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Yang HC, Lavadi RS, Sauerbeck AD, Wallendorf M, Kummer TT, Song SK, Lin TH. Diffusion basis spectrum imaging detects subclinical traumatic optic neuropathy in a closed-head impact mouse model of traumatic brain injury. Front Neurol 2023; 14:1269817. [PMID: 38152638 PMCID: PMC10752006 DOI: 10.3389/fneur.2023.1269817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/12/2023] [Indexed: 12/29/2023] Open
Abstract
Introduction Traumatic optic neuropathy (TON) is the optic nerve injury secondary to brain trauma leading to visual impairment and vision loss. Current clinical visual function assessments often fail to detect TON due to slow disease progression and clinically silent lesions resulting in potentially delayed or missed treatment in patients with traumatic brain injury (TBI). Methods Diffusion basis spectrum imaging (DBSI) is a novel imaging modality that can potentially fill this diagnostic gap. Twenty-two, 16-week-old, male mice were equally divided into a sham or TBI (induced by moderate Closed-Head Impact Model of Engineered Rotational Acceleration device) group. Briefly, mice were anesthetized with isoflurane (5% for 2.5 min followed by 2.5% maintenance during injury induction), had a helmet placed over the head, and were placed in a holder prior to a 2.1-joule impact. Serial visual acuity (VA) assessments, using the Virtual Optometry System, and DBSI scans were performed in both groups of mice. Immunohistochemistry (IHC) and histological analysis of optic nerves was also performed after in vivo MRI. Results VA of the TBI mice showed unilateral or bilateral impairment. DBSI of the optic nerves exhibited bilateral involvement. IHC results of the optic nerves revealed axonal loss, myelin injury, axonal injury, and increased cellularity in the optic nerves of the TBI mice. Increased DBSI axon volume, decreased DBSI λ||, and elevated DBSI restricted fraction correlated with decreased SMI-312, decreased SMI-31, and increased DAPI density, respectively, suggesting that DBSI can detect coexisting pathologies in the optic nerves of TBI mice. Conclusion DBSI provides an imaging modality capable of detecting subclinical changes of indirect TON in TBI mice.
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Affiliation(s)
- Hsin-Chieh Yang
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Raj Swaroop Lavadi
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Andrew D. Sauerbeck
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, United States
| | - Michael Wallendorf
- Department of Biostatistics, Washington University School of Medicine, St. Louis, MO, United States
| | - Terrance T. Kummer
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, United States
- VA Medical Center, St. Louis, MO, United States
| | - Sheng-Kwei Song
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, United States
| | - Tsen-Hsuan Lin
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States
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Pandey S, Reddy GS, Chug A, Dixit A, Raja BS. Comparison of Surgical Decompression and Steroid Therapy for the Management of Traumatic Optic Neuropathy: A Systematic Review and Meta-Analysis. Craniomaxillofac Trauma Reconstr 2023; 16:306-316. [PMID: 38047144 PMCID: PMC10693263 DOI: 10.1177/19433875221142682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Study Design A systematic review and meta-analysis. Objective Treatment of traumatic optic neuropathy (TON) has been a subject of debate for many decades due to the scarcity of evidence-based treatment protocols. This review compares surgical decompression (SD) and steroid therapy (ST) as treatment approaches in TON patients. Methods A PRISMA-guided systematic review using PubMed, Embase, Ovid and Scopus databases was performed till the last search date of July 31st 2021. The outcome of interest was an improvement in visual acuity. A meta-analysis of the odds ratio was performed using a random-effect model and sub-group analysis based upon criteria for assessment of improvement in visual acuity. Results Sixteen studies (including 1046 patients) were included in the review. The review could identify 590 patients treated with SD and 456 treated with ST. In addition, there was a second cohort of patients presenting with NLP (no light perception). A meta-analysis with a sub-group analysis revealed that there was statistically no significant difference between the two treatment approaches in terms of improvement in VA. Conclusions There is no difference in treatment results of SD or ST for TON. Several treatment protocols and different criteria for assessing visual acuity led to difficulty in generating evidence for selecting the correct treatment approach.
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Affiliation(s)
- Sameer Pandey
- Discipline of Craniomaxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Gosla S. Reddy
- GSR Institute of Craniofacial Surgery Saidabad, Hyderabad, India
| | - Ashi Chug
- Discipline of Craniomaxillofacial Surgery, Faculty of Dentistry and Craniomaxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Ashutosh Dixit
- Faculty of Dentistry and Craniomaxillofacial Surgery, All India Institute of Medical Science, Rishikesh, India
| | - Balgovind S. Raja
- Faculty of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Sujithra H, Shah K, Greeshma C. Clinical profile and visual outcome in patients with traumatic optic neuropathy. Indian J Ophthalmol 2023; 71:3046-3052. [PMID: 37530279 PMCID: PMC10538853 DOI: 10.4103/ijo.ijo_3318_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Purpose To analyze the visual outcome in patients with traumatic optic neuropathy (TON) with respect to different treatment modalities, to study the correlation of initial visual loss with the final visual outcome, and to find out the predictor of final visual outcome in patients with indirect TON. Methods A retrospective analysis of 36 eyes with TON was done. Data on clinical profile, including demographics, mode of trauma, best corrected visual acuity (BCVA), pupillary reflex examination, and anterior and posterior segment examination, was collected. Presence and location of orbital and cranial fractures were identified from computed tomography scan. Visual outcomes following steroid therapy, optic nerve (ON) decompression, and in untreated patients were analyzed. Pre- and post-treatment BCVA were divided into three groups based on logarithm of the minimum angle of resolution (logMAR) as follows: group A: 3, group B: 2.9-1.3, and group C<1.3. BCVA values at follow-up visits were taken as the primary outcome measure. Association between various risk factors and final visual outcome in patients with indirect TON was also analyzed. Results Out of 34 patients whose 36 eyes were studied, three (8.8%) patients were females and 31 (91.2%) patients were males. Most common mode of trauma was road traffic accident (RTA; 91.2%), which was followed by fall (8.8%) and assault (2.9%). Pre- and post-treatment BCVA values of 36 eyes were compared, and improvement in BCVA after treatment was found to be statistically significant. Also, 28.6% of patients with presenting BCVA of no light perception showed improvement compared to 94.1% and 100% in groups B and C, respectively. Orbital wall fractures were seen in 80.5% (n = 29) of the patients, with lateral wall fracture being the most common (58.3%) followed by medial wall (33.3%), roof (27.7%), floor (27.7%), and optic strut (5%). Conclusion Baseline BCVA had significant association with final vision improvement. Lateral wall fracture was the most common fracture associated with indirect TON. Patients treated with high-dose corticosteroids, irrespective of the time of presentation, had a better visual outcome.
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Affiliation(s)
- H Sujithra
- Department of Ophthalmology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Kannisha Shah
- Department of Ophthalmology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - C Greeshma
- Department of Biostatistics,, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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McCartan R, Gratkowski A, Browning M, Hahn-Townsend C, Ferguson S, Morin A, Bachmeier C, Pearson A, Brown L, Mullan M, Crawford F, Tzekov R, Mouzon B. Human amnionic progenitor cell secretome mitigates the consequence of traumatic optic neuropathy in a mouse model. Mol Ther Methods Clin Dev 2023; 29:303-318. [PMID: 37359418 PMCID: PMC10285248 DOI: 10.1016/j.omtm.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/12/2023] [Indexed: 06/28/2023]
Abstract
Traumatic optic neuropathy (TON) is a condition in which acute injury to the optic nerve from direct or indirect trauma results in vision loss. The most common cause of TON is indirect injury to the optic nerve caused by concussive forces that are transmitted to the optic nerve. TON occurs in up to 5% of closed-head trauma patients and there is currently no known effective treatment. One potential treatment option for TON is ST266, a cell-free biological solution containing the secretome of amnion-derived multipotent progenitor (AMP) cells. We investigated the efficacy of intranasal ST266 in a mouse model of TON induced by blunt head trauma. Injured mice treated with a 10-day regimen of ST266 showed an improvement in spatial memory and learning, a significant preservation of retinal ganglion cells, and a decrease in neuropathological markers in the optic nerve, optic tract, and dorsal lateral geniculate nucleus. ST266 treatment effectively downregulated the NLRP3 inflammasome-mediated neuroinflammation pathway after blunt trauma. Overall, treatment with ST266 was shown to improve functional and pathological outcomes in a mouse model of TON, warranting future exploration of ST266 as a cell-free therapeutic candidate for testing in all optic neuropathies.
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Affiliation(s)
- Robyn McCartan
- Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | | | | | | | - Scott Ferguson
- Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA
| | - Alexander Morin
- Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA
| | - Corbin Bachmeier
- Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA
- Bay Pines Veterans’ Hospital, Saint Petersburg, FL 33708, USA
| | - Andrew Pearson
- Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA
| | - Larry Brown
- Noveome Biotherapeutics, Inc., Pittsburgh, PA 15219, USA
| | - Michael Mullan
- Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA
| | - Fiona Crawford
- Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA
- James A. Haley Veterans’ Hospital, Tampa, FL 33612, USA
| | | | - Benoit Mouzon
- Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA
- James A. Haley Veterans’ Hospital, Tampa, FL 33612, USA
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Torrens JN, Hetzer SM, Evanson NK. Brief Oxygen Exposure after Traumatic Brain Injury Hastens Recovery and Promotes Adaptive Chronic Endoplasmic Reticulum Stress Responses. Int J Mol Sci 2023; 24:9831. [PMID: 37372978 DOI: 10.3390/ijms24129831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Traumatic brain injury (TBI) is a major public health concern, particularly in adolescents who have a higher mortality and incidence of visual pathway injury compared to adult patients. Likewise, we have found disparities between adult and adolescent TBI outcomes in rodents. Most interestingly, adolescents suffer a prolonged apneic period immediately post-injury, leading to higher mortality; therefore, we implemented a brief oxygen exposure paradigm to circumvent this increased mortality. Adolescent male mice experienced a closed-head weight-drop TBI and were then exposed to 100% O2 until normal breathing returned or recovered in room air. We followed mice for 7 and 30 days and assessed their optokinetic response; retinal ganglion cell loss; axonal degeneration; glial reactivity; and retinal ER stress protein levels. O2 reduced adolescent mortality by 40%, improved post-injury visual acuity, and reduced axonal degeneration and gliosis in optical projection regions. ER stress protein expression was altered in injured mice, and mice given O2 utilized different ER stress pathways in a time-dependent manner. Finally, O2 exposure may be mediating these ER stress responses through regulation of the redox-sensitive ER folding protein ERO1α, which has been linked to a reduction in the toxic effects of free radicals in other animal models of ER stress.
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Affiliation(s)
- Jordyn N Torrens
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Shelby M Hetzer
- Neuroscience Graduate Program, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Nathan K Evanson
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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Tu X, Xiong C, Qi H, Ou Y, Rao J, Sun Y, Fan Y, Liu G. Diagnosis and treatment of transnasal endoscopic optic canal decompression for traumatic optic neuropathy. Front Neurosci 2023; 17:1168962. [PMID: 37260841 PMCID: PMC10228362 DOI: 10.3389/fnins.2023.1168962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/12/2023] [Indexed: 06/02/2023] Open
Abstract
Objective To investigate the clinical efficacy and prognostic factors of transnasal endoscopic optic decompression in the treatment of traumatic optic neuropathy (TON). Methods A retrospective analysis was performed on 13 TON patients in The Seventh Affiliated Hospital of Sun Yat-sen University and Shenzhen Eye Hospital in Shenzhen City (China) from June 2020 to April 2022. These patients had received transnasal endoscopic optic decompression, and hormonal and neurotrophic drugs were given after surgery. Visual acuity (VA) improvement was used as the criterion to judge clinical efficacy. Results In a total of 13 patients, 13 injured eyes (12 men and 1 woman; mean age, 28.0 ± 11.8 years) received transnasal endoscopic optic decompression. After surgery, nine patients had improved VA, whereas four patients failed to show any improvement, resulting in a total effective rate of 69.2%. Of the six patients with no light perception preoperatively, three had effective results after the operation, giving an effective rate of 50.0%. Of the seven patients with residual light sensation preoperatively, six had effective results after the operation, giving an effective rate of 85.7%. Of the 10 patients operated on within 7 days after injury, seven had effective results, giving an effective rate of 70%. Of the three patients injured and operated on after 7 days, two had effective results, giving an effective rate of 66.7%. Conclusion Transnasal endoscopic optic nerve decompression is an effective treatment method for TON. The presence of residual light perception and the timing of surgery within 7 days are crucial to the prognosis.
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Affiliation(s)
- Xiang Tu
- Department of Otolaryngology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Cheng Xiong
- The Department of Orbital Disease and Ophthalmic Oncology, Shenzhen Eye Hospital, Shenzhen Eye Institute, Jinan University, Shenzhen, China
| | - Hui Qi
- Department of Otolaryngology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yangming Ou
- The Department of Orbital Disease and Ophthalmic Oncology, Shenzhen Eye Hospital, Shenzhen Eye Institute, Jinan University, Shenzhen, China
| | - Jing Rao
- The Department of Orbital Disease and Ophthalmic Oncology, Shenzhen Eye Hospital, Shenzhen Eye Institute, Jinan University, Shenzhen, China
| | - Yueqi Sun
- Department of Otolaryngology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yunping Fan
- Department of Otolaryngology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Guiqin Liu
- The Department of Orbital Disease and Ophthalmic Oncology, Shenzhen Eye Hospital, Shenzhen Eye Institute, Jinan University, Shenzhen, China
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Siyanaki MRH, Azab MA, Lucke-Wold B. Traumatic Optic Neuropathy: Update on Management. Encyclopedia (Basel, 2021) 2023; 3:88-101. [PMID: 36718432 PMCID: PMC9884099 DOI: 10.3390/encyclopedia3010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Traumatic optic neuropathy is one of the causes of visual loss caused by blunt or penetrating head trauma and is classified as both direct and indirect. Clinical history and examination findings usually allow for the diagnosis of traumatic optic neuropathy. There is still controversy surrounding the management of traumatic optic neuropathy; some physicians advocate observation alone, while others recommend steroid therapy, surgery, or both. In this entry, we tried to highlight traumatic optic neuropathy's main pathophysiologic mechanisms with the most available updated treatment. Recent research suggests future therapies that may be helpful in traumatic optic neuropathy cases.
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Affiliation(s)
| | - Mohammed A. Azab
- Department of Neurosurgery, University of Cairo University, Cairo 12613, Egypt
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
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Contartese DS, Rey-Funes M, Peláez R, Soliño M, Fernández JC, Nakamura R, Ciranna NS, Sarotto A, Dorfman VB, López-Costa JJ, Zapico JM, Ramos A, de Pascual-Teresa B, Larrayoz IM, Loidl CF, Martínez A. A hypothermia mimetic molecule (zr17-2) reduces ganglion cell death and electroretinogram distortion in a rat model of intraorbital optic nerve crush (IONC). Front Pharmacol 2023; 14:1112318. [PMID: 36755945 PMCID: PMC9899795 DOI: 10.3389/fphar.2023.1112318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/10/2023] [Indexed: 01/24/2023] Open
Abstract
Introduction: Ocular and periocular traumatisms may result in loss of vision. Our previous work showed that therapeutic hypothermia prevents retinal damage caused by traumatic neuropathy. We also generated and characterized small molecules that elicit the beneficial effects of hypothermia at normal body temperature. Here we investigate whether one of these mimetic molecules, zr17-2, is able to preserve the function of eyes exposed to trauma. Methods: Intraorbital optic nerve crush (IONC) or sham manipulation was applied to Sprague-Dawley rats. One hour after surgery, 5.0 µl of 330 nmol/L zr17-2 or PBS, as vehicle, were injected in the vitreum of treated animals. Electroretinograms were performed 21 days after surgery and a- and b-wave amplitude, as well as oscillatory potentials (OP), were calculated. Some animals were sacrificed 6 days after surgery for TUNEL analysis. All animal experiments were approved by the local ethics board. Results: Our previous studies showed that zr17-2 does not cross the blood-ocular barrier, thus preventing systemic treatment. Here we show that intravitreal injection of zr17-2 results in a very significant prevention of retinal damage, providing preclinical support for its pharmacological use in ocular conditions. As previously reported, IONC resulted in a drastic reduction in the amplitude of the b-wave (p < 0.0001) and OPs (p < 0.05), a large decrease in the number of RGCs (p < 0.0001), and a large increase in the number of apoptotic cells in the GCL and the INL (p < 0.0001). Interestingly, injection of zr17-2 largely prevented all these parameters, in a very similar pattern to that elicited by therapeutic hypothermia. The small molecule was also able to reduce oxidative stress-induced retinal cell death in vitro. Discussion: In summary, we have shown that intravitreal injection of the hypothermia mimetic, zr17-2, significantly reduces the morphological and electrophysiological consequences of ocular traumatism and may represent a new treatment option for this cause of visual loss.
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Affiliation(s)
- Daniela S. Contartese
- Departamento de Biología Celular, Histología, Embriología y Genética, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis” (IBCN), UBA-CONICET, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Manuel Rey-Funes
- Departamento de Biología Celular, Histología, Embriología y Genética, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis” (IBCN), UBA-CONICET, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Rafael Peláez
- Biomarkers and Molecular Signaling, Neurodegenerative Diseases Area, Center for Biomedical Research of La Rioja (CIBIR), Logroño, Spain
| | - Manuel Soliño
- Departamento de Biología Celular, Histología, Embriología y Genética, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis” (IBCN), UBA-CONICET, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Juan C. Fernández
- Departamento de Biología Celular, Histología, Embriología y Genética, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis” (IBCN), UBA-CONICET, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ronan Nakamura
- Departamento de Biología Celular, Histología, Embriología y Genética, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis” (IBCN), UBA-CONICET, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Nicolás S. Ciranna
- Departamento de Biología Celular, Histología, Embriología y Genética, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis” (IBCN), UBA-CONICET, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Aníbal Sarotto
- Departamento de Biología Celular, Histología, Embriología y Genética, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis” (IBCN), UBA-CONICET, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Verónica B. Dorfman
- Centro de Estudios Biomédicos Básicos, Aplicados y Desarrollo (CEBBAD), Universidad Maimónides, Buenos Aires, Argentina
| | - Juan J. López-Costa
- Departamento de Biología Celular, Histología, Embriología y Genética, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis” (IBCN), UBA-CONICET, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - José M. Zapico
- Department of Chemistry and Biochemistry, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Ana Ramos
- Department of Chemistry and Biochemistry, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Beatriz de Pascual-Teresa
- Department of Chemistry and Biochemistry, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Ignacio M. Larrayoz
- Biomarkers and Molecular Signaling, Neurodegenerative Diseases Area, Center for Biomedical Research of La Rioja (CIBIR), Logroño, Spain
| | - César F. Loidl
- Departamento de Biología Celular, Histología, Embriología y Genética, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis” (IBCN), UBA-CONICET, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Alfredo Martínez
- Angiogenesis Group, Center for Biomedical Research of La Rioja, Logroño, Spain,*Correspondence: Alfredo Martínez,
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Hsu CL, Wen YT, Hsu TC, Chen CC, Lee LY, Chen WP, Tsai RK. Neuroprotective Effects of Erinacine A on an Experimental Model of Traumatic Optic Neuropathy. Int J Mol Sci 2023; 24. [PMID: 36675019 DOI: 10.3390/ijms24021504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
Erinacine A (EA), a natural neuroprotectant, is isolated from a Chinese herbal medicine, Hericium erinaceus. The aim of this study was to investigate the neuroprotective effects of EA in a rat model of traumatic optic neuropathy. The optic nerves (ONs) of adult male Wistar rats were crushed using a standardized method and divided into three experimental groups: phosphate-buffered saline (PBS control)-treated group, standard EA dose-treated group (2.64 mg/kg in 0.5 mL of PBS), and double EA dose-treated group (5.28 mg/kg in 0.5 mL of PBS). After ON crush, each group was fed orally every day for 14 days before being euthanized. The visual function, retinal ganglion cell (RGC) density, and RGC apoptosis were determined using flash visual-evoked potentials (fVEP) analysis, retrograde Fluoro-Gold labelling, and TdT-dUTP nick end-labelling (TUNEL) assay, respectively. Macrophage infiltration of ON was detected by immunostaining (immunohistochemistry) for ED1. The protein levels of phosphor-receptor-interacting serine/threonine-protein kinase1 (pRIP1), caspase 8 (Cas8), cleaved caspase 3 (cCas3), tumour necrosis factor (TNF)-α, tumour necrosis factor receptor1 (TNFR1), interleukin (IL)-1β, inducible nitric oxide synthase (iNOS), nuclear factor erythroid 2-related factor 2 (Nrf2), haem oxygenase-1 (HO-1), and superoxide dismutase 1 (SOD1) were evaluated by Western blotting. When comparing the standard EA dose-treated group and the double EA dose-treated group with the PBS-treated group, fVEP analysis showed that the amplitudes of P1−N2 in the standard EA dose group and the double EA dose-treated group were 1.8 and 2.4-fold, respectively, higher than that in the PBS-treated group (p < 0.05). The density of RGC in the standard EA dose-treated group and the double EA dose-treated group were 2.3 and 3.7-fold, respectively, higher than that in the PBS-treated group (p < 0.05). The TUNEL assay showed that the standard EA dose-treated group and the double EA dose-treated group had significantly reduced numbers of apoptotic RGC by 10.0 and 15.6-fold, respectively, compared with the PBS-treated group (p < 0.05). The numbers of macrophages on ON were reduced by 1.8 and 2.2-fold in the standard EA dose-treated group and the double EA dose-treated group, respectively (p < 0.01). On the retinal samples, the levels of pRIP, Cas8, cCas3, TNF-α, TNFR1, IL-1β, and iNOS were decreased, whereas those of Nrf2, HO-1, and SOD1 were increased in both EA-treated groups compared to those in the PBS-treated group (p < 0.05). EA treatment has neuroprotective effects on an experimental model of traumatic optic neuropathy by suppressing apoptosis, neuroinflammation, and oxidative stress to protect the RGCs from death as well as preserving the visual function.
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Kumar M, Kowsalya A, Narayanamoorthy J, Kumarasamy D, Chitradevi, Balakrishnan H, Chaudhary S. Erythropoietin as a treatment option for indirect traumatic optic neuropathy: A pilot study. Indian J Ophthalmol 2023; 71:235-240. [PMID: 36588242 PMCID: PMC10155518 DOI: 10.4103/ijo.ijo_945_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose Our study aims to evaluate the effectiveness of intravenous erythropoietin (EPO) in patients with indirect traumatic optic neuropathy (TON), assess the side effects, and compare the visual function results among three groups of patients who had received different treatment options - EPO, steroids, and observation. Methods : Patients with indirect TON presenting to the neuro-ophthalmology clinic from August 2019 to March 2020, were assigned to three groups, with six patients in each group. In group 1, patients were recruited prospectively and received recombinant human erythropoietin, whereas, in groups 2 and 3, patients were recruited retrospectively and received intravenous methylprednisolone followed by oral steroids and multivitamins, respectively. Groups 1 and 2 included patients presenting within 2 weeks of trauma, whereas group 3 included those presenting beyond that. Best-corrected visual acuity, pupillary reaction, color vision, and visual fields following treatment were measured. Results Initial visual acuity in the EPO group ranged from 20/80 to no perception of light (No PL). The mean initial BCVA (1.82 logMAR, standard deviation [SD] = 0.847) improved to 1.32, SD = 0.93 logMAR after treatment recorded at the third month (P = 0.0375), with no significant adverse effects. The initial BCVA of group 2 ranged from 20/120 to No PL. The mean initial BCVA (1.95, SD = 0.77 logMAR) improved to 1.45 logMAR, SD = 0.97 after treatment (P = 0.0435) but three patients had side effects of steroids. Initial visual acuity in Group 3 ranged from 20/40 to no PL. The mean initial BCVA (1.09 logMAR, SD = 1.10) worsened to 1.19 logMAR, SD = 1.06 after treatment after treatment (P = 0.0193). The improvement in BCVA when compared between the three groups was not significant. Conclusion Both erythropoietin and steroids are effective in the management of traumatic optic neuropathy. However, erythropoietin shows lesser or no side effects when compared to steroids.
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Affiliation(s)
- Mahesh Kumar
- Department of Neuro Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Akkayasamy Kowsalya
- Department of Neuro Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | - Dhivya Kumarasamy
- Department of Neuro Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Chitradevi
- Department of Neuro Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | - Sameer Chaudhary
- Department of Neuro Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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11
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Chauhan MZ, Chacko JG, Ghaffarieh A, Moulin CM, Pelaez D, Uwaydat SH, Bhattacharya SK. Mitochondrial Triglyceride Dysregulation in Optic Nerves Following Indirect Traumatic Optic Neuropathy. Biomolecules 2022; 12:biom12121885. [PMID: 36551313 PMCID: PMC9775509 DOI: 10.3390/biom12121885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The purpose of this work is to identify mitochondrial optic nerve (ON) lipid alterations associated with sonication-induced traumatic optic neuropathy (TON). Briefly, a mouse model of indirect TON was generated using sound energy concentrated focally at the entrance of the optic canal using a laboratory sonifier (Branson Digital Sonifier 450, Danbury, CT, USA) with a microtip probe. We performed an analysis of a previously generated dataset from high-performance liquid chromatography-electrospray tandem mass spectrometry (LC-MS/MS). We analyzed lipids from isolated mitochondria from the ON at 1 day, 7 days, and 14 days post-sonication compared to non-sonicated controls. Lipid abundance alterations in post-sonicated ON mitochondria were evaluated with 1-way ANOVA (FDR-adjusted significant p-value < 0.01), debiased sparse partial correlation (DSPC) network modeling, and partial least squares-discriminant analysis (PLS-DA). We find temporal alterations in triglyceride metabolism are observed in ON mitochondria of mice following sonication-induced optic neuropathy with notable depletions of TG(18:1/18:2/18:2), TG(18:1/18:1/18:1), and TG(16:0/16:0/18:1). Depletion of mitochondrial triglycerides may mediate ON damage in indirect traumatic optic neuropathy through loss energy substrates for neuronal metabolism.
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Affiliation(s)
- Muhammad Z. Chauhan
- Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences Little Rock, Little Rock, AR 72205, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Joseph G. Chacko
- Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences Little Rock, Little Rock, AR 72205, USA
| | - Alireza Ghaffarieh
- Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences Little Rock, Little Rock, AR 72205, USA
| | - Chloe M. Moulin
- Dr. Nasser Al-Rashid Orbital Vision Research Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Daniel Pelaez
- Dr. Nasser Al-Rashid Orbital Vision Research Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Sami H. Uwaydat
- Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences Little Rock, Little Rock, AR 72205, USA
- Correspondence: (S.H.U.); (S.K.B.); Tel.: +305-482-4103 (S.K.B.)
| | - Sanjoy K. Bhattacharya
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Correspondence: (S.H.U.); (S.K.B.); Tel.: +305-482-4103 (S.K.B.)
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12
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McGrady NR, Holden JM, Ribeiro M, Boal AM, Risner ML, Calkins DJ. Axon hyperexcitability in the contralateral projection following unilateral optic nerve crush in mice. Brain Commun 2022; 4:fcac251. [PMID: 36267329 PMCID: PMC9576152 DOI: 10.1093/braincomms/fcac251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/02/2022] [Accepted: 10/01/2022] [Indexed: 11/07/2022] Open
Abstract
Optic neuropathies are characterized by degeneration of retinal ganglion cell axonal projections to the brain, including acute conditions like optic nerve trauma and progressive conditions such as glaucoma. Despite different aetiologies, retinal ganglion cell axon degeneration in traumatic optic neuropathy and glaucoma share common pathological signatures. We compared how early pathogenesis of optic nerve trauma and glaucoma influence axon function in the mouse optic projection. We assessed pathology by measuring anterograde axonal transport from retina to superior colliculus, current-evoked optic nerve compound action potential and retinal ganglion cell density 1 week following unilateral optic nerve crush or intraocular pressure elevation. Nerve crush reduced axon transport, compound axon potential and retinal ganglion cell density, which were unaffected by intraocular pressure elevation. Surprisingly, optic nerves contralateral to crush demonstrated 5-fold enhanced excitability in compound action potential compared with naïve nerves. Enhanced excitability in contralateral sham nerves is not due to increased accumulation of voltage-gated sodium channel 1.6, or ectopic voltage-gated sodium channel 1.2 expression within nodes of Ranvier. Our results indicate hyperexcitability is driven by intrinsic responses of αON-sustained retinal ganglion cells. We found αON-sustained retinal ganglion cells in contralateral, sham and eyes demonstrated increased responses to depolarizing currents compared with those from naïve eyes, while light-driven responses remained intact. Dendritic arbours of αON-sustained retinal ganglion cells of the sham eye were like naïve, but soma area and non-phosphorylated neurofilament H increased. Current- and light-evoked responses of sham αOFF-sustained retinal ganglion cells remained stable along with somato-dendritic morphologies. In retinas directly affected by crush, light responses of αON- and αOFF-sustained retinal ganglion cells diminished compared with naïve cells along with decreased dendritic field area or branch points. Like light responses, αOFF-sustained retinal ganglion cell current-evoked responses diminished, but surprisingly, αON-sustained retinal ganglion cell responses were similar to those from naïve retinas. Optic nerve crush reduced dendritic length and area in αON-sustained retinal ganglion cells in eyes ipsilateral to injury, while crush significantly reduced dendritic branching in αOFF-sustained retinal ganglion cells. Interestingly, 1 week of intraocular pressure elevation only affected αOFF-sustained retinal ganglion cell physiology, depolarizing resting membrane potential in cells of affected eyes and blunting current-evoked responses in cells of saline-injected eyes. Collectively, our results suggest that neither saline nor sham surgery provide a true control, chronic versus acute optic neuropathies differentially affect retinal ganglion cells composing the ON and OFF pathways, and acute stress can have near-term effects on the contralateral projection.
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Affiliation(s)
- Nolan R McGrady
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, AA7103 MCN/VUIIS, 1161 21st Ave. S., Nashville, TN 37232, USA
| | - Joseph M Holden
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, AA7103 MCN/VUIIS, 1161 21st Ave. S., Nashville, TN 37232, USA
| | - Marcio Ribeiro
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, AA7103 MCN/VUIIS, 1161 21st Ave. S., Nashville, TN 37232, USA
| | - Andrew M Boal
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, AA7103 MCN/VUIIS, 1161 21st Ave. S., Nashville, TN 37232, USA
| | - Michael L Risner
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, AA7103 MCN/VUIIS, 1161 21st Ave. S., Nashville, TN 37232, USA
| | - David J Calkins
- Correspondence to: David J. Calkins, PhD AA7103 MCN/VUIIS 1161 21st Ave. S., Nashville, TN 37232, USA E-mail:
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13
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王 鹏, 罗 生, 申 晨, 喻 哲, 聂 祖, 李 志, 文 婕, 李 萌, 曹 霞. [Protective effect of Epothilone D against traumatic optic nerve injury in rats]. Nan Fang Yi Ke Da Xue Xue Bao 2022; 42:575-583. [PMID: 35527494 PMCID: PMC9085595 DOI: 10.12122/j.issn.1673-4254.2022.04.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the therapeutic effect of Epothilone D on traumatic optic neuropathy (TON) in rats. METHODS Forty-two SD rats were randomized to receive intraperitoneal injection of 1.0 mg/kg Epothilone D or DMSO (control) every 3 days until day 28, and rat models of TON were established on the second day after the first administration. On days 3, 7, and 28, examination of flash visual evoked potentials (FVEP), immunofluorescence staining and Western blotting were performed to examine the visual pathway features, number of retinal ganglion cells (RGCs), GAP43 expression level in damaged axons, and changes of Tau and pTau-396/404 in the retina and optic nerve. RESULTS In Epothilone D treatment group, RGC loss rate was significantly decreased by 19.12% (P=0.032) on day 3 and by 22.67% (P=0.042) on day 28 as compared with the rats in the control group, but FVEP examination failed to show physiological improvement in the visual pathway on day 28 in terms of the relative latency of N2 wave (P=0.236) and relative amplitude attenuation of P2-N2 wave (P=0.441). The total Tau content in the retina of the treatment group was significantly increased compared with that in the control group on day 3 (P < 0.001), showing a consistent change with ptau-396/404 level. In the optic nerve axons, the total Tau level in the treatment group was significantly lower than that in the control group on day 7 (P=0.002), but the changes of the total Tau and pTau-396/404 level did not show an obvious correlation. Epothilone D induced persistent expression of GAP43 in the damaged axons, detectable even on day 28 of the experiment. CONCLUSION Epothilone D treatment can protect against TON in rats by promoting the survival of injured RGCs, enhancing Tau content in the surviving RGCs, reducing Tau accumulation in injured axons, and stimulating sustained regeneration of axons.
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Affiliation(s)
- 鹏飞 王
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - 生平 罗
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - 晨 申
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - 哲昊 喻
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - 祖庆 聂
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - 志伟 李
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - 婕 文
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - 萌 李
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - 霞 曹
- />昆明医科大学第二附属医院,云南 昆明 650101Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
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14
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Tam DCF, Murray MP. Total Isolated Monocular Vision Loss in a Patient Who Suffered Closed Head Injury. J Emerg Med 2022; 62:e65-e68. [PMID: 35065866 DOI: 10.1016/j.jemermed.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/01/2021] [Accepted: 11/27/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Head injuries are an important cause of morbidity and mortality in children and young adults. There are multiple sight-threatening complications of head injury, even in closed head injury without visible violation of the globe or orbits. One such entity is traumatic optic neuropathy. CASE REPORT Herein we describe a case of traumatic optic neuropathy in an otherwise healthy teenage patient who suffered total monocular vision loss after a fall and without any other injuries on examination. Unfortunately, the prognosis for this condition is relatively poor in terms of visual recovery. Though much research has been conducted attempting to treat this condition, to date there have been no studies showing a clear benefit of medical or surgical intervention. Why Should an Emergency Physician Be Aware of This? Although there is no proven treatment for traumatic optic neuropathy, emergency physicians may encounter this in their practice while caring for both pediatric and adult patients presenting with head injury. Having more background knowledge on this condition will enhance emergency physicians' ability to consult with subspecialist providers as well as to educate patients and their families on their condition and prognosis.
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Affiliation(s)
- Derek Chi Fung Tam
- University of California (UC) San Diego Department of Pediatrics, , Rady Children's Hospital of San Diego, San Diego, California
| | - Matthew P Murray
- UC San Diego Department of Emergency Medicine, Department of Pediatric Emergency Medicine, Rady Children's Hospital of San Diego, San Diego, California
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15
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Zhang Y, Li M, Yu B, Lu S, Zhang L, Zhu S, Yu Z, Xia T, Huang H, Jiang W, Zhang S, Sun L, Ye Q, Sun J, Zhu H, Huang P, Hong H, Yu S, Li W, Ai D, Fan J, Li W, Song H, Xu L, Chen X, Chen T, Zhou M, Ou J, Yang J, Li W, Hu Y, Wu W. Cold protection allows local cryotherapy in a clinical-relevant model of traumatic optic neuropathy. eLife 2022; 11:75070. [PMID: 35352678 PMCID: PMC9068221 DOI: 10.7554/elife.75070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
Therapeutic hypothermia (TH) is potentially an important therapy for central nervous system (CNS) trauma. However, its clinical application remains controversial, hampered by two major factors: (1) Many of the CNS injury sites, such as the optic nerve (ON), are deeply buried, preventing access for local TH. The alternative is to apply TH systemically, which significantly limits the applicable temperature range. (2) Even with possible access for 'local refrigeration', cold-induced cellular damage offsets the benefit of TH. Here we present a clinically translatable model of traumatic optic neuropathy (TON) by applying clinical trans-nasal endoscopic surgery to goats and non-human primates. This model faithfully recapitulates clinical features of TON such as the injury site (pre-chiasmatic ON), the spatiotemporal pattern of neural degeneration, and the accessibility of local treatments with large operating space. We also developed a computer program to simplify the endoscopic procedure and expand this model to other large animal species. Moreover, applying a cold-protective treatment, inspired by our previous hibernation research, enables us to deliver deep hypothermia (4 °C) locally to mitigate inflammation and metabolic stress (indicated by the transcriptomic changes after injury) without cold-induced cellular damage, and confers prominent neuroprotection both structurally and functionally. Intriguingly, neither treatment alone was effective, demonstrating that in situ deep hypothermia combined with cold protection constitutes a breakthrough for TH as a therapy for TON and other CNS traumas.
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Affiliation(s)
- Yikui Zhang
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityWenzhouChina
| | - Mengyun Li
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityWenzhouChina
| | - Bo Yu
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityWenzhouChina
| | - Shengjian Lu
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityWenzhouChina
| | - Lujie Zhang
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of TechnologyBeijingChina
| | - Senmiao Zhu
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityWenzhouChina
| | - Zhonghao Yu
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityWenzhouChina
| | - Tian Xia
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityWenzhouChina
| | - Haoliang Huang
- Department of Ophthalmology, Stanford University School of MedicinePalo AltoUnited States
| | - WenHao Jiang
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityWenzhouChina
| | - Si Zhang
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityWenzhouChina
| | - Lanfang Sun
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityWenzhouChina
| | - Qian Ye
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityWenzhouChina
| | - Jiaying Sun
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityWenzhouChina
| | - Hui Zhu
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityWenzhouChina
| | - Pingping Huang
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityWenzhouChina
| | - Huifeng Hong
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityWenzhouChina
| | - Shuaishuai Yu
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical UniversityWenzhouChina
| | - Wenjie Li
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of TechnologyBeijingChina
| | - Danni Ai
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of TechnologyBeijingChina
| | - Jingfan Fan
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of TechnologyBeijingChina
| | - Wentao Li
- School of Computer Science & Technology, Beijing Institute of TechnologyBeijingChina
| | - Hong Song
- School of Computer Science & Technology, Beijing Institute of TechnologyBeijingChina
| | - Lei Xu
- Medical Radiology Department, 2nd Affiliated Hospital, Wenzhou Medical UniversityWenzhouChina
| | - Xiwen Chen
- Animal Facility Center, Wenzhou Medical UniversityWenzhouChina
| | - Tongke Chen
- Animal Facility Center, Wenzhou Medical UniversityWenzhouChina
| | - Meng Zhou
- School of Biomedical Engineering, The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityWenzhouChina
| | - Jingxing Ou
- Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated, Hospital, Guangdong Province Engineering Laboratory for Transplantation MedicineGuangzhouChina,Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
| | - Jian Yang
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of TechnologyBeijingChina
| | - Wei Li
- Retinal Neurophysiology Section, National Eye Institute, National Institute of Health, NIHBethesdaUnited States
| | - Yang Hu
- Department of Ophthalmology, Stanford University School of MedicinePalo AltoUnited States
| | - Wencan Wu
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityWenzhouChina
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Kang EY, Liu PK, Wen YT, Quinn PMJ, Levi SR, Wang NK, Tsai RK. Role of Oxidative Stress in Ocular Diseases Associated with Retinal Ganglion Cells Degeneration. Antioxidants (Basel) 2021; 10:1948. [PMID: 34943051 DOI: 10.3390/antiox10121948] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 12/12/2022] Open
Abstract
Ocular diseases associated with retinal ganglion cell (RGC) degeneration is the most common neurodegenerative disorder that causes irreversible blindness worldwide. It is characterized by visual field defects and progressive optic nerve atrophy. The underlying pathophysiology and mechanisms of RGC degeneration in several ocular diseases remain largely unknown. RGCs are a population of central nervous system neurons, with their soma located in the retina and long axons that extend through the optic nerve to form distal terminals and connections in the brain. Because of this unique cytoarchitecture and highly compartmentalized energy demand, RGCs are highly mitochondrial-dependent for adenosine triphosphate (ATP) production. Recently, oxidative stress and mitochondrial dysfunction have been found to be the principal mechanisms in RGC degeneration as well as in other neurodegenerative disorders. Here, we review the role of oxidative stress in several ocular diseases associated with RGC degenerations, including glaucoma, hereditary optic atrophy, inflammatory optic neuritis, ischemic optic neuropathy, traumatic optic neuropathy, and drug toxicity. We also review experimental approaches using cell and animal models for research on the underlying mechanisms of RGC degeneration. Lastly, we discuss the application of antioxidants as a potential future therapy for the ocular diseases associated with RGC degenerations.
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Huang CT, Wen YT, Desai TD, Tsai RK. Intravitreal Injection of Long-Acting Pegylated Granulocyte Colony-Stimulating Factor Provides Neuroprotective Effects via Antioxidant Response in a Rat Model of Traumatic Optic Neuropathy. Antioxidants (Basel) 2021; 10:1934. [PMID: 34943037 DOI: 10.3390/antiox10121934] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 12/16/2022] Open
Abstract
Traumatic optic neuropathy (TON) may cause severe visual loss following direct or indirect head trauma which may result in optic nerve injuries and therefore contribute to the subsequent loss of retinal ganglion cells by inflammatory mediators and reactive oxygen species (ROS). Granulocyte colony-stimulating factor (G-CSF) provides the anti-inflammatory and anti-oxidative actions but has a short half-life and also induces leukocytosis upon typical systemic administration. The purpose of the present study was to investigate the relationship between the anti-oxidative response and neuroprotective effects of long-acting pegylated human G-CSF (PEG-G-CSF) in a rat model of optic nerve crush (ONC). Adult male Wistar rats (150–180 g) were chosen to have a sham operation in one eye and have ONC in the other. PEG-G-CSF or phosphate-buffered saline (PBS control) was immediately administered after ONC by intravitreal injection (IVI). We found the IVI of PEG-G-CSF does not induce systemic leukocytosis, but increases survival of RGCs and preserves the visual function after ONC. TUNEL assays showed fewer apoptotic cells in the retina in the PEG-G-CSF-treated eyes. The number of sorely ED1-positive cells was attenuated at the lesion site in the PEG-G-CSF-treated eyes. Immunoblotting showed up-regulation of p-Akt1, Nrf2, Sirt3, and HO-1 in the ON of the PEG-G-CSF-treated eyes. Our results demonstrated that one IVI of long-acting PEG-G-CSF is neuroprotective in the rONC. PEG-G-CSF activates the p-Akt1/Nrf2/Sirt3 and the p-Akt1/Nrf2/HO-1 axes to provide the antioxidative action and further attenuated RGC apoptosis and neuroinflammation. This provides crucial preclinical information for the development of alternative therapy with IVI of PEG-G-CSF in TON.
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18
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Hetzer SM, Shalosky EM, Torrens JN, Evanson NK. Chronic Histological Outcomes of Indirect Traumatic Optic Neuropathy in Adolescent Mice: Persistent Degeneration and Temporally Regulated Glial Responses. Cells 2021; 10:3343. [PMID: 34943851 PMCID: PMC8699438 DOI: 10.3390/cells10123343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Injury to the optic nerve, termed, traumatic optic neuropathy (TON) is a known comorbidity of traumatic brain injury (TBI) and is now known to cause chronic and progressive retinal thinning up to 35 years after injury. Although animal models of TBI have described the presence of optic nerve degeneration and research exploring acute mechanisms is underway, few studies in humans or animals have examined chronic TON pathophysiology outside the retina. We used a closed-head weight-drop model of TBI/TON in 6-week-old male C57BL/6 mice. Mice were euthanized 7-, 14-, 30-, 90-, and 150-days post-injury (DPI) to assess histological changes in the visual system of the brain spanning a total of 12 regions. We show chronic elevation of FluoroJade-C, indicative of neurodegeneration, throughout the time course. Intriguingly, FJ-C staining revealed a bimodal distribution of mice indicating the possibility of subpopulations that may be more or less susceptible to injury outcomes. Additionally, we show that microglia and astrocytes react to optic nerve damage in both temporally and regionally different ways. Despite these differences, astrogliosis and microglial changes were alleviated between 14-30 DPI in all regions examined, perhaps indicating a potentially critical period for intervention/recovery that may determine chronic outcomes.
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Affiliation(s)
- Shelby M. Hetzer
- Neuroscience Graduate Program, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
| | - Emily M. Shalosky
- Department of Biological Sciences, University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Jordyn N. Torrens
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
| | - Nathan K. Evanson
- Neuroscience Graduate Program, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA
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19
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Bacorn C, Morisada MV, Dedhia RD, Steele TO, Strong EB, Lin LK. Traumatic Optic Neuropathy Management: A Survey Assessment of Current Practice Patterns. J Emerg Trauma Shock 2021; 14:136-142. [PMID: 34759631 PMCID: PMC8527061 DOI: 10.4103/jets.jets_66_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/27/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction: The treatment of traumatic optic neuropathy (TON) is highly controversial with a lack of substantiated evidence to support the use of corticosteroids or surgical decompression of the optic nerve. The aim of the study was to determine if there was a general consensus in the management of TON despite controversy in the literature. Methods: An anonymous survey of members of the American Society of Ophthalmic Plastic and Reconstructive Surgery and the North American Neuro-Ophthalmology Society regarding their practice patterns in the management of patients with TON was performed. Results: The majority of 165 respondents indicated that they treated TON with corticosteroids (60%) while a significant minority (23%) performed surgical interventions (P < 0.0001). Subgroup analysis comparing rates of treatment with steroids among oculoplastic surgeons and neuro-ophthalmologists (67% vs. 47%) was not significant (Fisher's Exact test [FET], P =0.11) while results did suggest that a higher proportion of oculoplastic surgeons (33%) than neuro-ophthalmologists (11%) recommended surgical intervention (FET, P =0.004). In cases where visual acuity exhibited a downward trend treatment with steroids was the most commonly employed management. In general, neuro-ophthalmologists trended toward observation over treatment in TON patients with stable visual acuity while oculoplastic surgeons favored treatment with corticosteroids. Conclusions: In spite of the lack of class I evidence supporting intervention of TON, the majority of respondents were inclined to offer corticosteroid treatment to patients whose visual acuity showed progressive decline following injury.
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Affiliation(s)
- Colin Bacorn
- Department of Ophthalmology and Vision Science, University of California Davis Health Eye Center, Sacramento, California
| | - Megan V Morisada
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis Health, Sacramento, California, TN, USA
| | - Raj D Dedhia
- Department of Otolaryngology - Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Toby O Steele
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis Health, Sacramento, California, TN, USA
| | - Edward Bradley Strong
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis Health, Sacramento, California, TN, USA
| | - Lily Koo Lin
- Department of Ophthalmology and Vision Science, University of California Davis Health Eye Center, Sacramento, California
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20
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Tenewitz JE, Chen EJ, Cartwright MJ. A Rare Presentation of Direct Traumatic Optic Neuropathy in a Patient Poked in the Eye by an Antenna. Cureus 2021; 13:e18244. [PMID: 34722038 PMCID: PMC8544920 DOI: 10.7759/cureus.18244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/24/2021] [Indexed: 11/05/2022] Open
Abstract
Traumatic optic neuropathy (TON) is defined as a loss of vision due to a traumatic injury to the optic nerve. Numerous mechanisms may contribute to the development of TON; however, most cases involve injuries to the globe, orbit, or adnexa. This case report presents a 24-year-old male who was inadvertently poked in the eye with an antenna and developed a direct optic nerve injury in the absence of a significant injury to the surrounding orbital structures. A CT scan was used to confirm the diagnosis. No visual recovery was observed throughout his clinical course. The proposed pathophysiologic mechanisms, clinical presentation, complications, treatments, and prognosis of traumatic optic neuropathy are subsequently discussed.
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Affiliation(s)
- Jake E Tenewitz
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Evan J Chen
- Medicine, University of Central Florida College of Medicine, Orlando, USA
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21
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Dhakal S, He L, Lyuboslavsky P, Sidhu C, Chrenek MA, Sellers JT, Boatright JH, Geisert EE, Setterholm NA, McDonald FE, Iuvone PM. A Tropomycin-Related Kinase B Receptor Activator for the Management of Ocular Blast-Induced Vision Loss. J Neurotrauma 2021; 38:2896-2906. [PMID: 34353120 PMCID: PMC8820286 DOI: 10.1089/neu.2020.7392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pressure waves from explosions or other traumatic events can damage the neurons of the eye and visual centers of the brain, leading to functional loss of vision. There are currently few treatments for such injuries that can be deployed rapidly to mitigate damage. Brain-derived neurotrophic factor (BDNF) and activation of its receptor tropomycin-related kinase B (TrkB) have neuroprotective effects in a number of degeneration models. Small molecule activators of TrkB, such as N-[2-(5-hydroxy-1H-indol-3-yl)ethyl]-2-oxopiperidine-3-carboxamide (HIOC), cross the blood-brain and blood-retina barriers after systemic administration. We characterize the effects of blast-induced ocular trauma on retinal and visual function. We show that systemic administration of HIOC, a potent small molecule activator of the BDNF/TrkB receptor, preserves visual function in mice exposed to ocular blast injury. The HIOC treatment for one week preserves visual function for at least four months. The HIOC treatment effectively protected vision when the initial dose was administered up to 3 h after blast, but not if the initial treatment was delayed for 24 h. We provide evidence that the therapeutic effect of HIOC is mediated by activation of BDNF/TrkB receptors. The results indicate that HIOC may be useful for managing ocular blast injury and other forms of traumatic optic neuropathy.
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Affiliation(s)
- Susov Dhakal
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | - Li He
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | | | - Curran Sidhu
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | - Micah A. Chrenek
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | - Jana T. Sellers
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | | | - Eldon E. Geisert
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | | | | | - P. Michael Iuvone
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
- Department of Pharmacology and Chemical Biology, Emory University, Atlanta, Georgia, USA
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22
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Halsey J, Argüello-Angarita M, Carrasquillo OY, Hoppe IC, Lee ES, Granick MS. Periorbital and Globe Injuries in Pediatric Orbital Fractures: A Retrospective Review of 116 Patients at a Level 1 Trauma Center. Craniomaxillofac Trauma Reconstr 2021; 14:183-188. [PMID: 34471473 DOI: 10.1177/1943387520933697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design Retrospective chart review of pediatric and globe injuries associated with orbital fractures. Objective Our study seeks to examine these injuries and their association with orbital fractures at our trauma center to gain a better understanding of how to approach pediatric patients with orbital fractures. Methods A retrospective review of all facial fractures in pediatric patients at an urban level 1 trauma center was performed for the years 2002 to 2014. Patient demographics were collected, as well as orbital fracture location, mechanism of injury, concomitant injuries, ophthalmologic documentation, imaging, and perioperative records. Results One hundred sixteen pediatric patients over a 12-year period sustained an orbital fracture. The orbital floor was the most commonly fractured orbital bone in our series (60%). Thirty-four (30%) of the pediatric patients with orbital fractures had documented periorbital and/or globe injuries at the time of presentation. The most common periorbital injury was entrapment related to orbital floor fractures. Significant eyelid lacerations were present in seven patients, with five of these patients had canalicular injuries and two had canthal malposition. Five pediatric patients presented with traumatic optic neuropathy. Two patients had ruptured globes requiring enucleation. Conclusions Periorbital soft tissue and globe injuries associated with orbital fractures occurs in a substantial number of pediatric patients. There are no guidelines for treatment of these type of injuries in the pediatric population. Further research should be performed to better understand the appropriate management of periorbital injuries in conjunction with surgical management of the orbital fractures.
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Affiliation(s)
- Jordan Halsey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Marvin Argüello-Angarita
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Osward Y Carrasquillo
- Department of Dermatology, University of Puerto Rico School of Medicine, Puerto Rico
| | - Ian C Hoppe
- Department of Plastic Surgery, University of Mississippi College of Medicine, Jackson, MS, USA
| | - Edward S Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mark S Granick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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23
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Abstract
Traumatic brain injury (TBI) causes structural and functional damage to the central nervous system including the visual pathway. Defects in the afferent visual pathways affect visual function and in severe cases cause complete visual loss. Visual dysfunction is detectable by structural and functional ophthalmic examinations that are routine in the eye clinic, including examination of the pupillary light reflex and optical coherence tomography (OCT). Assessment of pupillary light reflex is a non-invasive assessment combining afferent and efferent visual function. While a assessment using a flashlight is relatively insensitive, automated pupillometry has 95% specificity and 78.1% sensitivity in detecting TBI-related visual and cerebral dysfunction with an area under the curve of 0.69-0.78. OCT may also serve as a noninvasive biomarker of TBI severity, demonstrating changes in the retinal ganglion cell layer and nerve fiber layer throughout the range of TBI severity even in the absence of visual symptoms. This review discusses the impact of TBI on visual structure and function.
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Affiliation(s)
- Noor Haziq Saliman
- Neuroscience and Ophthalmology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR-SRMRC), and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Antonio Belli
- Neuroscience and Ophthalmology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR-SRMRC), and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Richard J Blanch
- Neuroscience and Ophthalmology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR-SRMRC), and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom
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24
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Pattnaik S, Panda BB, Swain SC. Spectrum of Ocular Findings in Closed Head Injuries, Correlation With Severity of Neurological Involvement, and Treatment Outcome: A Hospital-Based Cross-Sectional Study. Cureus 2021; 13:e16515. [PMID: 34295601 PMCID: PMC8293860 DOI: 10.7759/cureus.16515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose: To study the various ocular findings in patients with closed head injuries, to find any association with the degree of neurological involvement, and to analyze the treatment outcome after the necessary intervention. Setting: Tertiary referral hospital in Eastern India. Design: Prospective observational study. Methods: Patients with closed head injuries attending our Outpatient department as well as referred from the Neurosurgery department for ophthalmic evaluation between October 2017 and September 2019 were recruited for the study. All patients meeting the inclusion criteria were examined by an experienced ophthalmologist. The Glasgow coma scale (GCS) was applied to grade the neurological involvement by the neurosurgery team. Ocular findings were recorded and necessary imaging was requested. Appropriate neurosurgery consultations were done in patients with neurological findings. All ocular injuries were managed as per institutional protocol. Descriptive statistics were used for analysis with p< 0.05 taken as statistically significant. Results: A total of 207 patients (414 eyes) were included in the study. The mean age was 33.82 years, with the prevalence of male patients (82.12%). The most common cause of head injury was RTA (57.01%) followed by assault (11.59%). The majority of patients (53.14%) were classified as having moderate, 46.37% patients with mild, and 0.48% with severe neurological involvement as per GCS scoring. Isolated ocular findings were seen in 70.04% of patients while 29.95% of patients had both neurological and ophthalmic features. Ocular adnexal involvement was observed in 38.6%, anterior segment involvement in 86%, neuro-ophthalmic manifestations in 33.3%, and posterior segment involvement in 38.6% of patients. Ocular signs were resolved over due course of time in 48.8% of patients, completely resolved in 28%, while there was no improvement in 6.28% of patients. The final best-corrected visual acuity of >6/18 was achieved in 51.69% of patients. Statistical significance was observed in the correlation between the GCS scoring and general ocular findings (p= 0.02) as well as a relative afferent pupillary defect (p=0.003). The association between age > 50 years and neuro-ophthalmic features was not found to be statistically significant (p=0.56). Conclusion: Poor visual acuity at presentation, optic canal fractures, the presence of multiple fractures of orbital walls, no improvement in vision within 48 hours of starting intravenous corticosteroids, were indicators of a poor visual prognosis in this study. The GCS, neuro-deficit, and ocular signs contribute significantly to the prediction of outcomes. Prompt treatment and referral can lead to a good resolution of symptoms and signs.
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Affiliation(s)
- Shradha Pattnaik
- Ophthalmology, Sriram Chandra Bhanja Medical College and Hospital, Cuttack, IND
| | - Bijnya B Panda
- Ophthalmology, Sriram Chandra Bhanja Medical College, Cuttack, IND
| | - Suresh C Swain
- Ophthalmology, Sriram Chandra Bhanja Medical College, Cuttack, IND
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25
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Baviskar PS, Natarajan S. Use of custom fabricated surgical jig to improve surgical outcomes in open reduction internal fixation of unilateral orbital fractures: A prospective clinical study. Saudi J Ophthalmol 2021; 35:244-250. [PMID: 35601861 PMCID: PMC9116094 DOI: 10.4103/sjopt.sjopt_49_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 06/28/2021] [Accepted: 08/04/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of the study was to assess the efficacy of virtual planning and surgical guide jig to improve surgical outcomes of open reduction and internal fixation with restoration and correction of orbital volume (OV) in unilateral orbital wall fractures. METHODS Fifteen patients with unilateral orbital fractures were assessed with ophthalmologic and radiographic parameters. The orbit was divided into three zones on computed tomography to localize defects. Fractures were coded into Fx Mx Rx Lx (F = Orbital Floor, M = Medial Wall, L = Lateral wall, R = Orbital Roof) based on pattern and specific wall involved. 1-mm sections were used to make stereolithographic models, design the custom fabricated surgical jig for intraoperative use as a guide. RESULTS Pre- and postoperative ophthalmological parameters, OV, were compared with the contralateral normal orbit serving as the reference. Postoperative ophthalmological parameters showed significant improvement in terms of visual acuity, enophthalmos, dystopia, and traumatic optic neuropathy. OV changes were concentrated in Zones 2 and 3. OV showed adequate restoration postoperatively. CONCLUSION The surgical jig served as an efficient guide to improve surgical outcomes of open reduction internal fixation. Preplanned intraoperative positioning helped achieve adequate anatomical reduction and fixation with an adequate reconstruction of OV aiding the effective transfer of virtual surgical plan on the table with improved surgical outcomes in clinical performance and functional restitution.Clinical trial registration: The Clinical Trials Registry of India (CTRI) Registration No.: CTRI/2019/11/021929.
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Affiliation(s)
- Padmakar S. Baviskar
- Department of Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Kamothe, Sector 01, Navi Mumbai, Maharashtra, India
| | - Srivalli Natarajan
- Department of Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Kamothe, Sector 01, Navi Mumbai, Maharashtra, India
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26
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Abri Aghdam K, Aghajani A, Razi-Khosroshahi M, Soltan Sanjari M, Chaibakhsh S, Falavarjani KG. Optical Coherence Tomography Angiography and Structural Analyses of the Pale Optic Discs: Is It Possible to Differentiate the Cause? Curr Eye Res 2021; 46:1876-1885. [PMID: 33980086 DOI: 10.1080/02713683.2021.1929331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: To compare the optic nerve head (ONH) structure and microvasculature in patients with optic atrophy due to non-arteritic anterior ischemic optic neuropathy (NAION), compressive optic neuropathy (CON), methanol-induced optic neuropathy (MION), and traumatic optic neuropathy (TON) using optical coherence tomography angiography.Methods: In this comparative, cross-sectional study, 32 eyes with NAION, 18 eyes with CON, 32 eyes with MION, 23 eyes with TON, and 55 normal eyes were enrolled. Radial peripapillary capillary (RPC) vessel density, peripapillary retinal nerve fiber layer (RNFL) thickness, disc area, cup volume, and cup/disc area ratio were obtained using the RTVue XR Avanti system (Optovue Inc., Fremont, CA, USA).Results: RPC vessel density and peripapillary RNFL thickness in all patients were significantly lower than normal subjects. A positive correlation was found between the RPC vessel density and peripapillary RNFL thickness in normal subjects and all study groups. The positive correlation between the inside and outside disc RPC vessel density was only found in the NAION (r = 0.36, P = .042) and MION (r = 0.42, P = .018) groups. No significant difference was found among the groups in terms of peripapillary and inside disc vascular densities (all P > .05). Disc area and cup volume in patients with MION was larger than the values in patients with NAION (P = .018) and TON (P = .044) and normal subjects (P = .015). The discriminating features among the study groups were the larger cup volume and cup/disc area ratio in patients with MION, and lower RNFL thickness in patients with TON.Conclusions: There was a positive correlation between the RNFL thickness and peripapillary RPC vessel density regardless of the cause of optic disc pallor. Structural evaluation of the ONH seems to be a better way to differentiate the cause of optic nerve head atrophy than the microangiographic changes.
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Affiliation(s)
- Kaveh Abri Aghdam
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Aghajani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Marjan Razi-Khosroshahi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Soltan Sanjari
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Chaibakhsh
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Khalil Ghasemi Falavarjani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.,Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
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27
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Hetzer SM, Guilhaume-Correa F, Day D, Bedolla A, Evanson NK. Traumatic Optic Neuropathy Is Associated with Visual Impairment, Neurodegeneration, and Endoplasmic Reticulum Stress in Adolescent Mice. Cells 2021; 10:cells10050996. [PMID: 33922788 PMCID: PMC8146890 DOI: 10.3390/cells10050996] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/02/2021] [Accepted: 04/17/2021] [Indexed: 02/02/2023] Open
Abstract
Traumatic brain injury (TBI) results in a number of impairments, often including visual symptoms. In some cases, visual impairments after head trauma are mediated by traumatic injury to the optic nerve, termed traumatic optic neuropathy (TON), which has few effective options for treatment. Using a murine closed-head weight-drop model of head trauma, we previously reported in adult mice that there is relatively selective injury to the optic tract and thalamic/brainstem projections of the visual system. In the current study, we performed blunt head trauma on adolescent C57BL/6 mice and investigated visual impairment in the primary visual system, now including the retina and using behavioral and histologic methods at new time points. After injury, mice displayed evidence of decreased optomotor responses illustrated by decreased optokinetic nystagmus. There did not appear to be a significant change in circadian locomotor behavior patterns, although there was an overall decrease in locomotor behavior in mice with head injury. There was evidence of axonal degeneration of optic nerve fibers with associated retinal ganglion cell death. There was also evidence of astrogliosis and microgliosis in major central targets of optic nerve projections. Further, there was elevated expression of endoplasmic reticulum (ER) stress markers in retinas of injured mice. Visual impairment, histologic markers of gliosis and neurodegeneration, and elevated ER stress marker expression persisted for at least 30 days after injury. The current results extend our previous findings in adult mice into adolescent mice, provide direct evidence of retinal ganglion cell injury after head trauma and suggest that axonal degeneration is associated with elevated ER stress in this model of TON.
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Affiliation(s)
- Shelby M. Hetzer
- Neuroscience Graduate Program, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA; (S.M.H.); (D.D.); (A.B.)
| | - Fernanda Guilhaume-Correa
- Translational Biology, Medicine and Health, Virginia Polytechnic Institute and State University, Roanoke, VA 24016, USA;
| | - Dylan Day
- Neuroscience Graduate Program, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA; (S.M.H.); (D.D.); (A.B.)
| | - Alicia Bedolla
- Neuroscience Graduate Program, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA; (S.M.H.); (D.D.); (A.B.)
| | - Nathan K. Evanson
- Neuroscience Graduate Program, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA; (S.M.H.); (D.D.); (A.B.)
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA
- Correspondence:
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28
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Wang T, Li Y, Guo M, Dong X, Liao M, Du M, Wang X, Yin H, Yan H. Exosome-Mediated Delivery of the Neuroprotective Peptide PACAP38 Promotes Retinal Ganglion Cell Survival and Axon Regeneration in Rats With Traumatic Optic Neuropathy. Front Cell Dev Biol 2021; 9:659783. [PMID: 33889576 PMCID: PMC8055942 DOI: 10.3389/fcell.2021.659783] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
Traumatic optic neuropathy (TON) refers to optic nerve damage caused by trauma, leading to partial or complete loss of vision. The primary treatment options, such as hormonal therapy and surgery, have limited efficacy. Pituitary adenylate cyclase-activating polypeptide 38 (PACAP38), a functional endogenous neuroprotective peptide, has emerged as a promising therapeutic agent. In this study, we used rat retinal ganglion cell (RGC) exosomes as nanosized vesicles for the delivery of PACAP38 loaded via the exosomal anchor peptide CP05 (EXOPACAP38). EXOPACAP38 showed greater uptake efficiency in vitro and in vivo than PACAP38. The results showed that EXOPACAP38 significantly enhanced the RGC survival rate and retinal nerve fiber layer thickness in a rat TON model. Moreover, EXOPACAP38 significantly promoted axon regeneration and optic nerve function after injury. These findings indicate that EXOPACAP38 can be used as a treatment option and may have therapeutic implications for patients with TON.
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Affiliation(s)
- Tian Wang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Yiming Li
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Miao Guo
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Xue Dong
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Inflammation Biology, Department of Pharmacology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Mengyu Liao
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Mei Du
- Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Inflammation Biology, Department of Pharmacology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Xiaohong Wang
- Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Inflammation Biology, Department of Pharmacology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Haifang Yin
- Tianjin Key Laboratory of Cellular Homeostasis and Human Diseases, Department of Cell Biology, Tianjin Medical University, Tianjin, China
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
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29
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Abstract
A host of different types of direct and indirect, primary and secondary injuries can affect different portions of the optic nerve(s). Thus, in the setting of penetrating as well as nonpenetrating head or facial trauma, a high index of suspicion should be maintained for the possibility of the presence of traumatic optic neuropathy (TON). TON is a clinical diagnosis, with imaging frequently adding clarification to the full nature/extent of the lesion(s) in question. Each pattern of injury carries its own unique prognosis and theoretical best treatment; however, the optimum management of patients with TON remains unclear. Indeed, further research is desperately needed to better understand TON. Observation, steroids, surgical measures, or a combination of these are current cornerstones of management, but statistically significant evidence supporting any particular approach for TON is absent in the literature. Nevertheless, it is likely that novel management strategies will emerge as more is understood about the converging pathways of various secondary and tertiary mechanisms of cell injury and death at play in TON. In the meantime, given our current deficiencies in knowledge regarding how to best manage TON, "primum non nocere" (first do no harm) is of utmost importance.
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Affiliation(s)
- Neil R Miller
- Department of Ophthalmology, Neurology & Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
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30
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Qu X, Zhu K, Li Z, Zhang D, Hou L. The Alteration of M6A-Tagged Transcript Profiles in the Retina of Rats After Traumatic Optic Neuropathy. Front Genet 2021; 12:628841. [PMID: 33664770 PMCID: PMC7920991 DOI: 10.3389/fgene.2021.628841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/25/2021] [Indexed: 12/27/2022] Open
Abstract
Messager RNA (mRNA) can be modified in a variety of ways, among which the modification of N6-methyladenosine (m6A) is one of the most common ones. Recent studies have found that the m6A modification in mRNA could functionally regulate the splicing, localization, translation, and stability of mRNA, which might be closely related to multiple diseases. However, the roles of m6A modification in traumatic optic neuropathy (TON) are unknown. Herein, we detected the expression of m6A-related genes via quantitative real-time PCR (qRT-PCR) and performed methylated RNA immunoprecipitation sequencing (MeRIP-seq) as well as RNA-sequencing to analyze the alteration profiles of m6A modification after TON. The results showed that the expression of m6A-related genes (METTL3, WTAP, FTO, and ALKBH5) were all upregulated after TON. In all, 2,810 m6A peaks were differentially upregulated and 689 m6A peaks were downregulated. In addition, the hypermethylated and hypomethylated profiles of mRNA transcripts were also identified. To sum up, our study revealed the differentially expressed m6A modification in the early stage of TON, which may provide novel insights into the mechanism and treatment of TON.
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Affiliation(s)
- Xiaolin Qu
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Kaixin Zhu
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhenxing Li
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China.,Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Danfeng Zhang
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Lijun Hou
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
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Khan RS, Ross AG, Aravand P, Dine K, Selzer EB, Shindler KS. RGC and Vision Loss From Traumatic Optic Neuropathy Induced by Repetitive Closed Head Trauma Is Dependent on Timing and Force of Impact. Transl Vis Sci Technol 2021; 10:8. [PMID: 33505775 PMCID: PMC7794277 DOI: 10.1167/tvst.10.1.8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose Traumatic optic neuropathy (TON) is often caused by blunt head trauma and has no currently effective treatment. Common animal models of TON induced by surgical crush injury are plagued by variability and do not mimic typical mechanisms of TON injury. Traumatic head impact models have recently shown evidence of TON, but the degree of head impact necessary to consistently induce TON is not well characterized, and it is examined here. Methods Traumatic skull impacts to C57BL/6J mice were induced using an electromagnetic controlled impact device. One impact performed at two depths (mild and severe), as well as three and five repetitive impacts with an interconcussion interval of 48 hours, were tested. Optokinetic responses (OKRs) and retinal ganglion cell (RGC) loss were measured. Results Five repetitive mild impacts significantly decreased OKR scores and RGC numbers compared with control mice 10 weeks after initial impact, with maximal pathology observed by 6 weeks and partial but significant loss present by 3 weeks. One severe impact induced similar TON. Three mild impacts also induced early OKR and RGC loss, but one mild impact did not. Equivalent degrees of TON were induced bilaterally, and a significant correlation was observed between OKR scores and RGC numbers. Conclusions Repetitive, mild closed head trauma in mice induces progressive RGC and vision loss that worsens with increasing impacts. Translational Relevance Results detail a reproducible model of TON that provides a reliable platform for studying potential treatments over a 3- to 6-week time course.
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Affiliation(s)
- Reas S Khan
- Department of Ophthalmology, F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Ahmara G Ross
- Department of Ophthalmology, F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Puya Aravand
- Department of Ophthalmology, F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Kimberly Dine
- Department of Ophthalmology, F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Evan B Selzer
- Thomas Jefferson University School of Medicine, Philadelphia, PA, USA
| | - Kenneth S Shindler
- Department of Ophthalmology, F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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Abstract
A diagnosis of traumatic brain injury (TBI) is typically based on patient medical history, a clinical examination, and imaging tests. Elevated plasma levels of glial fibrillary acidic protein (GFAP), ubiquitin c-terminal hydrolase L1 (UCH-L1), and neurofilament light chain (NFL) have been observed in numerous studies of TBI patients. It is reasonable to view traumatic optic neuropathy (TON) as a focal form of TBI. The purpose of this study was to assess if circulating GFAP, UCH-L1, and NFL are also elevated in a porcine model of TON. Serum levels of GFAP, UCH-L1, and NFL were measured immediately before optic nerve crush and 1 h post-injury in 10 Yucatan minipigs. Severity of optic nerve crush was confirmed by visual inspection of the optic nerve at time of injury, loss of visual function as measured by flash visual evoked potential (fVEP) at 7 and 14 days, and histological analysis of axonal transport of cholera toxin-β (CT-β) within the optic nerve. Post-crush concentrations of GFAP, UCH-L1, and NFL were all significantly elevated compared with pre-crush concentrations (p < 0.01, p = 0.01, and p < 0.01, respectively). The largest increase was observed for GFAP with the post-injury median concentration increasing nearly sevenfold. The use of these TBI biomarkers for diagnosing and managing TON may be helpful for non-ophthalmologists in particular in diagnosing this condition. In addition, the potential utility of these biomarkers for diagnosing other optic nerve and/or retinal pathologies should be evaluated.
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Affiliation(s)
- Gregory T Bramblett
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Jason N Harris
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Laura L Scott
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Andrew W Holt
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
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Wladis EJ, Aakalu VK, Sobel RK, McCulley TJ, Foster JA, Tao JP, Freitag SK, Yen MT. Interventions for Indirect Traumatic Optic Neuropathy: A Report by the American Academy of Ophthalmology. Ophthalmology 2020; 128:928-937. [PMID: 33161071 DOI: 10.1016/j.ophtha.2020.10.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To review the literature on the efficacy and safety of medical and surgical interventions for indirect traumatic optic neuropathy (TON), defined as injury to the nerve that occurs distal to the optic nerve head. METHODS A literature search was conducted on October 22, 2019, and updated on April 8, 2020, in the PubMed database for English language original research that assessed the effect of various interventions for indirect TON. One hundred seventy-two articles were identified; 41 met the inclusion criteria outlined for assessment and were selected for full-text review and abstraction. On full-text review, a total of 32 studies met all of the study criteria and were included in the analysis. RESULTS No study met criteria for level I evidence. Seven studies (1 level II study and 6 level III studies) explored corticosteroid therapy that did not have uniformly better outcomes than observation. Twenty studies (3 level II studies and 17 level III studies) assessed optic canal decompression and the use of corticosteroids. Although visual improvement was noted after decompression, studies that directly compared surgery with medical therapy did not report uniformly improved outcomes after decompression. Four studies (1 level II study and 3 level III studies) evaluated the use of erythropoietin. Although initial studies demonstrated benefit, a direct comparison of its use with observation and corticosteroids failed to confirm the usefulness of this medication. One study (level II) documented visual improvement with levodopa plus carbidopa. Complication rates were variable with all of these interventions. Pharmacologic interventions generally were associated with few complications, whereas optical canal decompression carried risks of serious side effects, including hemorrhages and cerebrospinal fluid leakage. CONCLUSIONS Despite reports of visual improvement with corticosteroids, optic canal decompression, and medical therapy for indirect TON, the weight of published evidence does not demonstrate a consistent benefit for any of these interventions. In summary, no consensus exists from studies published to date on a preferred treatment for TON. Treatment strategies should be customized for each individual patient. More definitive treatment trials will be needed to identify optimal treatment strategies for indirect TON.
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Affiliation(s)
- Edward J Wladis
- Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical Center, Albany (Slingerlands), New York
| | - Vinay K Aakalu
- Illinois Eye and Ear Infirmary, University of Illinois College of Medicine at Chicago, Chicago, Illinois
| | - Rachel K Sobel
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Timothy J McCulley
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jill A Foster
- Ophthalmic Surgeons and Consultants of Ohio, Columbus, Ohio
| | - Jeremiah P Tao
- Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, Irvine, California
| | - Suzanne K Freitag
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Michael T Yen
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
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Chakraborti C, Saha AK. Grease gun injury of the orbit: A rare case report. Indian J Ophthalmol 2020; 68:1701-1703. [PMID: 32709830 PMCID: PMC7640825 DOI: 10.4103/ijo.ijo_2281_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report a case of intraconal grease gun injury along with traumatic optic neuropathy in a 20-year-old male. He presented with dimness of vision and proptosis of the left eye (LE) following an accidental injury at work place. The computer tomography of orbit revealed hypodense grease orbit. Cream colored grease was continually exuding from the conjunctival wound. Patient improved rapidly after the surgical removal of the grease by anterior orbitotomy. Grease gun injuries to the orbit have rarely been reported. The present case is the eighth report throughout the world, and the first in India as per our knowledge.
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Affiliation(s)
- Chandana Chakraborti
- Department of Ophthalmology, North Bengal Medical College, Darjeeling, West Bengal, India
| | - Ajoy Kumar Saha
- Department of Ophthalmology, North Bengal Medical College, Darjeeling, West Bengal, India
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Abstract
OBJECTIVE This study aimed to evaluate the outcomes of endoscopic optic nerve decompression (EOND) for adults with traumatic optic neuropathy (TON) and seek factors that might affect surgery outcomes. METHODS From January 2016 to June 2019, 16 adults diagnosed with TON, who underwent endoscopic trans-ethmosphenoid optic canal decompression, were reviewed. All the patients were treated with steroids before the surgery. The main outcome measure was an improvement in visual acuity (VA) after treatment. RESULTS Eight (50.0%) patients had residual vision before the surgery, while eight (50.0%) had no light perception. After surgical decompression, partial recovery of VA was achieved in three (18.75%) patients who were operated within 10 days and had residual vision before the surgery. However, no improvement in VA was observed for the remaining patients (81.25%) who were operated more than 10 days after injuries. CONCLUSIONS EOND is beneficial for TON not responding to steroid therapy and can prevent permanent disability if earlier intervention is done prior to irreversible damage to the nerve. Endoscopic optic nerve surgery can decompress the traumatic and edematous optic nerve with proper exposure of optic canal and orbital apex without any major complications. The operation timing and residual vision are important factors affecting outcomes.
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Affiliation(s)
- Jingwen Sun
- Department of Otorhinolaryngology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, P.R. China
| | - Xiaojing Cai
- Department of Otorhinolaryngology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, P.R. China
| | - Wentao Zou
- Department of Otorhinolaryngology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, P.R. China
| | - Jiaxiong Zhang
- Department of Otorhinolaryngology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, P.R. China
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36
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Abstract
Traumatic optic neuropathy (TON) is an important cause of vision loss in the setting of cranial and/or facial trauma. Both direct and indirect variants exist, with the latter being more common. We describe the case of a young male presenting with loss of vision following trauma with an intact globe, an intraorbital foreign body, and Onodi cell hemorrhage. The challenges in diagnoses of type of TON, exact pathology, and management are discussed. We also highlight the role of thin section digital computed tomography imaging which is paramount for timely detection of subtle injuries and their management.
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Affiliation(s)
- Aditi Mehta
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramya Rathod
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chirag Ahuja
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Singh
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep S Virk
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Caras A, Alexander C, Young A, Miller W, Medhkour A. Reconstruction of Complex Cranial and Orbit Fractures with Associated Hemorrhages: Case Report and Review of the Literature. Cureus 2020; 12:e7694. [PMID: 32431973 PMCID: PMC7233501 DOI: 10.7759/cureus.7694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We present our experience following a unique case of coincident intracranial hemorrhage and comminuted fractures of both the squamous temporal bone and zygomaticofrontal orbit. Surgical techniques and outcome for this presentation have yet to be sufficiently described. A 55-year-old male presented following trauma with Glasgow Coma Scale score of 7. Radiographic evaluation revealed comminuted fractures of the squamous temporal bone with extension into the lateral orbit, along with zygomatic process fracture extending 2.5 cm medially into the orbital roof. Zygomaticofrontal orbital roof fragments reached superiorly into the middle cranial fossa and inferiorly into the orbit. Surgical intervention was deemed necessary to address underlying epidural hematoma, subarachnoid hemorrhage, correction of cranial bone defects, and decompression of the optic nerve and other intraorbital nerves. A frontotemporal approach was employed. Repair of temporal and orbital fractures was accomplished using a combination of wire mesh screws and titanium miniplates. Postoperative imaging demonstrated bony approximation and successful evacuation of traumatic hemorrhage. The patient remains functionally and neurologically intact apart from a sluggishly responsive left eye presumed to result from a left optic nerve or ciliary ganglion lesion. Although rapid reconstruction of complex cranial-orbital trauma and hematoma evacuation can permit acceptable gross functional neurological outcome following massive trauma, orbital fracture and subsequent hemorrhagic processes may be the nidus of neurological sequelae in this complex traumatic constellation. Thus, alterations in surgical approach and reconstruction are appropriate in order to maximize neurological function while supporting restoration of cosmetic space.
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Affiliation(s)
- Andrew Caras
- Neurological Surgery, The University of Toledo Medical Center, Toledo, USA
| | - Christopher Alexander
- Neurological Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Alexander Young
- Neurological Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - William Miller
- Neurological Surgery, The University of Toledo Medical Center, Toledo, USA
| | - Azedine Medhkour
- Neurological Surgery, The University of Toledo Medical Center, Toledo, USA
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38
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Thomas CN, Thompson AM, Ahmed Z, Blanch RJ. Retinal Ganglion Cells Die by Necroptotic Mechanisms in a Site-Specific Manner in a Rat Blunt Ocular Injury Model. Cells 2019; 8:E1517. [PMID: 31779177 DOI: 10.3390/cells8121517] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 12/17/2022] Open
Abstract
Closed-globe injury can cause visual loss in military and civilian populations, with retinal cell death, including retinal ganglion cell (RGC) degeneration, leading to irreversible blindness. RGC and optic nerve (ON) degeneration after eye or head injury is termed traumatic optic neuropathy (TON). There are currently no treatments for RGC loss, therefore novel therapeutics to prevent RGC death or promote axonal regeneration are a priority. We investigated necroptotic signaling mechanisms in a rat blunt ocular injury model. After bilateral blunt trauma, protein expression and retinal localization of necroptosis pathway members (receptor interacting protein kinase 1, RIPK1; receptor interacting protein kinase 3, RIPK3; and mixed lineage kinase domain like pseudokinase, MLKL) were assessed by Western blot and immunohistochemistry (IHC), and potent necroptosis inhibitor Necrostatin-1s (Nec-1s) was delivered by intravitreal injection to one eye and vehicle to the contralateral eye. RGC and photoreceptor survival were assessed by cell counting and outer nuclear layer (ONL) thickness measurements on histology. The neuroprotective effects of Nec-1s were assessed in primary retinal culture by βIII-tubulin+ RGC cell counts. MLKL protein expression were upregulated at 48 h after injury and MLKL immunolocalised to retinal binding protein with multiple splice (RBPMS)+ RGC, inner nuclear cells and ONL cells, specifically at the retinal injury site. RIPK3 expression did not increase but RIPK3 co-immunolocalised with RBPMS+ RGC in intact and injured retinae. In vitro, a Nec-1s concentration of 0.01 pg/µL was RGC neuroprotective. In the blunt ocular injury rat model, Nec-1s prevented RGC death at the center of the impact site but did not protect against ONL thinning or provide functional restitution. RGC degeneration in our blunt ocular injury model is site-specific, with necroptosis driving death at the center of the focal impact site.
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Shi LL, Zhen HT. [Application of image navigation assisted nasal endoscopic surgery in optic nerve decompression]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 32:1893-1896. [PMID: 30550134 DOI: 10.13201/j.issn.1001-1781.2018.24.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Indexed: 11/12/2022]
Abstract
Objective:To explore the application and to evaluate the advantage of image navigation assisted nasal endoscopic surgery in optic nerve decompression. Method:Sixty patients accepted the image navigation assisted nasal endoscopic surgery therapy in optic nerve decompression were included in this retrospective study and followed up for about six months to four years. Result:The visual acuity was improved in 16 cases with visual acuity above light. One case is 10 cm index, two cases are 40 cm index, one case is 70 cm index, the visual acuity of rest 12 cases was between 0.04 and 0.30, two of them were missing from the field of view, the effective rate was 100%. The 44 cases without light sensation before operation, postoperative visual acuity was improved in 11 cases, four of which were light sensation and visible figure. Visual acuity of seven cases was between 0.03 and 0.08, one of them was missing from the field of view, the effective rate was 25%. No complications occurred. Conclusion:With the help of the image navigation, it is convenient and accurate to locate the anatomical marker sites such as orbital apex, optic canal and fracture site, internal carotid artery and so on, as a result, the accuracy and the success rate of the surgery were greatly improved.
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Affiliation(s)
- L L Shi
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - H T Zhen
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
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40
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Chen M, Jiang Y, Pang WH, Li N, Niu YZ, Zhao H. [A 212 cases analysis of treatment for traumatic optic neuropathy by nasal endoscopic opticnerve decompression]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 31:1411-1414. [PMID: 29797995 DOI: 10.13201/j.issn.1001-1781.2017.18.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Indexed: 11/12/2022]
Abstract
Objective:To explore the clinical features and therapeutic efficacy of nasal endoscopic optic nerve decompression for traumatic optic neuropathy (TON)treatment.Method:Two hundred and twelve cases (217 eyes) with TON were retrospectively analyzed in our study, who were treated with nasal endoscopic optic nerve decompression in our institution from 1999 to 2016. χ ² -test was used to explore the potential prognostic factors on visual acuity.Result:All patients were followed up from 6 months to 2 years postoperatively, and the effective rate was 54.38%(118/217).In the 166 eyes with no light perception (NLP), the effective rate was 46.39% (77/166), while in the 51 eyes with light perception (LP), the effective rate was 80.39% (41/51).The therapeutic efficacy of patients with LP or above LP was better than that of NLP, and the difference was statistically significant(χ ²=18.186, P< 0.01).Moreover, the therapeutic efficacy of patients without an optic canal fracture was better than that with an optic canal fracture,and the difference had statistical significance (χ ²=10.096, P<0.01).Conclusion:The efficacy of nasal endoscopic optic nerve decompression on TON was positive, and even for the patients with NLP or a long history also should have a try.
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Affiliation(s)
- M Chen
- Department of Otolaryngology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Y Jiang
- Department of Otolaryngology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - W H Pang
- Department of Otolaryngology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - N Li
- Department of Otolaryngology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Y Z Niu
- Department of Otolaryngology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - H Zhao
- Department of Pathology, the Affiliated Hospital of Qingdao University
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41
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Suetov AA, Boiko EV, Alekperov SI. A case of a tumor-like condition in the optic nerve head of a pig. Clin Case Rep 2018; 6:2202-2207. [PMID: 30455921 PMCID: PMC6230634 DOI: 10.1002/ccr3.1858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 11/07/2022] Open
Abstract
A tumor-like condition of the optic nerve head of unknown etiology was found in a domestic pig. Clinical and histological manifestations suggest that the unusual tumor-like condition is probably a variant of proliferative optic neuropathy caused by unknown nonspecific damage (perhaps trauma), which was received earlier.
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Affiliation(s)
- Alexey A. Suetov
- State Scientific Research Test Institute of Military MedicineSt. PetersburgRussia
| | - Ernest V. Boiko
- St. Petersburg BranchS. Fyodorov Eye Microsurgery Federal State InstitutionSt. PetersburgRussia
- Department of OphthalmologyMilitary Medical AcademySt. PetersburgRussia
- Department of OphthalmologyMechnikov North‐West State Medical UniversitySt. PetersburgRussia
| | - Sergey I. Alekperov
- State Scientific Research Test Institute of Military MedicineSt. PetersburgRussia
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42
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Chen M, Jiang Y, Zhang J, Li N. Clinical treatment of traumatic optic neuropathy in children: Summary of 29 cases. Exp Ther Med 2018; 16:3562-3566. [PMID: 30250525 PMCID: PMC6143998 DOI: 10.3892/etm.2018.6637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 07/31/2018] [Indexed: 11/06/2022] Open
Abstract
Clinical features and treatments for traumatic optic neuropathy (TON) in children are reported. Twenty-nine children were enrolled in the Affiliated Hospital of Qingdao University from April 1999 to May 2015 for retrospective analysis. Of these 29 patients, 5 received drug therapy, and 24 received drug therapy combined with surgical therapy. Among the patients who received surgical therapy, 23 received nasal endoscopic optic decompression under general anaesthesia, and 1 received nasal endoscopic orbital decompression under general anaesthesia. All the patients were followed up for at least 6 months. In 29 cases, 48.28% (14/29) had visual improvement. Of the 5 patients who received drug therapy, 3 showed improvement (60%). Of the 24 cases who received drug and surgical therapy, 11 showed improvement (45.83%). Of the 22 patients who lost visual sensitivity, 10 showed improvement (45.45%). Of the 7 cases with visual acuity above basic light sensitivity, 4 showed improvement (57.14%). In conclusion, TON in children can lead to poor diagnosis and prognosis because of the difficulty of examining children and their limited language expression ability. Early ophthalmologic examination is therefore essential for children with craniofacial injuries, and proper treatment should be undertaken as soon as possible.
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Affiliation(s)
- Min Chen
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
- Shandong Key Laboratory of Otolaryngology Head and Neck surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Yan Jiang
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
- Shandong Key Laboratory of Otolaryngology Head and Neck surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Jisheng Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
- Shandong Key Laboratory of Otolaryngology Head and Neck surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Na Li
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
- Shandong Key Laboratory of Otolaryngology Head and Neck surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
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43
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Abstract
Traumatic optic neuropathy (TON) is a rare devastating complication of traumatic head injury and is an ophthalmic emergency. Herein, we report a rare case of a 46-year-old gentleman who experienced severe blurring of vision, binocular diplopia, and pain over his left eye following a fall from a tree about three meters in height. Examinations revealed the visual acuity was 6/60 with a marked relative afferent pupillary defect and generalized ophthalmoplegia over his left eye. Emergency computed tomography (CT) brain and orbit showed a left frontotemporoparietal extradural hemorrhage, comminuted frontotemporoparietal and greater wing of sphenoid fracture with a bony spur impinging the lateral rectus and indirectly on the optic nerve. A diagnosis of left frontotemporoparietal bone fracture with traumatic optic neuropathy was made. An emergency left craniotomy, elevation of depressed skull fracture, and evacuation of clot was done. Postoperatively, his visual acuity showed marked improvement with visual acuity of 6/6 and all optic nerve functions were normal.
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Affiliation(s)
- Juni Ejyj
- Ophthalmology, Hospital Universiti Sains Malaysia, Kelantan, MYS
| | - Wen-Jeat Ang
- Ophthalmology, Hospital Universiti Sains Malaysia, Kelantan, MYS
| | - Wan-Hazabbah Wh
- Ophthalmology, Hospital Universiti Sains Malaysia, Kelantan, MYS
| | - Yew Chin Tan
- Neurosurgery, Hospital Universiti Sains Malaysia, Kelantan, MYS
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Kelishadi SS, Zeiderman MR, Chopra K, Kelamis JA, Mundinger GS, Rodriguez ED. Facial Fracture Patterns Associated with Traumatic Optic Neuropathy. Craniomaxillofac Trauma Reconstr 2018; 12:39-44. [PMID: 30815214 DOI: 10.1055/s-0038-1641172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/24/2017] [Indexed: 10/17/2022] Open
Abstract
Traumatic optic neuropathy (TON) is rare. The heterogeneity of injury patterns and patient condition on presentation makes diagnosis difficult. Fracture patterns associated with TON have never been evaluated. Retrospective review of 42 patients diagnosed with TON at the R. Adams Cowley Shock Trauma Center from May 1998 to August 2010 was performed. Thirty-three patients met criteria for study inclusion of fracture patterns. Additional variables measured included patient demographics and mechanism. Cluster analysis was used to form homogenous groups of patients based on different fracture patterns. Fracture frequency was analyzed by group and study population. Visual depiction of fracture patterns was created for each group. Cluster analysis of fracture patterns yielded five common "groups" or fracture patterns among the study population. Group 1 ( n = 3, 9%) revealed contralateral lateral orbital wall (100%), zygoma (67%), and nasal bone (67%) fractures. Group 2 ( n = 7, 21%) demonstrated fractures of the frontal bone (86%), nasal bones (71%), and ipsilateral orbital roof (57%). Group 3 ( n = 14, 43%) involved fractures of the ipsilateral zygoma (100%), lateral orbital wall (29%), as well as frontal and nasal bones (21% each). Group 4 ( n = 5, 15%) consisted of mid- and upper-face fractures; 100% fractured the ipsilateral orbital floor, medial and lateral walls, maxilla, and zygoma; 80% fractured the orbital roof and bilateral zygoma. Group 5 ( n = 4, 12%) was characterized by fractures of the ipsilateral orbital floor, medial and lateral orbital walls (75% each), and orbital roof (50%). A notably high 15 of 33 patients (45%) sustained penetrating trauma. Our study demonstrates five fracture pattern groups associated with TON. Zygomatic, frontal, nasal, and orbital fractures were the most common. Fractures with a combination of frontal, nasal, and orbital fractures are particularly concerning and warrant close attention to the eye.
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Affiliation(s)
| | - Matthew R Zeiderman
- Division of Plastic Surgery, University of California Davis Medical Center, Sacramento, California
| | - Karan Chopra
- Section of Plastic Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Joseph A Kelamis
- Section of Plastic Surgery, Mercy Clinic in Fort Smith, Fort Smith, Arkansas
| | - Gerhard S Mundinger
- Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Eduardo D Rodriguez
- Department of Plastic Surgery, New York University Langone Medical Center, New York
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Abstract
PURPOSE To examine the choroidal thickness in patients with indirect traumatic optic neuropathy (TON) Methods: Patients with unilateral traumatic optic neuropathy over a period of 4 years were included in this study. Horizontal and vertical enhanced-depth imaging (EDI) from spectral-domain optical coherence tomography (SD-OCT) scans of the fovea were obtained in patients with unilateral TON within 2 weeks of injury. The main outcome measure was the choroidal thickness at nine locations. The choroidal thickness was compared between affected and unaffected eyes in the TON group, and the mean difference in the choroidal thickness in both eyes was compared between TON and control groups. RESULTS A total of 16 patients and 20 control subjects were included. The choroidal thickness at horizontal, vertical and average subfoveal, inner temporal, and outer inferior locations was significantly thicker (13-23%) in affected eyes than in unaffected fellow eyes (p = 0.042, 0.046, 0.024, 0.013, 0.018, and 0.027, respectively). The mean difference value between choroidal thickness measurements in both eyes was significantly larger in the TON group than in the control group at the horizontal, vertical and average subfoveal, inner temporal, inner nasal, inner superior, inner inferior, and outer superior locations (p = 0.001, 0.011, <0.001, 0.001, 0.033, 0.014, 0.011, and 0.014, respectively). The choroidal thickness at subfoveal locations showed no statistical difference between TON and control eyes (p > 0.05). CONCLUSION Eyes affected by TON showed a regionally thicker choroid than unaffected fellow eye. This thick choroid might be due to impaired blood circulation and vascular remodeling of the optic nerve head and choroid. These results help to better understand the pathophysiology of TON.
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Affiliation(s)
- Ju-Yeun Lee
- a Department of Ophthalmology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , South Korea
| | - Doo-Ri Eo
- a Department of Ophthalmology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , South Korea
| | - Kyung-Ah Park
- a Department of Ophthalmology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , South Korea
| | - Sei Yeul Oh
- a Department of Ophthalmology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , South Korea
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Sakamoto SI, Makino S, Kawashima H. Traumatic optic neuropathy and central retinal artery occlusion following blunt trauma to the eyebrow. J Gen Fam Med 2017; 18:456-457. [PMID: 29264089 PMCID: PMC5729355 DOI: 10.1002/jgf2.107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/20/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
- Shin-Ichi Sakamoto
- Department of Ophthalmology Jichi Medical University Shimotsuke Tochigi Japan
| | - Shinji Makino
- Department of Ophthalmology Jichi Medical University Shimotsuke Tochigi Japan
| | - Hidetoshi Kawashima
- Department of Ophthalmology Jichi Medical University Shimotsuke Tochigi Japan
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Sitaula S, Dahal HN, Sharma AK. Clinical Evaluation and Treatment Outcome of Traumatic Optic Neuropathy in Nepal: A Retrospective Case Series. Neuroophthalmology 2017; 42:17-24. [PMID: 29467804 DOI: 10.1080/01658107.2017.1331362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/12/2017] [Accepted: 05/13/2017] [Indexed: 10/19/2022] Open
Abstract
This study aims to report the clinical features and role of different treatment modalities in final visual outcome in traumatic optic neuropathy (TON). The authors retrospectively reviewed the records of patients with TON over 4 years. There were 37 patients of unilateral TON. Mean age was 28.70 ± 15.20 years (range: 8-90) and 89% (n = 33) were males. Road traffic accident was the common cause (43.2%), followed by fall injury (35.1%). There was improvement of visual acuity in 51.4% (n = 19) cases. Out of different treatment modalities, high-dose intravenous methylprednisolone (1 g/day) led to significant improvement in final visual acuity (p = 0.013). There was no significant improvement in final visual outcome in patients with poor initial visual acuity and those with intracranial injuries.
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Affiliation(s)
- Sanjeeta Sitaula
- B. P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Hira Nath Dahal
- B. P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Ananda Kumar Sharma
- B. P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
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Karna S, Jain M, Alam MS, Mukherjee B, Raman R. Carotid cavernous fistula with central retinal artery occlusion and Terson syndrome after mid-facial trauma. GMS Ophthalmol Cases 2017; 7:Doc12. [PMID: 28580223 PMCID: PMC5442449 DOI: 10.3205/oc000063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objectives: To report a rare occurrence combination of central retinal artery occlusion (CRAO) and Terson syndrome in a Barrow's type A carotid cavernous fistula (CCF) patient. Methods: Observational case report. Results: A twenty-year-old male patient with a history of road traffic accident presented with periorbital swelling and redness in the left eye. Examination revealed a CRAO with intraretinal and preretinal hemorrhages. On imaging, type A CCF and subarachnoid hemorrhage were detected. He underwent embolization of the fistula for cosmetic blemish. The possible mechanisms and clinical implications are discussed. Conclusion: Patients with a head injury can have serious ocular damage. Posterior segment manifestations of CCFs are varied and at times can occur in various rare combinations, making it challenging. Early recognition of these rare manifestations and a multi-disciplinary approach are needed in patients with head trauma.
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Affiliation(s)
- Satya Karna
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Mukesh Jain
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Md. Shahid Alam
- Department of Orbit Oculoplasty Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, India
| | - Bipasha Mukherjee
- Department of Orbit Oculoplasty Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India,*To whom correspondence should be addressed: Rajiv Raman, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai 600 006, India, E-mail:
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Abstract
Current states of traumatic eye injury are reviewed in terms of epidemiology in the developing countries and developed countries, causes of the trauma, eye injury types, traumatic eye injury diagnostic methods and treatments. Trauma-caused vision-threatening conditions such as open global injury, traumatic optic neuropathy and proliferative vitreoretinopathy are particularly discussed. Also the most updated clinic research in China as Eye Injury Vitrectomy Study is discussed. At the end, the current achievements and research in traumatic eye injury in the world are summerized.
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Affiliation(s)
- Zhuo Chen
- Lakewood Eye Care, Houston, TX, USA,Beijing Tongren Hospital, Beijing, China,Corresponding author. Lakewood Eye Care, Houston, TX, USA.Lakewood Eye CareHoustonTXUSA
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Pokharel S, Sherpa D, Shrestha R, Shakya K, Shrestha R, Malla OK, Pradhananga CL, Pokhrel RP, Shrestha P. Visual Outcome after Treatment with High Dose Intravenous Methylprednisolone in Indirect Traumatic Optic Neuropathy. J Nepal Health Res Counc 2016; 14:1-6. [PMID: 27426704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Traumatic optic neuropathy is an acute injury of the optic nerve due to trauma. It is an ocular emergency, requiring early treatment though there is no proven standard treatment protocol for the condition. Various studies have shown improvement in vision after intravenous steroids, but not statistically significant. Studies have revealed even optical decompression surgery is not the ultimate treatment because of no significant improvement of vision. Our study aims to assess visual outcome after high dose (1 gram) of intravenous methylprednisolone in cases with indirect optic neuropathy. METHODS This was a non-randomized interventional study carried out in Kathmandu Medical College Teaching Hospital from May 1st 2013- June 1st 2014. RESULTS There were 10 cases with indirect traumatic optic neuropathy included in the study. Four cases received IV methylprednisolone and six cases were observed without steroid treatment. Traumatic optic neuropathy was observed more in males[8 (80%)]with higher number in age group 21-30 years old. The visual recovery after intravenous steroid treatment was rapid and beneficial in cases with vision better than Non Perception of Light (NPL), even in cases presented 4 days after the trauma. CONCLUSIONS There was rapid and beneficial improvement in visual acuity after high dose of intravenous steroid treatment in cases with indirect traumatic optic neuropathy with vision better than Non Perception of Light (NPL).
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Affiliation(s)
- S Pokharel
- Department of Ophthalmology, Kathmandu Medical College Teaching Hospital, Nepal
| | - D Sherpa
- Department of Ophthalmology, National Academy of Medical Sciences, Nepal
| | - R Shrestha
- Department of Medicine, Neurology, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
| | - K Shakya
- Department of Ophthalmology, Kathmandu Medical College Teaching Hospital, Nepal
| | - R Shrestha
- Department of Ophthalmology, Kathmandu Medical College Teaching Hospital, Nepal
| | - O K Malla
- Department of Ophthalmology, Kathmandu Medical College Teaching Hospital, Nepal
| | - C L Pradhananga
- Department of Ophthalmology, Kathmandu Medical College Teaching Hospital, Nepal
| | - R P Pokhrel
- Department of Ophthalmology, Kathmandu Medical College Teaching Hospital, Nepal
| | - P Shrestha
- Department of Ophthalmology, Kathmandu Medical College Teaching Hospital, Nepal
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