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Neuro-Ophthalmological Manifestations Of Septo-Optic Dysplasia: Current Perspectives. 视间隔发育不良的神经眼科表现:目前的展望。
IF 4.4 Q1 Medicine Pub Date : 2019-10-18 eCollection Date: 2019-01-01 DOI: 10.2147/EB.S186307
Mario Ganau, Sibel Huet, Nikolaos Syrmos, Marco Meloni, Jayaratnam Jayamohan

Septo-optic dysplasia (SOD), also known as de Morsier syndrome, is a rare congenital disorder belonging to the group of mid-line brain malformations. Despite the highly variable phenotypic penetration, its classical triad include a) optic nerve hypoplasia (ONH), b) agenesis of septum pellucidum and corpus callosum, and c) hypoplasia of the hypothalamo-pituitary axis. SOD has stringent diagnostic criteria requiring 2 or more features of the classic triad, therefore it represents a separate entity from other conditions such as ONH and achiasmia syndromes which share only some of these aspects, or SOD plus syndrome which is characterized by additional cortical abnormalities. Starting from its etiology and epidemiology, this narrative review focuses on the management of SOD patients, including their diagnosis, treatment and follow-up. To date, SOD is not curable; nonetheless, many of its symptoms can be improved through a tailored approach, consisting of hormonal replacement, corrective ophthalmological surgery and neuropsychological support.

视隔发育不良(SOD),也称为德莫尔综合征,是一种罕见的先天性疾病,属于脑中线畸形组。尽管表型穿透高度可变,但其经典三联征包括a)视神经发育不全(ONH),b)透明隔和胼胝体发育不全,以及c)下丘脑-垂体轴发育不全。SOD具有严格的诊断标准,需要经典三联征的两个或多个特征,因此它代表了一个独立于其他疾病的实体,如仅具有这些方面的ONH和无意识综合征,或以额外皮质异常为特征的SOD+综合征。从其病因和流行病学出发,本叙述性综述侧重于SOD患者的管理,包括他们的诊断、治疗和随访。迄今为止,SOD是无法治愈的;尽管如此,它的许多症状可以通过量身定制的方法得到改善,包括激素替代、眼科矫正手术和神经心理支持。
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引用次数: 24
Evidence to date: ranibizumab and its potential in the treatment of retinopathy of prematurity 迄今为止的证据:雷珠单抗及其在治疗早产儿视网膜病变中的潜力
IF 4.4 Q1 Medicine Pub Date : 2019-08-23 DOI: 10.2147/EB.S189684
Samir N. Patel, M. Klufas
Abstract Retinopathy of prematurity (ROP) is a leading and preventable cause of childhood blindness worldwide. Although laser photocoagulation remains the gold standard for treatment, the off-label use of anti-vascular endothelial growth factor (anti-VEGF) therapy to treat ROP, particularly posterior zone I disease, is increasing. Although initial studies on anti-VEGF therapy for ROP have focused on bevacizumab, recent studies have proposed that ranibizumab may be a safer and more effective alternative for use in this population. This review updates recent evidence regarding the use of ranibizumab in the management of ROP.
摘要早产儿视网膜病变(ROP)是世界范围内儿童失明的主要且可预防的原因。尽管激光光凝仍然是治疗的金标准,但抗血管内皮生长因子(anti-VEGF)治疗ROP,特别是后I区疾病的标签外使用正在增加。尽管最初对ROP抗VEGF治疗的研究集中在贝伐单抗上,但最近的研究表明,在这一人群中使用雷珠单抗可能是一种更安全、更有效的替代方案。这篇综述更新了关于使用雷尼珠单抗治疗ROP的最新证据。
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引用次数: 12
Neuro-ophthalmological manifestations of tuberous sclerosis: current perspectives 结节性硬化症的神经-眼科表现:目前的观点
IF 4.4 Q1 Medicine Pub Date : 2019-06-01 DOI: 10.2147/EB.S186306
Michael J. Wan, Kathy Chan, B. Jastrzembski, Asim Ali
Abstract Tuberous sclerosis complex (TSC) is a complex, multi-system disorder with a well-described underlying genetic etiology. While retinal findings are common in TSC and important in establishing the diagnosis, TSC also has many potential neuro-ophthalmology manifestations. The neuro-ophthalmology manifestations of TSC can have a significant impact on visual function and are sometimes a sign of serious neurological disease. The purpose of this review is to describe the neuro-ophthalmological manifestations of TSC. These manifestations include optic nerve hamartomas, elevated intracranial pressure, cranial nerve palsies, cortical visual impairment, visual field deficits, and ocular toxicity from vigabatrin treatment of infantile spasms. It is important to be aware of potential neuro-ophthalmological manifestations in these patients in order to detect signs of vision- or life-threatening disease and to optimize visual function and quality-of-life.
摘要结节性硬化综合征(TSC)是一种复杂的多系统疾病,其潜在的遗传病因已被充分描述。虽然视网膜检查结果在TSC中很常见,对确定诊断很重要,但TSC也有许多潜在的神经眼科表现。TSC的神经眼科表现会对视觉功能产生重大影响,有时是严重神经疾病的征兆。这篇综述的目的是描述TSC的神经眼科表现。这些表现包括视神经错构瘤、颅内压升高、脑神经麻痹、皮质视觉损伤、视野缺陷以及维巴替林治疗婴儿痉挛的眼部毒性。重要的是要意识到这些患者潜在的神经眼科表现,以检测视力或危及生命的疾病迹象,并优化视觉功能和生活质量。
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引用次数: 10
Giant cell arteritis: early diagnosis is key. 巨细胞动脉炎:早期诊断是关键。
IF 4.4 Q1 Medicine Pub Date : 2019-01-17 eCollection Date: 2019-01-01 DOI: 10.2147/EB.S170388
Iyza F Baig, Alexis R Pascoe, Ashwini Kini, Andrew G Lee

Giant cell arteritis (GCA) is an inflammatory vasculitis typically affecting elderly that can potentially cause vision loss. Studies have demonstrated that early recognition and initiation of treatment can improve visual prognosis in patients with GCA. This review addresses the benefits of early diagnosis and treatment, and discusses the available treatment options to manage the disease.

巨细胞动脉炎(GCA)是一种炎症性血管炎,通常会影响老年人,并可能导致视力丧失。研究表明,早期识别和开始治疗可改善 GCA 患者的视力预后。本综述阐述了早期诊断和治疗的益处,并讨论了控制该疾病的现有治疗方案。
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引用次数: 0
Investigating possible retinal biomarkers of head trauma in Olympic boxers using optical coherence tomography. 利用光学相干断层扫描研究奥林匹克拳击手头部创伤可能的视网膜生物标志物。
IF 4.4 Q1 Medicine Pub Date : 2018-12-14 eCollection Date: 2018-01-01 DOI: 10.2147/EB.S183042
Charmaine Childs, Lynne A Barker, Alex Md Gage, Mike Loosemore

Purpose: Changes to retina have been reported after a number of neurodegenerative conditions. The purpose of this study was to investigate retinal structures in Olympic boxers exposed to frequent head blows.

Methods: Retinal imaging offers potential as a non-invasive biomarker of neuropathology. Macula and retinal nerve fiber layer (RNFL) thickness was measured using optical coherence tomography (OCT) in UK Olympic boxers attending two mandatory eye screening programs, 18 months apart. Data from the two eye screenings provide longitudinal data of retinal change over time. Sedentary healthy subjects (controls) without past or present history of concussion were also screened at the time of the second boxer screening to provide comparison of cross-sectional data.

Results: Sixteen Olympic boxers aged 20-33 years and 20 sedentary healthy controls, aged 24-45 years, were recruited. Significant macula thickening was observed over time (18 months) in 75% of right and 50% of left eye sectors. For RNFL, left eye quadrants thickened. For right eye RNFL quadrants, thickening and thinning of this layer were observed. Cross-sectional results showed thinner macula sectors and RNFL quadrants in Olympic boxers compared to controls.

Conclusion: Significant change to macula and RNFL densities, occurring over an 18 month interval is an unexpected finding in otherwise heathy elite sportsmen. In addition, macula and RNFL were thinner than healthy sedentary controls. OCT may prove clinically useful as a candidate retinal biomarker of neuropathological change after mild traumatic brain injury and/or repeat head blows.

目的:视网膜的改变在许多神经退行性疾病后已被报道。这项研究的目的是调查经常受到头部打击的奥运拳击手的视网膜结构。方法:视网膜成像为神经病理学的非侵入性生物标志物提供了潜力。使用光学相干断层扫描(OCT)测量了参加两次强制性眼科筛查项目的英国奥运拳击手的黄斑和视网膜神经纤维层(RNFL)厚度,间隔18个月。两次眼睛筛查的数据提供了视网膜随时间变化的纵向数据。在第二次拳击手筛查时,也对没有过去或现在脑震荡史的久坐健康受试者(对照组)进行筛查,以提供横截面数据的比较。结果:招募了16名年龄在20-33岁的奥运会拳击手和20名年龄在24-45岁的久坐健康对照者。随着时间的推移(18个月),75%的右眼和50%的左眼可见明显的黄斑增厚。对于RNFL,左眼象限变厚。右眼RNFL象限观察到该层增厚和变薄。横断面结果显示,与对照组相比,奥运会拳击手的黄斑区和RNFL象限更薄。结论:在健康的优秀运动员中,黄斑和RNFL密度在18个月的间隔内发生显著变化是出乎意料的。此外,黄斑和RNFL比健康久坐的对照组更薄。OCT作为轻度创伤性脑损伤和/或重复头部撞击后神经病理变化的候选视网膜生物标志物在临床上可能是有用的。
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引用次数: 13
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 Medicine 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 Medicine 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 Medicine 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 Medicine 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 Medicine 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
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