Clinical Study Of Non-arteritic Anterior Ischemic Optic Neuropathy Based On OCTA And Resting-state Functional Magnetic Resonance Imagin

Part one Clinical characteristics of patients with nonarteritic anterior ischemic optic neuropathy based on OCTA and microperimetryObjective:OCT,OCTA and microperimetry were used to explore the differences between the patients with NAION in different stages and healthy control group,such as RNFL,GCIPL,optic disc and macular vascular density,macular MS,etc.Meanwhile,qualitative the difference between the affected eyes and the fellow eyes of unilateral patients in different stage,and analyze the correlation with the structure and visual function.Methods:Using a prospective observational study,34 patients(42 eyes)with NAION diagnosed in the ophthalmology department of Beijing Tongren Hospital from January 2021 to December 2021 were collected.They were divided into acute and chronic group according to the time of onset.Healthy people matched with age and gender were included as controls.General eye examination,visual field examination,OCT,OCTA and microperimetry examination were performed to obtain the information of optic disc and macular structure,blood flow and function in different regions.Results:①The RNFL thickness were higher in acute phase than those in the healthy controls(HC)group except temporal quadrant(P<0.05);and they were lower in chronic phase than those in the HC group except nasal part,(P<0.05).There was no significant difference in GCIPL between acute and chronic groups,which were significantly lower than those in HC group(P<0.05).The whole and peripapillary vessel density of optic disc in acute and chronic stage were lower than those in HC group,and the superior temporal quadrant decreased most significantly(P<0.001).But there was no significant difference in peoples with NAION of different stages(P>0.05).Compared with the HC group,the vessel density of superficial vascular plexus(SVP)of macular in whole image,parafovea and perifovea all quadrants decreased significantly in acute and chronic groups(P<0.05).and decreased more significantly in perifovea(P<0.001).Compared with the acute and chronic groups,there was significant difference in the temporal quadrant of parafovea(P=0.036).There was no difference in deep macular vascular density among the three groups(P>0.05).The macular MS of the central and each quadrant in acute and chronic groups of microperimetry was especially lower than HC group(P<0.001),and the fixation rates of 2°and 4° in acute stage were lower than those of HC group.②The thickness of RNFL in the unilateral eye of acute stage was significantly higher than the fellow eye except superior quadrant(P<0.05),and in the chronic stage,it was significantly lower than the fellow eye except the nasal side(P<0.05).Compared with macular GCIPL,vessel density of optic disc and SVP of macular,macular MS,the affected eyes in acute and chronic stage were typical lower than the fellow eyes(P<0.05),but there was no obvious difference in deep macular vessel density between them.③There was a significant correlation between the vessel density of SVP and the thickness of RNFL in the corresponding area in acute group(P<0.01).There was significant correlation between macular MS and superficial vascular density(P=0.029).BCVA,visual field MD and macular MS were significantly correlated with GCIPL(P<0.05).The visual field MD was also negatively correlated with the thickness of RNFL of inferior quadrant and the vascular density in the temporal superior quadrant(P=0.024 and P=0.019).BCVA was also correlated with the vascular density of SVP in macular.Conclusion:The thickness of peripapillary RNFL increased significantly in acute phase and decreased significantly in chronic phase,while the thickness of macular GCIPL decreased significantly in the acute phase.The decrease of optic disc vessel density was most obvious in the temporal quadrant.The decrease of SVP vessel density in macular was mainly in the perifovea quadrants,but there was no significant change in deep macular vessel density.BCVA and macular MS were closely related to macular GCIPL thickness and SVP vascular density in macular.Visual field MD was significantly related to RNFL thickness below optic disc and vascular density above temporal disc.Part two Clinical characteristics of patients with nonarteritic anterior ischemic optic neuropathy based on resting-state functional magnetic resonance imagingObjective:Using rs-fMRI technology,to explore the functional changes of brain nerves in NAION patients and analyze the relationship between them and visual function.Methods:Using a prospective observational study,27 patients with NAION diagnosed in the Department of Ophthalmology of Dongfang Hospital of Beijing University of traditional Chinese medicine from January 2020 to December 2021 were collected.At the same time,26 healthy people were chose as controls with gender,age and education matched.Visual acuity,visual field,OCT and rs-fMRI were examined.The differences of fALFF,ReHo and FC between the two groups were obtained after data processing,and the correlation with ophthalmic clinical indexes was analyzed.Results:The NAION patients show significantly decreased fALFFs in the right lingual gyrus,fusiform gyrus and right parahippocampal gyrus.Compared with the healthy controls,patients with NAION showed higher ReHo in the left and right middle frontal gyrus,the left and right dorsolateral superior frontal gyrus,and lower ReHo in the right lingual gyrus and left insula.In the functional connection with lingual gyrus as the seed point,the connection between lingual gyrus and left thalamus,right precuneus and right caudate nucleus was enhanced in NAION patients.The fALFF of the right lingual gyrus/fusiform gyrus was negatively correlated with the MD and RNFL thickness of the right eye.Through ROC analysis,fALFF and ReHo have higher AUC value,were credible means of diagnosing patient with NAION.Conclusion:Patients with NAION have impairment of visual cortex and functional compensation of some brain networks,which are related to clinical indexes.It reflects the influence of NAION on visual conduction pathway and the plasticity of brain nerve function.Part three The clinical effect of flavored astragalus membranaceus soup on NAION patientsObjective:To observe the effects of flavored astragalus membranaceus soup on visual acuity,visual field,RNFL,GCIPL and vessel density in patients with NAION,and analyze its clinical efficacy in the treatment of NAION of qi deficiency and blood stasis type.Methods:Using a prospective randomized controlled clinical study,42 patients(42 eyes)of NAION diagnosed in the ophthalmology clinic and ward of Dongfang Hospital of Beijing University of traditional Chinese medicine from January 2020 to December 2021 were randomly divided into treatment group and control group.The control group was given basic treatment,and the treatment group was given basic combined with flavored astragalus membranaceus soup.The two groups were treated for 1 month.The visual acuity,visual field,RNFL and GCIPL thickness,optic disc and macular vessel density,TCM syndrome score changes of the two groups were observed before and after treatment,and the therapeutic effects of the two groups were evaluated.Results:After treatment,the visual field MS,visual field MD,RNFL,GCIPLand TCM syndrome score in the two groups were especially lower than those before treatment(P<0.05),and GCIPL in the control group was extremely lower(P<0.001).After treatment,the vessel density of the optic disc in the treatment group decreased significantly,while the SVP density in macular decreased significantly only below the parafovea(P<0.05).There was typical difference in visual field MD and MS between the two groups after treatment,(P=0.046 and P=0.008),but not special difference in BCVA,RNFL and GCIPL of them(P>0.05).The total effective rate of the treatment group was 86.36%,which was higher than 70%of the control group,but the difference is not significant(P>0.05);During the 2-month follow-up,the BCVA,visual field MS,MD and TCM syndrome scores of the treatment group still have differences from those before treatment(P<0.05),while there was no tipical difference in visual field MS and TCM syndrome scores in the control group(P>0.05),while the GCIPL thickness of acular was not significantly reduced in the treatment group(P>0.05).Conclusion:Flavored astragalus membranaceus soup can significantly improve the BCVA,visual field MS and MD levels of NAION patients,and has a certain effect on slowing down the thinning of retinal ganglion cells.