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Kaushik M, Shah VM, Murugesan S, Mani KK, Vardharajan S. Clinical profile and challenges faced in the management of optic neuritis: the Indian scenario. Int Ophthalmol 2024; 44:138. [PMID: 38488890 DOI: 10.1007/s10792-024-03081-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/23/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE Optic neuritis (ON) is a relatively common ophthalmic disease that has recently received renewed attention owing to immunological breakthroughs. We studied the profile of patients with ON with special reference to antibody-mediated ON and the challenges faced in its management. METHODS Case records of patients with ON presenting to a tertiary eye-care center in South India were analyzed. Data on demographics, presenting visual acuity (VA), clinical features, seropositivity for aquaporin-4 immunoglobulin G (AQP4-IgG) and myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG), details of magnetic resonance imaging (MRI) of orbits and brain, and treatment were collected. RESULTS Among 138 cases with acute ON, male: female ratio was 1:2. Isolated ON was present in 41.3% of cases. Antibody testing of sera was performed in 68 patients only due to financial limitations. Among these, 48.5% were MOG-IgG-seropositive, 11.76% were AQP4-IgG-seropositive, and 30.88% samples were double seronegative. Other causes included multiple sclerosis (n = 4), lactational ON (n = 4), tuberculosis (n = 2), invasive perineuritis (n = 2), COVID-19 vaccination (n = 2), and COVID-19 (n = 1). The mean presenting best corrected visual acuity (BCVA) was 1.31 ± 1.16 logMAR (logarithm of the minimum angle of resolution). The mean BCVA at 3 months was 0.167 ± 0.46 logMAR. Only initial VA ≤ 'Counting fingers' (CF) had a significant association with the visual outcome for final VA worse than CF. The steep cost of investigations and treatment posed challenges for many patients in the management of ON. CONCLUSION MOG-IgG-associated ON is common in India. Unfortunately, financial constraints delay the diagnosis and timely management of ON, adversely affecting the outcome.
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Affiliation(s)
- Madhurima Kaushik
- Neuro-Ophthalmology Services, Aravind Eye Hospital, Avinashi Road, Coimbatore, Tamil Nadu, 641014, India
| | - Virna Mahesh Shah
- Neuro-Ophthalmology Services, Aravind Eye Hospital, Avinashi Road, Coimbatore, Tamil Nadu, 641014, India.
| | - Sharmila Murugesan
- Neuro-Ophthalmology Services, Aravind Eye Hospital, Avinashi Road, Coimbatore, Tamil Nadu, 641014, India
| | - Karthik Kumar Mani
- Neuro-Ophthalmology Services, Aravind Eye Hospital, Avinashi Road, Coimbatore, Tamil Nadu, 641014, India
| | - Shriram Vardharajan
- Department of Imaging Sciences and Interventional Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, 641014, India
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Salvetat ML, Pellegrini F, Spadea L, Salati C, Zeppieri M. Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION): A Comprehensive Overview. Vision (Basel) 2023; 7:72. [PMID: 37987292 PMCID: PMC10661278 DOI: 10.3390/vision7040072] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/25/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
Non-arteritic anterior ischemic optic neuropathy (NA-AION) represents one of the most important causes of blindness or severely impaired vision in middle-aged and elderly people. Unilateral optic disc edema and abrupt, painless vision loss are its defining features. It is commonly assumed that NA-AION is caused by an ischemic infarction of the optic nerve head, and, although the exact pathogenesis is still unknown, several risk factors and comorbidities associated with its development have been found. NA-AION occurs generally in patients older than 50 years who have small optic discs and vasculopathy risk factors. Even though numerous treatment options have been proposed, no available effective medical or surgical therapy or prophylactic measure for NA-AION currently exists. The purpose of present-day therapeutic strategies is therefore to identify and possibly control any underlying modifiable risk factors, aiming to prevent the development of new NA-AION episodes in the affected and fellow eye. A thorough assessment of NAION, including its history, epidemiology, etiology, pathophysiology, risk factors, associated comorbidities, clinical findings, diagnostic tests, treatment choices, prognosis, and future research, is the goal of this work.
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Affiliation(s)
- Maria Letizia Salvetat
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy; (M.L.S.)
| | - Francesco Pellegrini
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy; (M.L.S.)
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, 00142 Rome, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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3
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Salvetat ML, Pellegrini F, Spadea L, Salati C, Zeppieri M. Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION): A Comprehensive Overview. Vision (Basel) 2023; 7:72. [DOI: : 10.3390/vision7040072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
Non-arteritic anterior ischemic optic neuropathy (NA-AION) represents one of the most important causes of blindness or severely impaired vision in middle-aged and elderly people. Unilateral optic disc edema and abrupt, painless vision loss are its defining features. It is commonly assumed that NA-AION is caused by an ischemic infarction of the optic nerve head, and, although the exact pathogenesis is still unknown, several risk factors and comorbidities associated with its development have been found. NA-AION occurs generally in patients older than 50 years who have small optic discs and vasculopathy risk factors. Even though numerous treatment options have been proposed, no available effective medical or surgical therapy or prophylactic measure for NA-AION currently exists. The purpose of present-day therapeutic strategies is therefore to identify and possibly control any underlying modifiable risk factors, aiming to prevent the development of new NA-AION episodes in the affected and fellow eye. A thorough assessment of NAION, including its history, epidemiology, etiology, pathophysiology, risk factors, associated comorbidities, clinical findings, diagnostic tests, treatment choices, prognosis, and future research, is the goal of this work.
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Affiliation(s)
- Maria Letizia Salvetat
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy
| | - Francesco Pellegrini
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, 00142 Rome, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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Budihardja BM, Anggraini E, Pratiwi RW, Nastiti AD, Nusanti S. Neuroprotective Strategies for Nonarteritic Anterior Ischemic Optic Neuropathy: A Systematic Review. KOREAN JOURNAL OF OPHTHALMOLOGY 2023; 37:328-339. [PMID: 37563973 PMCID: PMC10427903 DOI: 10.3341/kjo.2022.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/08/2023] [Accepted: 07/22/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE Nonarteritic anterior ischemic optic neuropathy (NAION) is the second most common form of optic neuropathy. Most patients show no improvement over time. Until now, there is still no definitive therapy for NAION. The available literatures on the possible treatment of NAION are quite diverse and controversial. Neuroprotection strategies have been suggested as one of the potential treatments for NAION. This review aims to critically evaluate the literature on neuroprotective strategy for NAION. METHODS This report was written in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We performed a systematic literature search in Pubmed, Science Direct, Proquest, and Cochrane databases. Only neuroprotective agents that directly work in protecting neurons were included. The outcome of interest in this review is retinal ganglion cell density and apoptosis for animal studies and retinal nerve fiber layer thickness for human studies. RESULTS The systematic search identified 591 studies of which 24 met the eligibility criteria, including 21 animal studies and three human studies. Only a few of the studies evaluated the same treatments, showing how diverse neuroprotector treatments are currently being evaluated as NAION treatment. From 21 animal studies, 14 studies showed significantly higher retinal ganglion cell density (1.49- to 2.81-fold) with neuroprotective treatment compared to control group. Two of three human studies in this review had also found a beneficial effect of preserving retinal nerve fiber layer thickness in NAION patients. CONCLUSIONS This review suggests the potential of neuroprotection as a viable option in the quest for an effective treatment strategy for NAION. Further studies, particularly clinical studies, are necessary to establish its efficacy in NAION patients.
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Affiliation(s)
- Brigitta Marcia Budihardja
- Department of Ophthalmology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta,
Indonesia
| | - Erika Anggraini
- Department of Ophthalmology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta,
Indonesia
| | - Rianti Wulandari Pratiwi
- Department of Ophthalmology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta,
Indonesia
| | - Anya Dewi Nastiti
- Department of Ophthalmology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta,
Indonesia
| | - Syntia Nusanti
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta,
Indonesia
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Management of ocular arterial ischemic diseases: a review. Graefes Arch Clin Exp Ophthalmol 2023; 261:1-22. [PMID: 35838806 DOI: 10.1007/s00417-022-05747-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 06/19/2022] [Accepted: 06/28/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To summarize the existing treatment options regarding central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), arteritic anterior ischemic optic neuropathy (AAION), non-arteritic anterior ischemic optic neuropathy (NAION), and ocular ischemic syndrome (OIS), proposing an approach to manage and treat these patients. METHODS A systematic literature search of articles published since 1st January 2010 until 31st December 2020 was conducted using MEDLINE (PubMed), Scopus, and Web of Science. Exclusion criteria included case reports, non-English references, articles not conducted in humans, and articles not including diagnostic or therapeutic options. Further references were gathered through citation tracking, by hand search of the reference lists of included studies, as well as topic-related European society guidelines. RESULTS Acute ocular ischemia, with consequent visual loss, has a variety of causes and clinical presentations, with prognosis depending on an accurate diagnosis and timely therapeutic implementation. Unfortunately, most of the addressed entities do not have a standardized management, especially regarding their treatment, which often lacks good quality evidence on whether it should or not be used to treat patients. CONCLUSION Ophthalmologic signs and symptoms may be a warning sign of cardiovascular or cerebrovascular events, namely stroke. Most causes of acute ocular ischemia do not have a standardized management, especially regarding their treatment. Timely intervention is essential to improve the visual, and possibly vital, prognosis. Awareness must be raised among non-ophthalmologist clinicians that might encounter these patients. Further research should focus on assessing the benefit of the management strategies already being employed .
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Karamali F, Behtaj S, Babaei-Abraki S, Hadady H, Atefi A, Savoj S, Soroushzadeh S, Najafian S, Nasr Esfahani MH, Klassen H. Potential therapeutic strategies for photoreceptor degeneration: the path to restore vision. J Transl Med 2022; 20:572. [PMID: 36476500 PMCID: PMC9727916 DOI: 10.1186/s12967-022-03738-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/29/2022] [Indexed: 12/12/2022] Open
Abstract
Photoreceptors (PRs), as the most abundant and light-sensing cells of the neuroretina, are responsible for converting light into electrical signals that can be interpreted by the brain. PR degeneration, including morphological and functional impairment of these cells, causes significant diminution of the retina's ability to detect light, with consequent loss of vision. Recent findings in ocular regenerative medicine have opened promising avenues to apply neuroprotective therapy, gene therapy, cell replacement therapy, and visual prostheses to the challenge of restoring vision. However, successful visual restoration in the clinical setting requires application of these therapeutic approaches at the appropriate stage of the retinal degeneration. In this review, firstly, we discuss the mechanisms of PR degeneration by focusing on the molecular mechanisms underlying cell death. Subsequently, innovations, recent developments, and promising treatments based on the stage of disorder progression are further explored. Then, the challenges to be addressed before implementation of these therapies in clinical practice are considered. Finally, potential solutions to overcome the current limitations of this growing research area are suggested. Overall, the majority of current treatment modalities are still at an early stage of development and require extensive additional studies, both pre-clinical and clinical, before full restoration of visual function in PR degeneration diseases can be realized.
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Affiliation(s)
- Fereshteh Karamali
- grid.417689.5Department of Animal Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Sanaz Behtaj
- grid.1022.10000 0004 0437 5432Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Queensland, Australia ,grid.1022.10000 0004 0437 5432Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222 Australia
| | - Shahnaz Babaei-Abraki
- grid.417689.5Department of Animal Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Hanieh Hadady
- grid.417689.5Department of Animal Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Atefeh Atefi
- grid.417689.5Department of Animal Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Soraya Savoj
- grid.417689.5Department of Animal Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Sareh Soroushzadeh
- grid.417689.5Department of Animal Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Samaneh Najafian
- grid.417689.5Department of Animal Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Mohammad Hossein Nasr Esfahani
- grid.417689.5Department of Animal Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Henry Klassen
- grid.266093.80000 0001 0668 7243Gavin Herbert Eye Institute, Irvine, CA USA
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Chiquet C, Vignal C, Gohier P, Heron E, Thuret G, Rougier MB, Lehmann A, Flet L, Quesada JL, Roustit M, Milea D, Pepin JL. Treatment of nonarteritic anterior ischemic optic neuropathy with an endothelin antagonist: ENDOTHELION (ENDOTHELin antagonist receptor in Ischemic Optic Neuropathy)—a multicentre randomised controlled trial protocol. Trials 2022; 23:916. [DOI: 10.1186/s13063-022-06786-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Nonarteritic anterior ischemic optic neuropathy (NAAION) is a major cause of blindness in individuals over 50 years of age, with no available effective treatment. The oral dual endothelin receptor antagonist, bosentan, increases retinal optic nerve head blood flow in healthy humans and glaucoma patients. The objective of this trial is to assess the efficacy of bosentan administered at the acute stage in improving outcomes in NAAION patients.
Methods
ENDOTHELION (ENDOTHELin antagonist receptor in Ischemic Optic Neuropathy) is a phase III, interventional, prospective, multicentre, placebo-controlled randomised double-blind clinical trial. The primary outcome is change in the visual field mean deviation (MD) at 3 months (Humphrey 30-2 SITA standard programme). Secondary outcomes include MD and visual acuity changes up to 24 months, changes in peripapillary retinal nerve fibre and macular ganglion cell layer thickness in the affected eye, as measured by optical coherence tomography, rate of NAAION bilateralisation at 2 years, and quality-of-life. Patients over 50 years of age presenting with typical NAAION of recent onset (less than 21 days) are randomly assigned to either 125 mg oral bosentan or placebo, twice a day, during 8 weeks. Besides visits during the treatment phase, patients attend follow-up visits at 2, 3, 6, 12 and 24 months. The inclusion of patients began in August 2015 at five French University hospital ophthalmology departments and two specialised ophthalmology centres. It is planned to include 86 patients in this trial. To date we have included 72 patients and 49 have completed the full follow-up process.
Discussion
An endothelin receptor antagonist is a potential approach to improving the anatomical and functional prognosis of patients with NAAION. This multicentre double-blind randomised controlled trial is an opportunity to assess (1) the effect of bosentan on the structure and function of the optic nerve in NAAION, at 3 months, (2) the effect of bosentan on the bilateralisation rate at 24 months and (3) the tolerance profile of bosentan in this population.
Trial registration
ClinicalTrials.gov NCT02377271. Registered on March 3, 2015.
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Lantos K, Dömötör ZR, Farkas N, Kiss S, Szakács Z, Garami A, Varga G, Lujber L, Kanaan R, Hegyi P, Fehér G, Gaál V. Efficacy of Treatments in Nonarteritic Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2718. [PMID: 35270411 PMCID: PMC8910678 DOI: 10.3390/ijerph19052718] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) is the second most common cause of optic nerve-related permanent visual loss in adults. AIM We aimed to analyze the efficacy of the noninvasive and minimally invasive therapeutic options of NAION. METHODS We performed a systematic literature search in MEDLINE, EMBASE, and CENTRAL from inception to 10 June 2019 to identify the studies that report on the effect of different therapies on visual acuity (VA) and visual field (VF). Weighted mean difference (WMD) with 95% confidence interval (CI) was calculated for these outcomes. The efficacy of steroids was investigated in quantitative, oxygen, steroid plus erythropoietin (EPO), levodopa/carbidopa, memantine, and heparin-induced extracorporeal LDL/fibrinogen precipitation (HELP) therapies and other therapeutic modalities in qualitative synthesis. RESULTS Thirty-two studies were found to be eligible. We found that steroid therapy compared to control did not improve VA (p = 0.182, WMD = 0.14, 95% CI: -0.07, 0.35) or VF (p = 0.853, WMD = 0.16, 95% CI: -1.54, 1.86). Qualitative analysis could be performed for oxygen, steroid plus EPO, and HELP as well, however, none of them showed VA and VF benefit. Two individual studies found memantine and levodopa beneficial regarding VA. CONCLUSION Our systematic review did not reveal any effective treatment. Further investigations are needed to find therapy for NAION.
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Affiliation(s)
- Krisztina Lantos
- Department of Ophthalmology, Medical School, University of Pécs, 7632 Pécs, Hungary;
| | - Zsuzsa Réka Dömötör
- Department of Ophthalmology, Medical School, University of Debrecen, 4032 Debrecen, Hungary;
| | - Nelli Farkas
- Institute of Bioanalysis, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Szabolcs Kiss
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary;
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (Z.S.); (A.G.); (P.H.)
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (Z.S.); (A.G.); (P.H.)
| | - András Garami
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (Z.S.); (A.G.); (P.H.)
| | - Gábor Varga
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University, 1089 Budapest, Hungary;
| | - László Lujber
- Department of Otorhinolaryngology, Medical School, University of Pécs, 7621 Pécs, Hungary;
| | - Reem Kanaan
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (Z.S.); (A.G.); (P.H.)
| | - Gergely Fehér
- Department of Primary Health Care, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Valéria Gaál
- Department of Ophthalmology, Medical School, University of Pécs, 7632 Pécs, Hungary;
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Huang HM, Kuo HK, Chiang WY, Wu PC, Poon LYC. Combination Therapy with Intravitreal Triamcinolone Acetonide and Oral Levodopa for the Treatment of Nonarteritic Anterior Ischemic Optic Neuropathy: A Pilot Study. J Ocul Pharmacol Ther 2022; 38:167-175. [PMID: 35049379 DOI: 10.1089/jop.2021.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Purpose: To determine the clinical effectiveness of combination therapy with intravitreal injection of triamcinolone acetonide (IVITA) and oral levodopa in eyes affected by nonarteritic anterior ischemic optic neuropathy (NAION). Methods: Longitudinal study involving 45 eyes of 45 patients with NAION who were evaluated within 14 days of NAION onset. The treatment group received an IVITA 4 mg/0.1 mL followed by 25 mg carbidopa/100 mg levodopa (Sinemet 25-100) 3 times daily for 12 weeks and the control group was untreated. Best-corrected visual acuity (BCVA) converted to logarithmic minimum angle of resolution (logMAR), visual field (VF) grades based on automated or Goldman perimetry, and mean retinal nerve fiber layer (RNFL) thickness measured on optical coherence tomography were assessed at the initial visit, 1, 3, and 6 months after NAION attack. Results: At the first visit and 6 months after NAION onset, the mean logMAR BCVA in the treatment group was significantly better than the control group (P < 0.05). BCVA was not significantly different between onset and the 6-month visit for both the control and the treatment group; however, the change in BCVA after 6 months was significantly greater in the treatment group compared with the control group (P = 0.007). Concomitant systemic disease, the changes in VF grades, and RNFL thickness from initial to 6 months after NAION onset were not significantly different between 2 groups. Conclusions: Combination therapy with IVITA and oral levodopa/carbidopa appears to be effective in the treatment of recent-onset NAION.
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Affiliation(s)
- Hsiu-Mei Huang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan (R.O.C.)
| | - Hsi-Kung Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan (R.O.C.)
| | - Wei-Yu Chiang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan (R.O.C.)
| | - Pei-Chang Wu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan (R.O.C.)
| | - Linda Yi-Chieh Poon
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan (R.O.C.)
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10
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Pavlenko TA, Chesnokova NB, Nodel MR, Kim AR, Ugrumov MV. Molecular Mechanisms and Clinical Manifestations of Catecholamine Dysfunction in the Eye in Parkinson's Disease As a Basis for Developing Early Diagnosis. Acta Naturae 2020; 12:52-62. [PMID: 32742727 PMCID: PMC7385097 DOI: 10.32607/actanaturae.10906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/16/2020] [Indexed: 01/08/2023] Open
Abstract
This review provides information on the non-motor peripheral manifestations of Parkinson's disease (PD) associated with a pathology of the visual analyzer and the auxiliary apparatus of the eye. The relationship between neurodegenerative processes that take place in the brain and in the eye opens new prospects to use preventive ophthalmologic examination to diagnose PD long before the characteristic motor symptoms appear. This will encourage the use of neuroprotective therapy, which stops, or at least slows down, neuronal death, instead of the current replacement therapy with dopamine agonists. An important result of an eye examination of patients with PD may be a non-invasive identification of new peripheral biomarkers manifesting themselves as changes in the composition of the lacrimal fluid.
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Affiliation(s)
- T. A. Pavlenko
- Helmholtz Moscow Research Institute of Eye Diseases of Ministry of Health of the Russian Federation, Moscow, 105062 Russia
| | - N. B. Chesnokova
- Helmholtz Moscow Research Institute of Eye Diseases of Ministry of Health of the Russian Federation, Moscow, 105062 Russia
| | - M. R. Nodel
- Sechenov First Moscow State Medical University, Moscow, 119991 Russia
- Pirogov Russian National Research Medical University, Russian Clinical and Research Center of Gerontology, Moscow, 129226 Russia
| | - A. R. Kim
- Koltzov Institute of Developmental Biology of Russian Academy of Sciences, Moscow, 119334 Russia
| | - M. V. Ugrumov
- Koltzov Institute of Developmental Biology of Russian Academy of Sciences, Moscow, 119334 Russia
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11
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[Acute ischemic optic nerve disease: Pathophysiology, clinical features and management (French translation of the article)]. J Fr Ophtalmol 2020; 43:256-270. [PMID: 32057527 DOI: 10.1016/j.jfo.2019.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/28/2019] [Indexed: 11/23/2022]
Abstract
Ischemic optic neuropathies are among the leading causes of severe visual acuity loss in people over 50 years of age. They constitute a set of various entities that are clinically, etiologically and therapeutically different. Anatomically, it is necessary to distinguish anterior and posterior forms. From an etiological point of view, the diagnosis of the arteritic form due to giant cell arteritis requires emergent management to prevent blindness and even death in the absence of prompt corticosteroid treatment. When this diagnosis has been ruled out with certainty, non-arteritic ischemic optic neuropathies represent a vast etiological context that in the majority of cases involves a local predisposing factor (small optic nerves, disc drusen) with a precipitating factor (severe hypotension, general anesthesia or dialysis) in a context of vascular disease (sleep apnea syndrome, hypertension, diabetes, etc.). In the absence of specific available treatment, it is the responsibility of the clinician to identify the risk factors involved, in order to reduce the risk of contralateral recurrence that may occur even several years later. Due to their complexity, these pathologies are the subject of debates regarding both the pathophysiological and therapeutic perspectives; this review aims to provide a synthesis of validated knowledge while discussing controversial data.
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12
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Augstburger E, Héron E, Abanou A, Habas C, Baudouin C, Labbé A. Acute ischemic optic nerve disease: Pathophysiology, clinical features and management. J Fr Ophtalmol 2020; 43:e41-e54. [PMID: 31952875 DOI: 10.1016/j.jfo.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/18/2019] [Indexed: 11/28/2022]
Abstract
Ischemic optic neuropathies are among the leading causes of severe visual acuity loss in people over 50 years of age. They constitute a set of various entities that are clinically, etiologically and therapeutically different. Anatomically, it is necessary to distinguish anterior and posterior forms. From an etiological point of view, the diagnosis of the arteritic form due to giant cell arteritis requires emergent management to prevent blindness and even death in the absence of prompt corticosteroid treatment. When this diagnosis has been ruled out with certainty, non-arteritic ischemic optic neuropathies represent a vast etiological context that in the majority of cases involves a local predisposing factor (small optic nerves, disc drusen) with a precipitating factor (severe hypotension, general anesthesia or dialysis) in a context of vascular disease (sleep apnea syndrome, hypertension, diabetes, etc.). In the absence of specific available treatment, it is the responsibility of the clinician to identify the risk factors involved, in order to reduce the risk of contralateral recurrence that may occur even several years later. Due to their complexity, these pathologies are the subject of debates regarding both the pathophysiological and therapeutic perspectives; this review aims to provide a synthesis of validated knowledge while discussing controversial data.
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Affiliation(s)
- E Augstburger
- Ophthalmology Service III, CHNO des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France
| | - E Héron
- Internal medicine service, CHNO des Quinze-Vingts, Paris, France
| | - A Abanou
- Neuroradiology center, CHNO des Quinze-Vingts, Paris, France
| | - C Habas
- Neuroradiology center, CHNO des Quinze-Vingts, Paris, France; Inserm, U968; Inserm-DHOS CIC 503, UPMC Univ Paris 06, UMR_S968, CNRS, UMR 7210, institut de la Vision, CHNO des Quinze-Vingts, Paris, France
| | - C Baudouin
- Ophthalmology Service III, CHNO des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France; Inserm-DHOS CIC 1423, CHNO des Quinze-Vingts, IHU FOReSIGHT, Paris, France; Inserm, U968; Inserm-DHOS CIC 503, UPMC Univ Paris 06, UMR_S968, CNRS, UMR 7210, institut de la Vision, CHNO des Quinze-Vingts, Paris, France; Ophthalmology service, université de Versailles Saint-Quentin-en-Yvelines, hôpital Ambroise-Paré, AP-HP, Versailles, France
| | - A Labbé
- Ophthalmology Service III, CHNO des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France; Inserm-DHOS CIC 1423, CHNO des Quinze-Vingts, IHU FOReSIGHT, Paris, France; Inserm, U968; Inserm-DHOS CIC 503, UPMC Univ Paris 06, UMR_S968, CNRS, UMR 7210, institut de la Vision, CHNO des Quinze-Vingts, Paris, France; Ophthalmology service, université de Versailles Saint-Quentin-en-Yvelines, hôpital Ambroise-Paré, AP-HP, Versailles, France.
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Systematic Evaluation of Levodopa Effect on Visual Improvement in Amblyopia: A Meta-analysis. Clin Neuropharmacol 2019; 43:20-25. [PMID: 31738189 DOI: 10.1097/wnf.0000000000000372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE This study aims to evaluate the effectiveness of levodopa as a therapeutic drug in the treatment of children and adults with amblyopia. METHODS We performed a systematic review and meta-analysis with randomized controlled trials of levodopa and placebo in the treatment of amblyopia. All data were identified and extracted from the PubMed, EMBASE, Cochrane libraries, and the Chinese knowledge resource integration database. RESULTS After screening the literature and evaluating the quality, 11 studies met the criteria from 308 studies. The mean difference of LogMAR visual acuity between levodopa and the placebo group was -0.1031 (95% confidence interval, -0.11 to -0.09; P < 0.0001). The improvement of visual acuities of the subgroup of younger patients with amblyopia was significantly higher than that of the placebo group (P < 0.0001). Increasing the dosage of levodopa and prolonging the treatment can significantly improve the curative effect. CONCLUSIONS Levodopa is effective in the treatment of amblyopia by prolonging the treatment, especially for young patients.
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Abstract
PURPOSE OF REVIEW Vision is often threatened or lost by acute ischemic damage to the optic nerves. Such pathology most often affects the anterior portion of the nerve and is visible on funduscopic examination. Ischemic optic neuropathy is associated with typical vascular risk factors and with one systemic disease in particular: giant cell arteritis (GCA). This article provides an overview of the three major classes of ischemic optic neuropathy, including information on risk factors, differential diagnosis, evaluation, and management. RECENT FINDINGS Optical coherence tomography provides precise anatomic imaging in ischemic optic neuropathy, showing neural loss weeks before it is visible on examination. Refinements of optical coherence tomography reveal optic nerve microvasculature and may assist in understanding pathogenesis and verifying diagnosis. New diagnostic algorithms and cranial vascular imaging techniques help define the likelihood of GCA in patients with ischemic optic neuropathy. Finally, intraocular drug and biological agent delivery holds promise for nonarteritic ischemic optic neuropathy, whereas newer immunologic agents may provide effective steroid-sparing treatment for GCA. SUMMARY It is essential to recognize ischemic optic neuropathy upon presentation, especially to determine the likelihood of GCA and the need for immediate steroid therapy. A broad differential diagnosis should be considered so as not to miss alternative treatable pathology, especially in cases with retrobulbar optic nerve involvement.
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Treatment of Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION). Neuroophthalmology 2019. [DOI: 10.1007/978-3-319-98455-1_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Pardue MT, Allen RS. Neuroprotective strategies for retinal disease. Prog Retin Eye Res 2018; 65:50-76. [PMID: 29481975 PMCID: PMC6081194 DOI: 10.1016/j.preteyeres.2018.02.002] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/14/2018] [Accepted: 02/20/2018] [Indexed: 12/20/2022]
Abstract
Diseases that affect the eye, including photoreceptor degeneration, diabetic retinopathy, and glaucoma, affect 11.8 million people in the US, resulting in vision loss and blindness. Loss of sight affects patient quality of life and puts an economic burden both on individuals and the greater healthcare system. Despite the urgent need for treatments, few effective options currently exist in the clinic. Here, we review research on promising neuroprotective strategies that promote neuronal survival with the potential to protect against vision loss and retinal cell death. Due to the large number of neuroprotective strategies, we restricted our review to approaches that we had direct experience with in the laboratory. We focus on drugs that target survival pathways, including bile acids like UDCA and TUDCA, steroid hormones like progesterone, therapies that target retinal dopamine, and neurotrophic factors. In addition, we review rehabilitative methods that increase endogenous repair mechanisms, including exercise and electrical stimulation therapies. For each approach, we provide background on the neuroprotective strategy, including history of use in other diseases; describe potential mechanisms of action; review the body of research performed in the retina thus far, both in animals and in humans; and discuss considerations when translating each treatment to the clinic and to the retina, including which therapies show the most promise for each retinal disease. Despite the high incidence of retinal diseases and the complexity of mechanisms involved, several promising neuroprotective treatments provide hope to prevent blindness. We discuss attractive candidates here with the goal of furthering retinal research in critical areas to rapidly translate neuroprotective strategies into the clinic.
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Affiliation(s)
- Machelle T Pardue
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA; Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive, Atlanta, GA, 30332, USA.
| | - Rachael S Allen
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA
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Retinal vessel diameter obtained by optical coherence tomography is spared in Parkinson’s disease. Int Ophthalmol 2018; 39:813-819. [DOI: 10.1007/s10792-018-0873-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 02/21/2018] [Indexed: 11/25/2022]
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Johnson MA, Miller NR, Nolan T, Bernstein SL. Peripapillary Retinal Nerve Fiber Layer Swelling Predicts Peripapillary Atrophy in a Primate Model of Nonarteritic Anterior Ischemic Optic Neuropathy. Invest Ophthalmol Vis Sci 2016; 57:527-32. [PMID: 26868755 PMCID: PMC4758301 DOI: 10.1167/iovs.15-17880] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose To determine the relationship between peripapillary retinal nerve fiber layer (PRNFL) swelling and eventual PRNFL atrophy, and between PRNFL swelling/atrophy and neural function, in a nonhuman primate model of nonarteritic anterior ischemic optic neuropathy (pNAION). Methods pNAION was induced in five normal, adult male rhesus monkeys by laser activation of intravenously injected rose bengal at the optic nerve head. Spectral-domain optical coherence tomography measurements of the PRNFL were performed at baseline; 1 day; 1, 2, and 4 weeks; and several later times over a period of an additional 2 to 3 months. Simultaneous pattern-reversal electroretinograms (PERGs) and visual evoked potentials (VEPs) were recorded and color fundus photographs taken at the same time points. Results In all cases, initial PRNFL swelling was associated with atrophy, and the greater the initial swelling, the greater the degree of eventual atrophy (r = 0.65, P = 0.0002). The change in PRNFL thickness closely correlated with VEP amplitude loss (r = 0.90), although this relationship was only a strong trend (P = 0.083). Furthermore, VEP amplitude loss closely correlated with PERG N95 amplitude loss (r = 0.80, P = 0.00002) Conclusions In our model of human NAION, the degree of initial PRNFL swelling correlated with the severity of atrophy. Areas that did not swell developed little to no atrophy. The amount of PRNFL loss was reflected in VEP and PERG N95 amplitude reductions.
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Affiliation(s)
- Mary A Johnson
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Neil R Miller
- The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Theresa Nolan
- Department of Veterinary Resources, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Steven L Bernstein
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States 4Department of Anatomy & Neurobiology, University of Maryland School of Medicine, Baltimore, Maryland, United States
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