Purpose: Nonarteritic anterior ischemic optic neuropathy (NAION) is the second most common form of optic neuropathy. Most patients show no improvement over time. Until now, there is still no definitive therapy for NAION. The available literatures on the possible treatment of NAION are quite diverse and controversial. Neuroprotection strategies have been suggested as one of the potential treatments for NAION. This review aims to critically evaluate the literature on neuroprotective strategy for NAION. Methods: This report was written in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We performed a systematic literature search in Pubmed, Science Direct, Proquest, and Cochrane databases. Only neuroprotective agents that directly work in protecting neurons were included. The outcome of interest in this review is retinal ganglion cell density and apoptosis for animal studies and retinal nerve fiber layer thickness for human studies. Results: The systematic search identified 591 studies of which 24 met the eligibility criteria, including 21 animal studies and three human studies. Only a few of the studies evaluated the same treatments, showing how diverse neuroprotector treatments are currently being evaluated as NAION treatment. From 21 animal studies, 14 studies showed significantly higher retinal ganglion cell density (1.49- to 2.81-fold) with neuroprotective treatment compared to control group. Two of three human studies in this review had also found a beneficial effect of preserving retinal nerve fiber layer thickness in NAION patients. Conclusions This review suggests the potential of neuroprotection as a viable option in the quest for an effective treatment strategy for NAION. Further studies, particularly clinical studies, are necessary to establish its efficacy in NAION patients.

Purpose: This study investigated demographics, clinical profiles, imaging results, and treatment outcomes in patients with carotid cavernous fistula (CCF). Methods: This retrospective analysis examined medical records of the patients with CCF from January 2016 to January 2022. The study included 51 cases: 34 traumatic and 17 spontaneous CCFs. Results: A total of 51 patients with CCFs was analyzed. Traumatic CCF (34 patients, 66.7%) was more common than spontaneous CCF (17 patients, 33.3%). Traumatic CCF predominantly affected male patients, while spontaneous CCF was more frequent in female patients (p = 0.005). Clinical signs including proptosis and lagophthalmos were more common in traumatic CCF, with significant differences in eye movement restriction (p = 0.006) and bruit (p = 0.008). According to the Barrow classification, all spontaneous CCF cases were categorized as types B, C, or D, whereas traumatic CCF was predominantly classified as type A (p < 0.001). Endovascular treatment was more effective than conservative treatment in reducing clinical signs of traumatic CCF (p < 0.05), while no significant differences were observed in outcomes for spontaneous CCF between the two approaches. Conclusions Spontaneous CCF is less common than traumatic CCF in this study cohort. Traumatic and spontaneous CCF may have different clinical characteristics. Eye movement restriction and bruit are more frequently observed in traumatic CCF. After treatment for traumatic CCF, the incidence of proptosis, conjunctival abnormalities, and bruit is significantly lower in patients who undergo endovascular treatment compared to those who receive conservative management.

Purpose: This study investigated demographics, clinical profiles, imaging results, and treatment outcomes in patients with carotid cavernous fistula (CCF). Methods: This retrospective analysis examined medical records of the patients with CCF from January 2016 to January 2022. The study included 51 cases: 34 traumatic and 17 spontaneous CCFs. Results: A total of 51 patients with CCFs was analyzed. Traumatic CCF (34 patients, 66.7%) was more common than spontaneous CCF (17 patients, 33.3%). Traumatic CCF predominantly affected male patients, while spontaneous CCF was more frequent in female patients (p = 0.005). Clinical signs including proptosis and lagophthalmos were more common in traumatic CCF, with significant differences in eye movement restriction (p = 0.006) and bruit (p = 0.008). According to the Barrow classification, all spontaneous CCF cases were categorized as types B, C, or D, whereas traumatic CCF was predominantly classified as type A (p < 0.001). Endovascular treatment was more effective than conservative treatment in reducing clinical signs of traumatic CCF (p < 0.05), while no significant differences were observed in outcomes for spontaneous CCF between the two approaches. Conclusions Spontaneous CCF is less common than traumatic CCF in this study cohort. Traumatic and spontaneous CCF may have different clinical characteristics. Eye movement restriction and bruit are more frequently observed in traumatic CCF. After treatment for traumatic CCF, the incidence of proptosis, conjunctival abnormalities, and bruit is significantly lower in patients who undergo endovascular treatment compared to those who receive conservative management.

Purpose: This study investigated demographics, clinical profiles, imaging results, and treatment outcomes in patients with carotid cavernous fistula (CCF). Methods: This retrospective analysis examined medical records of the patients with CCF from January 2016 to January 2022. The study included 51 cases: 34 traumatic and 17 spontaneous CCFs. Results: A total of 51 patients with CCFs was analyzed. Traumatic CCF (34 patients, 66.7%) was more common than spontaneous CCF (17 patients, 33.3%). Traumatic CCF predominantly affected male patients, while spontaneous CCF was more frequent in female patients (p = 0.005). Clinical signs including proptosis and lagophthalmos were more common in traumatic CCF, with significant differences in eye movement restriction (p = 0.006) and bruit (p = 0.008). According to the Barrow classification, all spontaneous CCF cases were categorized as types B, C, or D, whereas traumatic CCF was predominantly classified as type A (p < 0.001). Endovascular treatment was more effective than conservative treatment in reducing clinical signs of traumatic CCF (p < 0.05), while no significant differences were observed in outcomes for spontaneous CCF between the two approaches. Conclusions Spontaneous CCF is less common than traumatic CCF in this study cohort. Traumatic and spontaneous CCF may have different clinical characteristics. Eye movement restriction and bruit are more frequently observed in traumatic CCF. After treatment for traumatic CCF, the incidence of proptosis, conjunctival abnormalities, and bruit is significantly lower in patients who undergo endovascular treatment compared to those who receive conservative management.

Purpose: This study investigated demographics, clinical profiles, imaging results, and treatment outcomes in patients with carotid cavernous fistula (CCF). Methods: This retrospective analysis examined medical records of the patients with CCF from January 2016 to January 2022. The study included 51 cases: 34 traumatic and 17 spontaneous CCFs. Results: A total of 51 patients with CCFs was analyzed. Traumatic CCF (34 patients, 66.7%) was more common than spontaneous CCF (17 patients, 33.3%). Traumatic CCF predominantly affected male patients, while spontaneous CCF was more frequent in female patients (p = 0.005). Clinical signs including proptosis and lagophthalmos were more common in traumatic CCF, with significant differences in eye movement restriction (p = 0.006) and bruit (p = 0.008). According to the Barrow classification, all spontaneous CCF cases were categorized as types B, C, or D, whereas traumatic CCF was predominantly classified as type A (p < 0.001). Endovascular treatment was more effective than conservative treatment in reducing clinical signs of traumatic CCF (p < 0.05), while no significant differences were observed in outcomes for spontaneous CCF between the two approaches. Conclusions Spontaneous CCF is less common than traumatic CCF in this study cohort. Traumatic and spontaneous CCF may have different clinical characteristics. Eye movement restriction and bruit are more frequently observed in traumatic CCF. After treatment for traumatic CCF, the incidence of proptosis, conjunctival abnormalities, and bruit is significantly lower in patients who undergo endovascular treatment compared to those who receive conservative management.

Purpose: This study investigated demographics, clinical profiles, imaging results, and treatment outcomes in patients with carotid cavernous fistula (CCF). Methods: This retrospective analysis examined medical records of the patients with CCF from January 2016 to January 2022. The study included 51 cases: 34 traumatic and 17 spontaneous CCFs. Results: A total of 51 patients with CCFs was analyzed. Traumatic CCF (34 patients, 66.7%) was more common than spontaneous CCF (17 patients, 33.3%). Traumatic CCF predominantly affected male patients, while spontaneous CCF was more frequent in female patients (p = 0.005). Clinical signs including proptosis and lagophthalmos were more common in traumatic CCF, with significant differences in eye movement restriction (p = 0.006) and bruit (p = 0.008). According to the Barrow classification, all spontaneous CCF cases were categorized as types B, C, or D, whereas traumatic CCF was predominantly classified as type A (p < 0.001). Endovascular treatment was more effective than conservative treatment in reducing clinical signs of traumatic CCF (p < 0.05), while no significant differences were observed in outcomes for spontaneous CCF between the two approaches. Conclusions Spontaneous CCF is less common than traumatic CCF in this study cohort. Traumatic and spontaneous CCF may have different clinical characteristics. Eye movement restriction and bruit are more frequently observed in traumatic CCF. After treatment for traumatic CCF, the incidence of proptosis, conjunctival abnormalities, and bruit is significantly lower in patients who undergo endovascular treatment compared to those who receive conservative management.

Since coronavirus disease 2019 was declared a global pandemic by the World Health Organization, it has become a challenging situation to continue medical education, including in Indonesia. The situation prohibited face-to-face (direct) educational activities in clinical settings, therefore also postponing examinations involving especially procedural skills. Adaptations were urgently needed to maintain the delivery of high-stake examinations to sustain the number of ophthalmology graduates and the continuation of eye health service. Objective structured clinical examination (OSCE) has been one of our widely used method to assess clinical competencies for ophthalmology residents, and is the one method that involves gatherings, close contact of examiners, examinees and patients, therefore the most difficult to adjust. Pandemic challenges brought technical changes in our delivering the OSCE to online, maximizing digital platforms of meetings, while still concerned to guarding the safety of candidates, patients and staffs. OSCE scenarios were also made as timely efficient as possible by changing continuous station models to a cascade one. The purpose of this article is to document our experience in conducting a feasible and reproducible OSCE in this pandemic era filled with limitations.