Over the past decade, ocular imaging strategies have greatly advanced the diagnosis and follow-up of patients with optic neuropathies. Developments in optic nerve imaging have specifically improved ...the care of patients with papilloedema and idiopathic intracranial hypertension, inflammatory optic neuropathies, and compressive optic neuropathies. For example, optic nerve imaging with optical coherence tomography (OCT) is now widely used as an outcome measure in clinical trials of neurological disorders (eg, demyelinating diseases), and OCT findings could be informative of disease progression in patients with various neurodegenerative disorders (eg, Alzheimer's disease or Parkinson's disease). In the past 5 years, multimodality optic nerve imaging has expanded to systematically include focused and wide-field colour and autofluorescence fundus photographs; various types of optic nerve, macular, and vascular OCT; and specific MRI techniques. Such multimodality imaging makes the diagnosis of optic neuropathies easier and provides objective information on optic nerve damage, which is useful for prognosis. Non-mydriatic ocular fundus cameras and OCT have become readily available in non-ophthalmic settings and could easily be implemented in neurological clinics and emergency departments, allowing for direct access to optic nerve imaging and enabling teleconsultations. In the future, these imaging studies could be used in association with artificial intelligence deep-learning systems, which are already transforming the field of ocular imaging.
Global peripapillary retinal nerve fiber layer thickness (pRNFL)/Bruch membrane opening-minimum rim width (BMO-MRW) ratio is an objective and effective parameter to separate glaucomatous optic ...neuropathies (GONs) from nonGONs (NGONs).
This study was undertaken to evaluate the diagnostic capability of the pRNFL/ BMO-MRW ratio to differentiate GONs from NGONs.
This retrospective study included patients with an optic neuropathy (ON), visual loss for>6 months and a confirmed single etiology. pRNFL thickness and BMO-MRW were measured with spectral-domain optical coherence tomography (Spectralis, Heidelberg Engineering, Heidelberg, Germany). The diagnostic accuracies of pRNFL, BMO-MRW and the global pRNFL/BMO-MRW ratio were evaluated with the areas under receiver operating characteristics curves.
One eye each from 171 patients was investigated: 50 primary open angle glaucomas, 15 normal pressure glaucomas, 50 optic neuritises, 15 nonarteritic anterior ischemic ONs, 24 compressive ONs, 10 dominant optic atrophies, and 7 nutritional ONs. The global pRNFL/BMO-MRW ratio had the highest area under receiver operating characteristics curve 0.97 vs. 0.92; P =0.01. It was able to distinguish between GONs and NGONs with a cutoff value of 0.34. Increased mean deviation of the visual field-defect severity was associated with a higher ratio for GONs and a lower ratio for NGONs.
Compared with NGONs and for the same degree of pRNFL thinning, lower BMO- MRW was found to be a specific marker of glaucoma, reflecting the neuroglial architecture changes within the optic nerve head typical of glaucoma and supporting fundamental pathophysiological differences.
Background and purpose
Middle‐aged persons living with HIV (PLHIV) have a heightened risk of more concomitant age‐related comorbidities that are acknowledged as signs of poorer prognosis after ...deep‐brain stimulation of the subthalamic nucleus (STN‐DBS) at younger‐than‐expected ages. To assess the beneficial and adverse effects of STN‐DBS in PLHIV with Parkinson's disease (PD).
Methods
We retrospectively included nine PLHIV with PD who had sustained virological control. Patients were followed up for 7 ± 4 years.
Results
Patients’ mean ages at PD onset and STN‐DBS were 45 ± 15 and 53 ± 16 years, respectively. At STN‐DBS, mean HIV infection and PD durations were 15 ± 12 and 8 ± 4 years, respectively. STN‐DBS significantly improved 1‐year Unified Parkinson's Disease Rating Scale (UPDRS)‐III scores (71%), daily off‐time (63%), motor fluctuations (75%) and daily levodopa‐equivalent dose (68%); mean 5‐year UPDRS‐III score and motor fluctuation improvements remained ~45%. Impulse control disorders (affecting 6/9 patients) fully resolved after STN‐DBS. Postoperative course was uneventful. No serious adverse events occurred during follow‐up.
Conclusion
Our findings indicate that STN‐DBS is a safe and effective treatment for PLHIV with PD.
To assess the characteristics and outcomes of patients with AIDS-related primary CNS lymphoma (AR-PCNSL) in the combined antiretroviral therapy (cART) era systematically treated with high-dose ...methotrexate (HD-MTX).
We retrospectively analyzed (intention-to-treat analysis) 51 consecutive patients with AR-PCNSL (median age 39 years) who were diagnosed from 1996 to 2014 and treated with a median of 6 (range 1-15) infusions of HD-MTX (3 g/m
) combined with cART.
Median all-patients' and survivors' follow-up lasted 23 (range 0-186) and 76 (range 23-186) months, respectively. At PCNSL diagnosis, 83% of the patients were on cART, median plasma HIV load was 175,600 copies/mL, and median CD4+ T-cell count was 24/μL. Median Eastern Cooperative Oncology Group performance status was 2 (range 1-4). Median overall survival (OS) was 5.7 years, with 5- and 10-year rates of 48% and 41%. Median time to progression was not reached (69% at 10 months). PCNSL was the direct cause of 14 deaths, all observed within the 10 months after its diagnosis: 6 patients died before HD-MTX could be administered, 4 had refractory disease, and 4 relapsed. Multivariate analyses retained time interval between AIDS diagnosis and PCNSL diagnosis, age at AR-PCNSL diagnosis, and deep brain structure involvement as independent OS-predictive factors. To restore effective immune function, cART tailored to HIV genotypes was started and combined with HD-MTX; no interactions and no immune reconstitution inflammatory syndrome occurred. No patient died of acute treatment-related toxicity, and 21 of 51 (41%) patients experienced grade 3/4 toxicity.
Combined short-term HD-MTX monochemotherapy and optimal cART simply and effectively treat AR-PCNSL, achieving long-term survival with few relapses.
This study provides Class IV evidence that short-term HD-MTX monochemotherapy improves long-term survival of patients with AIDS with primary CNS lymphoma receiving cARTs.
Background:
A paradoxical discrepancy between severe peripapillary retinal nerve fiber layer (pRNFL) atrophy and good visual outcome had been reported in patients with myelin oligodendrocyte ...glycoprotein-immunoglobulin G (MOG-IgG)-associated optic neuritis (ON). However, only visual acuity (VA) was assessed.
Objectives:
To study visual field (VF) outcomes of patients with MOG-IgG-associated ON and evaluate the correlation between functional eye outcome and retinal structural changes assessed by optical coherence tomography.
Methods:
The records of 32 patients with MOG-IgG-associated ON who underwent ophthalmological examination at least 12 months after ON onset were reviewed. Degree of VF disability was determined by mean deviation (MD).
Results:
At final assessment (median, 35 months), 4.2% of 48 affected eyes (AE) had VA ⩽ 0.1, 40% had abnormal MD, and among AE with final VA ⩾ 1.0, 31% had mild to moderate damage. Thinning of the inner retinal layers was significantly correlated with MD impairment. Analysis demonstrated a threshold of pRNFL thickness (50 µm), below which MD was significantly worse (mean, −2.27 dB vs −17.72 dB; p = 0.0003). ON relapse was significantly associated with poor visual outcome assessed by MD.
Conclusion:
Functional impairment measured with VF is not rare, and MD assessment better reflects actual structural damage.
Background
According to population-based studies, microalbuminuria is associated with subsequent cognitive decline over a 4–6-year period, because of cerebral small-vessel disease (CSVD). This ...prospective cross-sectional study (NCT02852772) was designed to evaluate whether a history of microalbuminuria is associated with subsequent cognitive decline in combined antiretroviral therapy (cART)-treated persons living with human immunodeficiency virus (PLHIVs).
Methods
From our computerized medical database, we identified 30 PLHIVs (median age 52 years), immunovirologically controlled on cART, who had microalbuminuria in 2008 and had undergone, between 2013 and 2015, a comprehensive neuropsychological assessment (NPA) including seven domains (cases): information-processing speed, motor skills, executive functions, attention/working memory, learning/memory, reasoning and verbal fluency. Forty-nine PLHIVs matched for age (median age 48 years;
p
= 0.19), sex, and year of first HIV-seropositivity without microalbuminuria in 2008 were identified and underwent the same NPA between 2013 and 2015 (controls).
Results
Cases performed less well than controls for information-processing speed (
p
= 0.01) and motor skills (
p
= 0.02), but no differences were found for the other cognitive domains and global
z
-scores. A multivariable linear-regression model adjusted for confounding factors confirmed the microalbuminuria effect for the information-processing-speed
z
score.
Conclusion
cART-treated PLHIVs with a history of microalbuminuria subsequently had worse cognitive performances for the information-processing-speed domain, possibly because of CSVD. Our observations should be considered preliminary findings of a temporal link between microalbuminuria, CSVD, and subsequent cognitive impairment.
Primary open-angle glaucoma (POAG) can be associated with abnormal ocular motor behavior, possibly as a compensatory strategy following visual field loss. The aim of this study was to explore the ...characteristics of saccadic eye movements in patients with early-stage POAG without any detectable glaucomatous visual field loss (i.e., preperimetric POAG).
Binocular eye movements were explored in 16 patients with bilateral preperimetric POAG and 16 age-matched healthy controls in a cross-sectional, observational study. Visually guided horizontal prosaccades (5°, 10°, 15°, and 20° amplitude) and antisaccades (12° amplitude) were measured using infrared oculography. The latency, average and peak velocities, amplitude and gain of prosaccades as well as the percentage of errors in the antisaccades task were compared between groups.
POAG patients exhibited a reduced average velocity of saccades compared to controls across all amplitudes of peripheral visual target presentation (P = 0.03). Saccades performed by POAG patients were hypometric, and with reduced amplitude (P = 0.007) and gain (P = 0.01) compared to controls. On average, POAG patients displayed more antisaccade errors (40.6%), as compared to controls (23.4%; P = 0.04).
Here, we show that patients with POAG without detectable glaucomatous visual field loss exhibit altered saccadic eye movements. These abnormalities may indicate disordered cortical and subcortical saccadic regulation, either on the basis of subthreshold visual impairment, or as a result of wider disease-associated neurodegeneration. Additional studies, controlling for glaucoma medications, are required to delineate the neural basis of eye movement abnormalities associated with POAG.
Pupil size not only varies to changes in illumination but is also modulated by several cognitive factors, making it a potentially versatile physiological marker of cortical states. We recorded pupil ...dynamics while subjects continuously reported their bistable perception of ambiguous moving stimuli, plaids, and partially occluded rotating diamonds. We observed small (about 5% of surface change on average) but reliable pupil dilation around (-300 ms to 1.5 s) the button presses indicating the changes of percepts. We found that 70% of pupil dilation could be accounted for by the motor response. The remaining perceptual component was similar for spontaneously occurring transitions and transitions triggered by physical stimulus manipulations. Moreover, the amplitude of pupil modulation in the spontaneous condition was unrelated to the duration of each perceptual state. It is therefore unlikely that the mechanisms of endogenous perceptual bistability reflect in the pupil. In addition, we measured a clear constriction of the pupil after blinks (about 8% of surface change on average). As pupil changes have the potential to entail retino-cortical activity, their monitoring in studies of visual processing could prove worthwhile.
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