practically zero, these tumors can blind or disfigure patients. Given that the clinical course can be variable, and treatment has the capacity to cause morbidity itself, the management of these patients can be difficult. We review the literature to discuss the prevalence of optic nerve sheath meningiomas, the association with neurofibromatosis type 2, natural history, and management options and strategies.

视神经鞘脑膜瘤是少见的视神经周围脑膜的良性肿瘤。它们是致病的重要原因。虽然死亡率几乎为零,但这些肿瘤可以使患者失明或毁容。鉴于临床过程可能是可变的,治疗本身就有可能导致发病率,因此对这些患者的管理可能是困难的。我们回顾文献,讨论视神经鞘脑膜瘤的患病率,与2型神经纤维瘤病的关系,自然病史,以及治疗方案和策略。
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引用次数: 42
Curvilinear, symmetrical, and profound pigment deposition on the posterior lens capsule in a patient with bilateral pigmentary dispersion syndrome. 双侧色素分散综合征患者晶状体后囊呈曲线状、对称状、深度色素沉积。
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2018-09-13 eCollection Date: 2018-01-01 DOI: 10.2147/EB.S160999
Julia Canestraro, Jerome Sherman

Introduction: The classic presentation of pigmentary dispersion syndrome (PDS) often consists of midperipheral iris transillumination defects, Krukenberg's spindle, and dense homogeneous trabecular pigmentation. Other subtle, sometimes overlooked features include pigment on the lens zonules, pigment on the anterior lens capsule and pigment along the equator of the posterior lens capsule.

Case: This unique presentation of PDS presented with bilateral, dense, oblique, and symmetrical pigment deposition along the posterior lens capsule that changed in shape, density, and extent over the span of 3 years.

Discussion: There have been few reports in the literature that describe a central accumulation of pigment along the posterior lens capsule associated with PDS. There are reported cases of pigment deposition along the central aspect of the posterior lens capsule, some changing over time, although none were bilateral and symmetrical. There are suggestions that perhaps this central pigment deposition is related to a break in the ligament of Weiger, allowing communication between the posterior chamber and posterior lens capsule. This is a case in which curvilinear, symmetrical, and changing pigment deposition on the posterior lens capsule is suggestive of perhaps another key features of PDS.

摘要:色素分散综合征(PDS)的典型表现通常包括虹膜中外周穿越性缺损、Krukenberg纺锤体和致密均匀的小梁色素沉着。其他微妙的,有时被忽视的特征包括晶状体小带上的色素,晶状体前囊上的色素和晶状体后囊赤道上的色素。病例:这种独特的PDS表现为双侧、密集、倾斜和对称的色素沉积沿晶状体后囊,其形状、密度和范围在3年内发生了变化。讨论:文献中很少有报道描述与PDS相关的晶状体后囊中央性色素积累。有报道的情况下,色素沉积沿中央方面的晶状体后囊,一些改变随着时间的推移,虽然没有双边和对称。有迹象表明,这种中央色素沉积可能与韦格韧带断裂有关,韦格韧带使后房室和晶状体后囊之间能够通信。这种情况下,后晶状体囊上的曲线、对称和变化的色素沉积可能提示PDS的另一个关键特征。
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引用次数: 5
Effects of tDCS-like electrical stimulation on retinal ganglion cells. tdcs样电刺激对视网膜神经节细胞的影响。
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2018-08-27 eCollection Date: 2018-01-01 DOI: 10.2147/EB.S163914
Christianne E Strang, Mary Katherine Ray, Mary M Boggiano, Franklin R Amthor

Purpose: Transcranial direct current stimulation (tDCS) has been studied in humans for its effects on enhancement of learning, amelioration of psychiatric disorders, and modification of other behaviors for over 50 years. Typical treatments involve injecting 2 mA current through scalp electrodes for 20 minutes, sometimes repeated weekly for two to five sessions. Little is known about the direct effects of tDCS at the neural circuit or the cellular level. This study assessed the effects of tDCS-like currents on the central nervous system by recording effects on retinal ganglion cell responsiveness using the rabbit retina eyecup preparation.

Materials and methods: We examined changes in firing to On and Off light stimuli during and after brief applications of a range of currents and polarity and in different classes of ganglion cells.

Results: The responses of Sustained cells were consistently suppressed during the first round of current application, but responses could be enhanced after subsequent rounds of stimulation. The observed first round suppression was independent of current polarity, amplitude, or number of trials. However, the light responses of Transient cells were more likely to be enhanced by negative currents and unaffected or suppressed by first round positive currents. Short-duration currents, that is, minutes, as low as 2.5 µA produced a remarkable persistency of firing changes, for up to 1.5 hours, after cessation of current.

Conclusion: The results are consistent with postulated tDCS alteration of central nervous system function, which outlast the tDCS session and provide evidence for the isolated retina as a useful model to understand tDCS actions at the neuronal level.

目的:经颅直流电刺激(tDCS)对人类学习能力的增强、精神障碍的改善和其他行为的改变已经进行了50多年的研究。典型的治疗包括通过头皮电极注射2毫安电流20分钟,有时每周重复两到五次。关于tDCS在神经回路或细胞水平上的直接作用,我们所知甚少。本研究通过记录兔视网膜杯制剂对视网膜神经节细胞反应性的影响,评估了tdcs样电流对中枢神经系统的影响。材料和方法:我们研究了在一系列电流和极性的短暂应用期间和之后,不同类型的神经节细胞对开和关光刺激的放电变化。结果:在第一轮电流刺激中,持续细胞的反应一直受到抑制,但在随后的几轮刺激后,反应可以增强。观察到的第一轮抑制与电流极性、振幅或试验次数无关。然而,瞬态细胞的光响应更有可能被负电流增强,而不受第一轮正电流的影响或抑制。短时间电流,即几分钟,低至2.5µA,在电流停止后可持续1.5小时,产生显著的持续放电变化。结论:实验结果与假设的tDCS对中枢神经系统功能的改变一致,这种改变持续时间长于tDCS过程,并为离体视网膜在神经元水平上理解tDCS的作用提供了有用的模型。
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引用次数: 8
Retinal imaging with optical coherence tomography: a biomarker in multiple sclerosis? 视网膜光学相干断层成像:多发性硬化症的生物标志物?
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2018-07-31 eCollection Date: 2018-01-01 DOI: 10.2147/EB.S139417
Fiona Costello, Jodie M Burton

Multiple sclerosis (MS) is a progressive neurological disorder characterized by both inflammatory and degenerative components that affect genetically susceptible individuals. Currently, the cause of MS remains unclear, and there is no known cure. Commonly used therapies tend to target inflammatory aspects of MS, but may not halt disease progression, which may be governed by the slow, subclinical accumulation of injury to neuroaxonal structures in the central nervous system (CNS). A recognized challenge in the field of MS relates to the need for better methods of detecting, quantifying, and ameliorating the effects of subclinical disease. Simply stated, better biomarkers are required. To this end, optical coherence tomography (OCT) provides highly reliable, reproducible measures of axonal damage and neuronal loss in MS patients. OCT-detected decrements in retinal nerve fiber layer thickness and ganglion-cell layer-inner plexiform layer thickness, which represent markers of axonal damage and neuronal injury, respectively, have been shown to correlate with worse visual outcomes, increased clinical disability, and magnetic resonance imaging-measured burden of disease in MS patients. Recent reports have also suggested that OCT-measured microcystic macular edema and associated thickening of the retinal inner nuclear layer represent markers of active CNS inflammatory activity. Using the visual system as a putative clinical model in MS, OCT measures of neuroaxonal structure can be correlated with functional outcomes to help us elucidate mechanisms of CNS injury and repair. In this review, we evaluate evidence from the published literature and ongoing clinical trials that support the emerging role of OCT in diagnosing, staging, and determining response to therapy in MS patients.

多发性硬化症(MS)是一种进行性神经系统疾病,以炎症和退行性成分为特征,影响遗传易感个体。目前,多发性硬化症的病因尚不清楚,也没有已知的治疗方法。常用的治疗方法倾向于针对MS的炎症方面,但可能无法阻止疾病进展,这可能是由中枢神经系统(CNS)神经轴突结构损伤的缓慢、亚临床积累所控制的。MS领域的一个公认的挑战是需要更好的方法来检测、量化和改善亚临床疾病的影响。简单地说,需要更好的生物标志物。为此,光学相干断层扫描(OCT)为多发性硬化症患者的轴突损伤和神经元丢失提供了高度可靠、可重复的测量方法。oct检测到的视网膜神经纤维层厚度和神经节-细胞层-内丛状层厚度的减少,分别代表轴突损伤和神经元损伤的标志,已被证明与MS患者更差的视觉结果、临床残疾增加和磁共振成像测量的疾病负担相关。最近的报道也表明oct测量的微囊性黄斑水肿和相关的视网膜内核层增厚是中枢神经系统炎症活动活跃的标志。使用视觉系统作为MS的假定临床模型,OCT测量神经轴突结构可以与功能结果相关联,从而帮助我们阐明中枢神经系统损伤和修复的机制。在这篇综述中,我们评估了来自已发表文献和正在进行的临床试验的证据,这些证据支持OCT在MS患者的诊断、分期和确定治疗反应方面的新作用。
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引用次数: 58
Neurotrophic keratitis: current challenges and future prospects. 神经营养性角膜炎:当前的挑战和未来的前景。
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2018-06-28 eCollection Date: 2018-01-01 DOI: 10.2147/EB.S117261
Piera Versura, Giuseppe Giannaccare, Marco Pellegrini, Stefano Sebastiani, Emilio C Campos

Neurotrophic keratitis (NK) is a degenerative corneal disease caused by damage of trigeminal corneal innervation, which leads to spontaneous epithelial breakdown and corneal ulceration. The impairment of corneal sensory innervation causes the reduction of both protective reflexes and trophic neuromodulators that are essential for the vitality, metabolism, and wound healing of ocular surface tissues. A wide range of ocular and systemic conditions, including herpetic keratitis, ocular chemical burns, corneal surgery, diabetes, multiple sclerosis, and neurosurgical procedures, can cause NK by damaging trigeminal innervation. Diagnosis of NK requires careful investigation of any ocular and systemic condition associated with the disease, complete ocular surface examination, and quantitative measurement of corneal sensitivity. The clinical stages of NK range from corneal epithelial alterations (stage 1) to persistent epithelial defect (stage 2) and ulcer (stage 3), which may progress to corneal perforation. Management of NK is based on clinical severity, and the aim of the therapy is to halt the progression of corneal damage and promote epithelial healing. Although several medical and surgical treatments have been proposed, no therapies are currently available to restore corneal sensitivity, and thus, NK remains difficult and challenging to treat. The purpose of this review is to summarize available evidence on the pathogenesis, diagnosis, and treatment of NK. Novel medical and surgical therapies including the topical administration of nerve growth factor and corneal neurotization are also described.

神经营养性角膜炎(NK)是一种由三叉神经角膜神经支配损伤引起的退行性角膜疾病,可导致自发上皮破坏和角膜溃疡。角膜感觉神经支配的损伤导致保护性反射和营养性神经调节剂的减少,而保护性反射和营养性神经调节剂对眼表组织的活力、代谢和伤口愈合至关重要。许多眼部和全身疾病,包括疱疹性角膜炎、眼部化学烧伤、角膜手术、糖尿病、多发性硬化症和神经外科手术,都可以通过破坏三叉神经支配引起NK。NK的诊断需要仔细调查与疾病相关的任何眼部和全身状况,进行完整的眼表检查,并定量测量角膜敏感性。NK的临床分期从角膜上皮改变(第1期)到持续性上皮缺损(第2期)和溃疡(第3期),后者可能发展为角膜穿孔。NK的管理是基于临床严重程度,治疗的目的是阻止角膜损伤的进展,促进上皮愈合。虽然已经提出了几种药物和手术治疗方法,但目前没有治疗方法可以恢复角膜敏感性,因此NK的治疗仍然困难且具有挑战性。本文综述了NK的发病机制、诊断和治疗的相关证据。新的医学和外科疗法,包括局部施用神经生长因子和角膜神经化也被描述。
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引用次数: 107
The development of human visual cortex and clinical implications. 人类视觉皮层的发展及其临床意义。
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2018-04-24 eCollection Date: 2018-01-01 DOI: 10.2147/EB.S130893
Caitlin R Siu, Kathryn M Murphy

The primary visual cortex (V1) is the first cortical area that processes visual information. Normal development of V1 depends on binocular vision during the critical period, and age-related losses of vision are linked with neurobiological changes in V1. Animal studies have provided important details about the neurobiological mechanisms in V1 that support normal vision or are changed by visual diseases. There is very little information, however, about those neurobiological mechanisms in human V1. That lack of information has hampered the translation of biologically inspired treatments from preclinical models to effective clinical treatments. We have studied human V1 to characterize the expression of neurobiological mechanisms that regulate visual perception and neuroplasticity. We have identified five stages of development for human V1 that start in infancy and continue across the life span. Here, we describe these stages, compare them with visual and anatomical milestones, and discuss implications for translating treatments for visual disorders that depend on neuroplasticity of V1 function.

初级视觉皮层(V1)是处理视觉信息的第一个皮层区域。V1 的正常发育取决于关键时期的双眼视觉,与年龄相关的视力丧失与 V1 的神经生物学变化有关。动物研究提供了有关 V1 神经生物学机制的重要细节,这些机制支持正常视觉或因视觉疾病而改变。然而,关于人类 V1 神经生物学机制的信息却很少。这种信息的匮乏阻碍了将生物启发疗法从临床前模型转化为有效的临床疗法。我们对人类 V1 进行了研究,以确定调节视觉感知和神经可塑性的神经生物学机制的表达特征。我们确定了人类 V1 的五个发育阶段,它们从婴儿期开始,贯穿整个生命周期。在此,我们描述了这些阶段,将它们与视觉和解剖学里程碑进行了比较,并讨论了转化治疗依赖于 V1 功能神经可塑性的视觉疾病的意义。
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引用次数: 0
State of the art of robotic surgery related to vision: brain and eye applications of newly available devices. 与视觉相关的机器人手术技术的现状:新设备在大脑和眼睛方面的应用。
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2018-02-01 eCollection Date: 2018-01-01 DOI: 10.2147/EB.S148644
Raffaele Nuzzi, Luca Brusasco

Background: Robot-assisted surgery has revolutionized many surgical subspecialties, mainly where procedures have to be performed in confined, difficult to visualize spaces. Despite advances in general surgery and neurosurgery, in vivo application of robotics to ocular surgery is still in its infancy, owing to the particular complexities of microsurgery. The use of robotic assistance and feedback guidance on surgical maneuvers could improve the technical performance of expert surgeons during the initial phase of the learning curve.

Evidence acquisition: We analyzed the advantages and disadvantages of surgical robots, as well as the present applications and future outlook of robotics in neurosurgery in brain areas related to vision and ophthalmology.

Discussion: Limitations to robotic assistance remain, that need to be overcome before it can be more widely applied in ocular surgery.

Conclusion: There is heightened interest in studies documenting computerized systems that filter out hand tremor and optimize speed of movement, control of force, and direction and range of movement. Further research is still needed to validate robot-assisted procedures.

背景:机器人辅助手术已经彻底改变了许多外科专科,主要是在狭窄的,难以可视化的空间中进行的手术。尽管在普通外科和神经外科方面取得了进展,但由于显微外科的特殊复杂性,机器人在眼科手术中的体内应用仍处于起步阶段。在学习曲线的初始阶段,使用机器人辅助和反馈指导手术操作可以提高专家外科医生的技术表现。证据获取:我们分析了手术机器人的优缺点,以及机器人在视觉和眼科相关脑区神经外科中的应用现状和未来展望。讨论:机器人辅助的局限性仍然存在,需要克服它才能更广泛地应用于眼科手术。结论:人们对计算机系统过滤手部震颤并优化运动速度、力量控制、运动方向和范围的研究越来越感兴趣。还需要进一步的研究来验证机器人辅助手术。
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引用次数: 18
Profile of tocilizumab and its potential in the treatment of giant cell arteritis. 托西珠单抗的简介及其治疗巨细胞动脉炎的潜力。
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2018-01-23 eCollection Date: 2018-01-01 DOI: 10.2147/EB.S127812
Susan Patricia Mollan, John Horsburgh, Bhaskar Dasgupta

Giant cell arteritis (GCA) remains a medical emergency due to the threat of permanent sight loss. High-dose glucocorticoids (GCs) are effective in inducing remission in the majority of patients, however, relapses are common which lengthen GC therapy. GC toxicity remains a major morbidity in this group of patients, and conventional steroid-sparing therapies have not yet shown enough of a clinical benefit to change the standard of care. As the understanding of the underlying immunopathophysiology of GCA has increased, positive clinical observations have been made with the use of IL-6 receptor inhibitor therapies, such as tocilizumab (TCZ). This has led to prospective randomized control trials that have highlighted the safety and efficacy of TCZ in both new-onset and relapsing GCA.

巨细胞动脉炎(GCA)可导致永久性失明,因此仍是一种医学急症。大剂量糖皮质激素(GCs)能有效缓解大多数患者的病情,但复发也很常见,这延长了 GCs 治疗的时间。糖皮质激素的毒性仍然是这类患者的主要发病原因,而传统的类固醇节省疗法尚未显示出足以改变治疗标准的临床疗效。随着对 GCA 潜在免疫病理生理学认识的加深,使用 IL-6 受体抑制剂疗法(如妥西珠单抗 (TCZ))取得了积极的临床观察结果。因此,前瞻性随机对照试验强调了 TCZ 对新发和复发 GCA 的安全性和有效性。
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引用次数: 0
Nonarteritic anterior ischemic optic neuropathy: cause, effect, and management. 非动脉性前缺血性视神经病变:病因、影响和治疗。
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2017-09-27 eCollection Date: 2017-01-01 DOI: 10.2147/EB.S125311
Shauna Berry, Weijie V Lin, Ama Sadaka, Andrew G Lee

Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common form of ischemic optic neuropathy and the second most common optic neuropathy. Patients are generally over the age of 50 years with vasculopathic risk factors (eg, diabetes mellitus, hypertension, and obstructive sleep apnea). The exact mechanism of NAION is not fully understood. In addition, several treatment options have been proposed. This article summarizes the current literature on the diagnosis, treatment, and management of NAION.

非动脉性前部缺血性视神经病变(NAION)是缺血性视神经病变最常见的形式,也是第二常见的视神经病变。患者一般年龄在50岁以上,伴有血管病变危险因素(如糖尿病、高血压和阻塞性睡眠呼吸暂停)。NAION的确切机制尚不完全清楚。此外,还提出了几种治疗方案。本文综述了目前关于非源性脑出血的诊断、治疗和管理方面的文献。
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引用次数: 66
Visual consequences of medications for multiple sclerosis: the good, the bad, the ugly, and the unknown. 多发性硬化症药物治疗的视觉后果:好的、坏的、丑陋的和未知的。
IF 4.4 Q1 OPHTHALMOLOGY Pub Date : 2017-06-29 eCollection Date: 2017-01-01 DOI: 10.2147/EB.S140481
Heather E Moss

Multiple sclerosis (MS) is associated with vision changes both due to MS effects on visual pathways and due to medication effects on the visual pathways. Distinguishing the causes of vision change are critical to appropriate diagnosis and management. The incidence, presentation, and treatment of fingolimod-associated macular edema, alemtuzumab-associated thyroid orbitopathy, and progressive multifocal leukoencephalopathy in MS patients are reviewed. Evidence for beneficial effects of acute, chronic, and symptomatic MS medications on vision is presented.

多发性硬化症(MS)与视觉变化有关,这是由于MS对视觉通路的影响以及药物对视觉通路的影响。辨别视力改变的原因对适当的诊断和治疗至关重要。本文综述了多发性硬化症患者中fingolimod相关黄斑水肿、阿仑单抗相关甲状腺眼窝病和进行性多灶性脑白质病的发病率、表现和治疗。证据表明,急性、慢性和症状性MS药物对视力有有益影响。
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引用次数: 14
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