Loss Of Vision
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Author(s):  
Ilaria Testi ◽  
Sandra Vermeirsch ◽  
Carlos Pavesio

Abstract Background Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a rare inflammatory eye disease, affecting the inner choroid and the outer retina. Recent advances in multimodal imaging have been important in the understanding of the pathophysiology of the disease, allowing a better characterization of the morphology of this condition. Methods Narrative review. Results In this review, a comprehensive overview of clinical features, imaging findings, treatment management, and long-term outcomes of patients with APMPPE will be provided. Conclusions Although APMPPE was originally believed to be a self-limited condition with a good prognosis, the disease can be recurrent and result in significant loss of vision function. Fundus imaging plays an important role in the diagnosis and management of the disease, allowing to evaluate response to treatment and onset of complications.


2021 ◽  
Vol 11 (9) ◽  
pp. 1215
Author(s):  
Erwan David ◽  
Julia Beitner ◽  
Melissa Le-Hoa Võ

We wish to make the following correction to the published paper “Effects of Transient Loss of Vision on Head and Eye Movements during Visual Search in a Virtual Environment” [...]


Cells ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 2394
Author(s):  
Nicoletta Marchesi ◽  
Foroogh Fahmideh ◽  
Federica Boschi ◽  
Alessia Pascale ◽  
Annalisa Barbieri

The possible interconnection between the eye and central nervous system (CNS) has been a topic of discussion for several years just based on fact that the eye is properly considered an extension of the brain. Both organs consist of neurons and derived from a neural tube. The visual process involves photoreceptors that receive light stimulus from the external environment and send it to retinal ganglionic cells (RGC), one of the cell types of which the retina is composed. The retina, the internal visual membrane of the eye, processes the visual stimuli in electric stimuli to transfer it to the brain, through the optic nerve. Retinal chronic progressive neurodegeneration, which may occur among the elderly, can lead to different disorders of the eye such as glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR). Mainly in the elderly population, but also among younger people, such ocular pathologies are the cause of irreversible blindness or impaired, reduced vision. Typical neurodegenerative diseases of the CSN are a group of pathologies with common characteristics and etiology not fully understood; some risk factors have been identified, but they are not enough to justify all the cases observed. Furthermore, several studies have shown that also ocular disorders present characteristics of neurodegenerative diseases and, on the other hand, CNS pathologies, i.e., Alzheimer disease (AD) and Parkinson disease (PD), which are causes of morbidity and mortality worldwide, show peculiar alterations at the ocular level. The knowledge of possible correlations could help to understand the mechanisms of onset. Moreover, the underlying mechanisms of these heterogeneous disorders are still debated. This review discusses the characteristics of the ocular illnesses, focusing on the relationship between the eye and the brain. A better comprehension could help in future new therapies, thus reducing or avoiding loss of vision and improve quality of life.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Reza Dana ◽  
Marjan Farid ◽  
Preeya K. Gupta ◽  
Pedram Hamrah ◽  
Paul Karpecki ◽  
...  

Abstract Background Neurotrophic keratopathy (NK) is a relatively uncommon, underdiagnosed degenerative corneal disease that is caused by damage to the ophthalmic branch of the trigeminal nerve by conditions such as herpes simplex or zoster keratitis, intracranial space-occupying lesions, diabetes, or neurosurgical procedures. Over time, epithelial breakdown, corneal ulceration, corneal melting (thinning), perforation, and loss of vision may occur. The best opportunity to reverse ocular surface damage is in the earliest stage of NK. However, patients typically experience few symptoms and diagnosis is often delayed. Increased awareness of the causes of NK, consensus on when and how to screen for NK, and recommendations for how to treat NK are needed. Methods An 11-member expert panel used a validated methodology (a RAND/UCLA modified Delphi panel) to develop consensus on when to screen for and how best to diagnose and treat NK. Clinicians reviewed literature on the diagnosis and management of NK then rated a detailed set of 735 scenarios. In 646 scenarios, panelists rated whether a test of corneal sensitivity was warranted; in 20 scenarios, they considered the adequacy of specific tests and examinations to diagnose and stage NK; and in 69 scenarios, they rated the appropriateness of treatments for NK. Panelist ratings were used to develop clinical recommendations. Results There was agreement on 94% of scenarios. Based on this consensus, we present distinct circumstances when we strongly recommend or may consider a test for corneal sensitivity. We also present recommendations on the diagnostic tests to be performed in patients in whom NK is suspected and treatment options for NK. Conclusions These expert recommendations should be validated with clinical data. The recommendations represent the consensus of experts, are informed by published literature and experience, and may improve outcomes by helping improve diagnosis and treatment of patients with NK.


Author(s):  
Jennifer J Danks ◽  
James D Dalgliesh ◽  
Tom Ayton

Abstract Background The rise of cosmetic injectables has seen new clinical scenarios related to complications. The scenario of hyaluronic acid (HA) aesthetic interventional induced visual loss (AIIVL) has become more recognized. While this complication is rare, there can be delayed recognition and treatment, with limited opportunity to evaluate potential treatments and establish best practice guidelines. Objectives We report a case of documented visual recovery with extra-orbital and intra-orbital hyaluronidase. Central retinal artery occlusion (CRAO) is an ischemic event requiring urgent intervention. We hope to assist protocols being developed for HA AIIVL. Methods Following loss of vision, 675 international units (IU) of hyaluronidase was given immediately to the injection site and extra-orbital area. Within four hours, 3,000 IU intra-orbital and 1,500 IU extra-orbital hyaluronidase was given in the Emergency Department (ED). Results Visual loss in a 38-year-old female, following ipsilateral glabella and nasal injection of 0.15 ml of hyaluronic acid filler Juvéderm Voluma via the nasal tip, was documented at no perception of light (NPL) with afferent pupil defect (APD), CRAO, fundoscopy showing a cherry red spot. This was associated with cerebral irritation and Magnetic Resonance Imaging (MRI) ischemia. Hyaluronidase was injected as described above. The following day, visual acuity (VA) in the affected eye recovered to 6/18 with a relative superior visual field scotoma. VA improved to 6/6 at one month. Conclusions We believe immediate injection, followed by high dose intra-orbital and extra-orbital injection of hyaluronidase, had a positive effect in this case. Recovery of vision was remarkable, from NPL to 6/6, documented at a tertiary referral eye hospital.


Biomolecules ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1239
Author(s):  
Sophie Coyle ◽  
Mohammed Naeem Khan ◽  
Melody Chemaly ◽  
Breedge Callaghan ◽  
Chelsey Doyle ◽  
...  

Glaucoma is a group of optic neuropathies characterised by the degeneration of retinal ganglion cells, resulting in damage to the optic nerve head (ONH) and loss of vision in one or both eyes. Increased intraocular pressure (IOP) is one of the major aetiological risk factors in glaucoma, and is currently the only modifiable risk factor. However, 30–40% of glaucoma patients do not present with elevated IOP and still proceed to lose vision. The pathophysiology of glaucoma is therefore not completely understood, and there is a need for the development of IOP-independent neuroprotective therapies to preserve vision. Neuroinflammation has been shown to play a key role in glaucoma and, specifically, the NLRP3 inflammasome, a key driver of inflammation, has recently been implicated. The NLRP3 inflammasome is expressed in the eye and its activation is reported in pre-clinical studies of glaucoma. Activation of the NLRP3 inflammasome results in IL-1β processing. This pro inflammatory cytokine is elevated in the blood of glaucoma patients and is believed to drive neurotoxic inflammation, resulting in axon degeneration and the death of retinal ganglion cells (RGCs). This review discusses glaucoma as an inflammatory disease and evaluates targeting the NLRP3 inflammasome as a therapeutic strategy. A hypothetical mechanism for the action of the NLRP3 inflammasome in glaucoma is presented.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wei-ning Li ◽  
Xiu-juan Du ◽  
Yu-ting Zhang ◽  
Le-yi Wang ◽  
Jing Zhu

Abstract Background Retinitis pigmentosa (RP) is a rare, progressive, and hereditary disorder that leads to the progressive loss of vision and visual field, and in some cases blindness. The specific relationship between RP and glaucoma has been debated for decades. Methods In this study, we examined a Han RP family with concomitant angle-closure glaucoma (ACG), performed an inductive analysis of their clinical features and assistant results, and applied whole-exome sequencing (WES) technology for a molecular diagnosis. Results A novel transversion mutation (c.626 T > A) was identified in the peripherin-2 (PRPH2) gene in the proband, resulting in the substitution of Valine to aspartic acid in codon 209. A full ophthalmic examination showed that the proband with the c.626 T > A mutation had a typical RP manifestation, with close angles; however, the proband’s elder brother, who lacked the novel mutation, had a normal fundus and open angles. Conclusion Our results extend the genetic mutation spectrum of PRPH2 in RP, and provide evidence to support a genetic correlation between RP and ACG.


2021 ◽  
pp. 875647932110332
Author(s):  
Patrick J. Fish

Intraocular foreign bodies (IOFB) present differently depending on the type of material (wood, glass, metal) for the IOFB, extent of the injury, and location of the injury. IOFB and the injury can cause a perforation or penetration of the globe which can require more extensive treatment including surgery. Proper evaluation of the IOFB and injury can help to determine extent of the injury, the prognosis of the vision, and health of the eye before and after treatment but may be difficult for the physician depending on the view of the posterior chamber being compromised by media or simply by patient sensitivity. The extent of the injury may also prevent proper evaluation due to swelling, lacerations on the lids, or pain. Proper ophthalmic sonography can provide a quick evaluation of the globe for any IOFB in both the outpatient setting as well as emergency department setting. Evaluation via sonography may allow the physician to accurately diagnose and properly treat the patient to help restore and prevent further loss of vision.


Author(s):  
Atik Rahmawati ◽  
Dina Fatmawati

Optic neuritis denotes an inflammation of the optic nerve characterized by loss of vision progressing over a few hours to a few days. Based on the site involved, optic neuritis is classified as retrobulbar (2/3 cases), atypical, and typical optic neuritis. In some cases, pediatric patients with optic neuritis have atypical symptoms and signs and no comprehensive medical history leading to a challenging diagnosis. In this case series, we report cases of optic neuritis in pediatric patients at different ages and clinical features treated with methylprednisolone 1 mg/kg body weight and oral mecobalamin and respective management. With a poor initial vision at presentation, the patients recovered rapidly.  The diagno-sis of optic neuritis was based on anamnesis, ophthalmologic examination, and simple laboratory and physical examination. The administration of steroids at a dose of 1 mg/kg body weight followed by a taper of dose can improve vision loss.


2021 ◽  
Vol 22 (15) ◽  
pp. 7994
Author(s):  
Stefania Vernazza ◽  
Francesco Oddone ◽  
Sara Tirendi ◽  
Anna Maria Bassi

Retinal ganglion cells (RGCs) are a population of neurons of the central nervous system (CNS) extending with their soma to the inner retina and with their axons to the optic nerve. Glaucoma represents a group of neurodegenerative diseases where the slow progressive death of RGCs results in a permanent loss of vision. To date, although Intra Ocular Pressure (IOP) is considered the main therapeutic target, the precise mechanisms by which RGCs die in glaucoma have not yet been clarified. In fact, Primary Open Angle Glaucoma (POAG), which is the most common glaucoma form, also occurs without elevated IOP. This present review provides a summary of some pathological conditions, i.e., axonal transport blockade, glutamate excitotoxicity and changes in pro-inflammatory cytokines along the RGC projection, all involved in the glaucoma cascade. Moreover, neuro-protective therapeutic approaches, which aim to improve RGC degeneration, have also been taken into consideration.


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