Pub Date : 2019-10-18eCollection Date: 2019-01-01DOI: 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.
{"title":"Neuro-Ophthalmological Manifestations Of Septo-Optic Dysplasia: Current Perspectives.","authors":"Mario Ganau, Sibel Huet, Nikolaos Syrmos, Marco Meloni, Jayaratnam Jayamohan","doi":"10.2147/EB.S186307","DOIUrl":"https://doi.org/10.2147/EB.S186307","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":51844,"journal":{"name":"Eye and Brain","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2019-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/EB.S186307","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41219865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Evidence to date: ranibizumab and its potential in the treatment of retinopathy of prematurity","authors":"Samir N. Patel, M. Klufas","doi":"10.2147/EB.S189684","DOIUrl":"https://doi.org/10.2147/EB.S189684","url":null,"abstract":"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.","PeriodicalId":51844,"journal":{"name":"Eye and Brain","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2019-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/EB.S189684","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41347288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Neuro-ophthalmological manifestations of tuberous sclerosis: current perspectives","authors":"Michael J. Wan, Kathy Chan, B. Jastrzembski, Asim Ali","doi":"10.2147/EB.S186306","DOIUrl":"https://doi.org/10.2147/EB.S186306","url":null,"abstract":"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.","PeriodicalId":51844,"journal":{"name":"Eye and Brain","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/EB.S186306","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47960420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-17eCollection Date: 2019-01-01DOI: 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.
{"title":"Giant cell arteritis: early diagnosis is key.","authors":"Iyza F Baig, Alexis R Pascoe, Ashwini Kini, Andrew G Lee","doi":"10.2147/EB.S170388","DOIUrl":"10.2147/EB.S170388","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":51844,"journal":{"name":"Eye and Brain","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2019-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/89/12/eb-11-001.PMC6340646.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36956999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-14eCollection Date: 2018-01-01DOI: 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.
{"title":"Investigating possible retinal biomarkers of head trauma in Olympic boxers using optical coherence tomography.","authors":"Charmaine Childs, Lynne A Barker, Alex Md Gage, Mike Loosemore","doi":"10.2147/EB.S183042","DOIUrl":"https://doi.org/10.2147/EB.S183042","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":51844,"journal":{"name":"Eye and Brain","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2018-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/EB.S183042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36806029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-24eCollection Date: 2018-01-01DOI: 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.
{"title":"Optic nerve sheath meningiomas: prevalence, impact, and management strategies.","authors":"Richard T Parker, Christopher A Ovens, Clare L Fraser, Chameen Samarawickrama","doi":"10.2147/EB.S144345","DOIUrl":"https://doi.org/10.2147/EB.S144345","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":51844,"journal":{"name":"Eye and Brain","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2018-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/EB.S144345","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36737240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-13eCollection Date: 2018-01-01DOI: 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.
{"title":"Curvilinear, symmetrical, and profound pigment deposition on the posterior lens capsule in a patient with bilateral pigmentary dispersion syndrome.","authors":"Julia Canestraro, Jerome Sherman","doi":"10.2147/EB.S160999","DOIUrl":"https://doi.org/10.2147/EB.S160999","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Case: </strong>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.</p><p><strong>Discussion: </strong>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.</p>","PeriodicalId":51844,"journal":{"name":"Eye and Brain","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2018-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/EB.S160999","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36525884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-08-27eCollection Date: 2018-01-01DOI: 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.
{"title":"Effects of tDCS-like electrical stimulation on retinal ganglion cells.","authors":"Christianne E Strang, Mary Katherine Ray, Mary M Boggiano, Franklin R Amthor","doi":"10.2147/EB.S163914","DOIUrl":"https://doi.org/10.2147/EB.S163914","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":51844,"journal":{"name":"Eye and Brain","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2018-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/EB.S163914","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36488117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-31eCollection Date: 2018-01-01DOI: 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.
{"title":"Retinal imaging with optical coherence tomography: a biomarker in multiple sclerosis?","authors":"Fiona Costello, Jodie M Burton","doi":"10.2147/EB.S139417","DOIUrl":"https://doi.org/10.2147/EB.S139417","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":51844,"journal":{"name":"Eye and Brain","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2018-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/EB.S139417","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36394920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-28eCollection Date: 2018-01-01DOI: 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.
{"title":"Neurotrophic keratitis: current challenges and future prospects.","authors":"Piera Versura, Giuseppe Giannaccare, Marco Pellegrini, Stefano Sebastiani, Emilio C Campos","doi":"10.2147/EB.S117261","DOIUrl":"https://doi.org/10.2147/EB.S117261","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":51844,"journal":{"name":"Eye and Brain","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2018-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/EB.S117261","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36297229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}