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Choi DD, Kim KA, Park KA, Oh SY. Pregnancy prevalence and outcomes after optic neuritis in South Korea. Sci Rep 2023; 13:12167. [PMID: 37500694 PMCID: PMC10374557 DOI: 10.1038/s41598-023-38851-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023] Open
Abstract
To compare pregnancy rates and complications in women with and without a history of optic neuritis (ON). A nationwide, population-based, retrospective study using data from the Korean National Health Claims from January 2011, to December 2017 was done. ON cohort (ON group) consisting of women aged 18 to 50 with a history of ON and 1:3 age-matched controls (control group) were compared for pregnancy and delivery rates using logistic regression after adjusting for possible confounders. Pregnancy-ON cohort (pregnancy-ON group), women aged 18 to 55 with a history of ON and pregnancy, and 1:3 age at pregnancy matched controls (pregnancy-control group) were analyzed for pregnancy complications using logistic regression after adjusting for covariates. ON group (n = 2516) showed decreased odds ratio (OR) for pregnancy [Adjusted OR2: 0.716, 95% confidence interval (CI): 0.626-0.820] and delivery (adjusted OR2: 0.647, 95% CI: 0.554-0.756) compared to controls (n = 7548). Pregnancy-ON group (n = 550) showed increased risk of delayed fetal growth (adjusted OR2: 9.867, 95% CI: 1.224-79.564), pre-eclampsia (adjusted OR2: 8.327, 95% CI: 2.911-23.819), preterm delivery (adjusted OR2: 3.914, 95% CI: 2.667-5.742), pregnancy and postpartum infection (adjusted OR1: 1.671, 95% CI: 1.296-2.154), diabetes in pregnancy (adjusted OR2: 1.365, 95% CI: 1.062-1.754) compared to pregnancy-control group (n = 1650). Our population-based cohort study suggests that history of ON is associated with decreased pregnancy and delivery rates. It may be a risk factor for various pregnancy complications.
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Affiliation(s)
- Daye Diana Choi
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea
| | - Kyung-Ah Kim
- Statistics and Data Center, Samsung Medical Center, Seoul, Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
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CHAUDHURY PRANATI, MISRA ANITA, MOHANTY SUBHRAJYOTI, BADWAL KALPANA, GUPTA RUPA, SUBUDHI PRIYAMBADA. A STUDY ON CLINICAL PROFILE AND OUTCOME OF VISUAL PARAMETERS OF OPTIC NEURITIS PATIENTS IN A TERTIARY EYE CARE CENTRE. Asian J Pharm Clin Res 2023:68-70. [DOI: 10.22159/ajpcr.2023.v16i7.48208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
Abstract
Introduction: Optic neuritis (ON) is the inflammation of the optic nerve secondary to autoimmune, infectious, or inflammatory conditions.
Objective: The objective is to study the clinical profile and changes in visual parameters after the treatment of patients with ON.
Methods: This prospective interventional research was done at the ophthalmology department of a tertiary eye care center. 36 cases diagnosed with ON have been analyzed, treated, and followed up for 1 year, for the type of clinical presentation, rate of recurrence, and changes in visual parameters.
Results: The prevalence rate was bimodal, more common among age groups between 46 and 55 years at 32% and age group 16–25 at 27%. A higher prevalence rate was seen in females in 63% of cases. The bilateral presentation was observed in 18%. 44% of cases presented as retrobulbar neuritis (RBN) whereas 56% were as papillitis. At 1 year follow up Optic disc edema suggestive of papillitis was seen in 17% of cases, normal disc with RBN in 44% and disc pallor in 32% discs. At the final follow-up after 1 year, 75% of patients could read maximum (10/13) color plates, 64% of cases showed standard contrast sensitivity and 47% showed normal visual field. VA of 6/60 or worse at presentation was seen in 53% cases and <6/12 in (84%) cases which improved to better than 6/12 in 58% cases and better than 6/60 in 67% cases at final follow up at 1 year. The most common visual field abnormality at presentation was generalized field constriction in (34%), central or centrocecal scotoma in (18%), hemianopia or quadrantanopia (12%), and enlarged blind spot in (06%) cases. During the final follow-up at 1 year, 22 cases (61%) showed normal field. Visual Field could not be tested in (30%) at presentation as vision was <3/60, although visual evoked potential was abnormal in all of 36 (100%) cases with mean P 100 latency being 128 ms. Furthermore, 3 (8%) cases demonstrated additional neurological symptoms till the final follow-up and were subsequently identified to be multiple sclerosis (MS). Recurrence rate was 08 (22%) within 1 year follow-up, of which 06 (17%) cases were clinically RBN and 02 (05%) were papillitis.
Conclusion: In our study, findings of clinical profile and visual outcomes of ON patients were different from that of Western studies as well as from those done previously in the Indian population, notably lesser prevalence of MS, although other differences were not very significant.
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Park K, Yang HK, Han J, Kim S, Park SE, Lee H, Han S, Oh SY, Hwang J, Meduri A. Characteristics of Optic Neuritis in South Korean Children and Adolescents: A Retrospective Multicenter Study. J Ophthalmol 2022; 2022:1-8. [PMID: 36119139 PMCID: PMC9473900 DOI: 10.1155/2022/4281772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/15/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To analyze the clinical characteristics and prognosis of optic neuritis (ON) in pediatric patients aged <19 years in South Korea. Methods This multicenter retrospective cohort study included 127 pediatric patients (median age: 10.3 (IQR: 7.3–14.2) years; female, 62.2%) who experienced ON for the first time between January 2004 and January 2018, with data obtained from five tertiary university-based hospitals in Korea. When ON was bilateral, the worse eye was selected for analysis. The baseline clinical characteristics and prognoses of patients, as well as the associations between these parameters, were analyzed. Results The baseline clinical characteristics of the patients were as follows: best-corrected visual acuity (BCVA) < 20/200, 65.9%; pain on eye movement, 47.2%; optic disc swelling, 66.9%; and bilateral involvement, 41.7%. Among 101 patients who were followed up for ≥6 months, 48 (47.5%), 12 (11.9%), 19 (18.8%), 13 (12.9%), and 9 (8.9%) had been diagnosed with isolated ON, recurrent ON, multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and acute disseminated encephalomyelitis (ADEM)-related ON, respectively. At the latest visit, 81.9% and 71.1% had achieved BCVA of ≥20/40 and ≥ 20/25, respectively. Only disc swelling at presentation was associated with poor baseline BCVA (coefficient: 0.31, P=0.004) and greater improvement in BCVA (coefficient: 0.49, P = 0.001P=0.001); there were no significant associations between the baseline factors and final BCVA. Conclusions This study demonstrated pediatric ON-related clinical characteristics and visual outcomes in South Korea. Within this cohort, in about 40.6% of patients, ON was associated with other demyelinating diseases, namely, MS, NMOSD, and ADEM.
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Ambasta A, Kusumesh R, Sharma J, Sinha BP, Shree S, Gupta A, Priyadarshi RN. Clinico-epidemiologic characteristics of optic neuritis in a tertiary eye centre in Eastern India based on the status of serum aquaporin-4 antibody. Indian J Ophthalmol 2022; 70:490-496. [PMID: 35086223 PMCID: PMC9023929 DOI: 10.4103/ijo.ijo_290_21] [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: 11/17/2022] Open
Abstract
Purpose: To elucidate the clinico-epidemiologic characteristics of optic neuritis based on the status of serum aquaporin-4 antibody (AQP4-Ab) in patients with optic neuritis (ON). Methods: Medical records of 106 patients with ON and a follow-up of 3 years were reviewed. For each patient, the following data were extracted: medical history, findings of the ocular examination, brain, orbital or spinal MRI, and serological tests for AQP4. The ON was classified as typical or atypical based on disc examination and improvement in vision after intravenous methylprednisolone (IVMP). The clinical findings (typical or atypical), disease course, and outcomes were analyzed according to the serostatus of the ON. Results: 10 patients ((9.4%) were seropositive for AQP4-Ab; all had atypical ON. 96 patients (91%) were seronegative for AQP4-Ab: 36 atypical ON and 60 typical ON. Profound visual impairment at presentation was seen in all patients. However, at the end of the study period, seropositive and seronegative atypical ON had poor visual outcomes as compared to seronegative typical ON (P = 0.002). Five seropositive and four seronegative patients with atypical ON developed transverse myelitis. Bilateral disease with relapse was more in seropositive patients (80%); however, seronegative with atypical ON also had bilateral presentation and relapse in 42% and 41%, respectively. Conclusion: AQP4-Ab seropositive patients mostly present with atypical features such as bilateral recurrent ON, poor visual outcome, and increased incidence of transverse myelitis. However, atypical clinical features can also be seen in seronegative ON with a poor visual outcome and a recalcitrant course.
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Affiliation(s)
- Anita Ambasta
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Rakhi Kusumesh
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Janardan Sharma
- Department of Neurology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Bibhuti Prassan Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Srishti Shree
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Abhishek Gupta
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Rajeev N Priyadarshi
- Department of Radiology, All India Institute of Medical Sciences, Patna, Bihar, India
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Reen Wang C, Hsu SM, Chen YC. Rheumatoid arthritis with aquaporin-4 antibody-positive neuromyelitis optica receiving rituximab therapy. Arch Rheumatol 2021; 37:153-155. [PMID: 35949868 PMCID: PMC9326371 DOI: 10.46497/archrheumatol.2022.8688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/05/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Chrong Reen Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sheng-Min Hsu
- Department of Ophthalmology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ying-Chen Chen
- Department of Medical Imaging, National Cheng Kung University Hospital, Tainan, Taiwan
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Abstract
Idiopathic Intracranial Hypertension (IIH), also known as pseudotumor cerebri is a clinical syndrome of unknown etiology, which typically affects young, obese women of childbearing age and is characterized by increased intracranial pressure and bilateral papilledema. Unilateral and highly asymmetrical papilledema is a rare presentation in IIH occurring in less than 4% of patients with definite IIH and can poses a diagnostic challenge for the treating physician as it usually raises the suspicion of localized ocular pathology. As per current consensus, papilledema results in stasis of axoplasmic transport due to mechanical compression, leading to secondary vascular changes of venous dilation and hemorrhage. Given this mechanism, the underlying reasons for unilateral and asymmetrical papilledema remain unclear.
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Affiliation(s)
- Mousumi Banerjee
- Rajendra Prasad Centre For Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Phuljhele Aalok
- Rajendra Prasad Centre For Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- All India Institute of Medical Sciences, New Delhi, India
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Jari M, Mohammadi T, Taheri E. Bilateral Retrobulbar Optic Neuritis as the First Manifestation of Neuro-Behçet Disease. Case Rep Rheumatol 2020; 2020:8834399. [PMID: 33083081 DOI: 10.1155/2020/8834399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/13/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
Background Behçet disease (BD) is a polygenic and chronic autoinflammatory multisystem vasculitis. Acute optic neuritis has been rarely reported in patients with BD, especially in children. Case Presentation. We reported an 8-year-old girl with a sudden visual loss and color vision impairment. The patient had a history of recurrent oral aphthous ulcers, genital ulcers, and chronic abdominal pain. On ophthalmic examination, anterior and posterior chambers and funduscopy of both eyes were normal. The results of laboratory tests for infectious and rheumatic diseases were normal. Brain magnetic resonance imaging and the result of cerebrospinal fluid analysis for oligoclonal bands and auto-antibodies were also normal. Pathergy skin test and human leukocyte antigens (HLA) B5 and HLA-B51 were positive. The patient was recognized as a case of BD-related bilateral retrobulbar optic neuritis and was treated by corticosteroids, azathioprine, colchicine, and infliximab. Conclusion Retrobulbar optic neuritis may be the first manifestation of neuro-BD.
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Koseoglu M, Tutuncu M. Conversion of Optic Neuritis to Relapsing Remitting Multiple Sclerosis: A Retrospective Comorbidity Cohort Study. Eur Neurol 2020; 83:287-292. [PMID: 32690849 DOI: 10.1159/000507547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/10/2020] [Accepted: 03/26/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to determine the risk of multiple sclerosis (MS) conversion after optic neuritis (ON) and to identify the predictive factors on conversion in Turkish patients. METHODS Patients whose first clinical attacks had been ON were included in the study. The primary end point was the diagnosis of clinical relapse-remitting MS. RESULT Except for the bilateral involvement rate, the clinical and demographic characteristics of the cohort are similar to Western studies. Though one-third of the patients with ON had bilateral involvement, bilateral involvement reduces the risk of conversion. Also, active lesions at the initial cranial magnetic resonance imagination increase the conversion rate. CONCLUSION This research confirms previous findings and contributes additional evidence that if the patients have unilateral involvement and active lesions, they should be closely monitored. Moreover, our research supports the hypothesis that risk factors may be affected by racial, environmental, and genetic factors.
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Affiliation(s)
- Mesrure Koseoglu
- Neurology Department/University of Health Sciences Istanbul Bakirköy Prof. Dr. Mazhar Osman Psychiatric Training and Research Hospital, Istanbul, Turkey
| | - Mesude Tutuncu
- Neurology Department/University of Health Sciences Istanbul Bakirköy Prof. Dr. Mazhar Osman Psychiatric Training and Research Hospital, Istanbul, Turkey,
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Kim DS, Hong EH, Shin YU, Kang MH, Seong M, Cho HY. A Comparison of Retinal Thickness Changes According to Initial Optic Disc Edema in Optic Neuritis Patients. J Korean Ophthalmol Soc 2020. [DOI: 10.3341/jkos.2020.61.7.803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kim H, Park KA, Oh SY, Min JH, Kim BJ. Association of Optic Neuritis with Neuromyelitis Optica Spectrum Disorder and Multiple Sclerosis in Korea. Korean J Ophthalmol 2019; 33:82-90. [PMID: 30746915 PMCID: PMC6372377 DOI: 10.3341/kjo.2018.0050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 05/29/2018] [Accepted: 09/12/2018] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To describe the clinical characteristics and course of optic neuritis (ON) and its association with neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) in Korea. METHODS In this retrospective case series, 125 eyes of 91 Korean patients with ON were included. The medical documents of adult patients with ON were retrospectively reviewed. Patients were assigned into idiopathic ON, NMOSD, and MS groups according to the presence of an association with NMOSD or MS for subgroup analysis. Clinical characteristics, disease course, and visual and systemic prognosis were analyzed. RESULTS During the mean follow-up of 3.7 years, 73 patients were diagnosed as idiopathic ON, 14 patients were diagnosed as NMOSD, and four patients developed definite MS. At the final visit, there were 13 (13%) eyes out of 100 eyes with idiopathic ON, nine (43%) eyes out of 21 eyes with NMOSD, and one (25%) eye out of four eyes with MS had a severe visual loss of 20 / 200 or less. The mean Expanded Disability Status Scale was 3.1 ± 1.5 in NMOSD and 1.8 ± 1.5 in the MS group at the final visit. In the NMOSD group, 50% of patients showed severe visual loss in at least one eye or were unable to ambulate without assistance at the final visit (5.3 ± 4.4 years after the initial episode of ON). CONCLUSIONS Fourteen percent of patients showed positive results for NMO-immunoglobulin G test and 50% of patients with NMOSD showed a severe visual loss in at least one eye or were unable to ambulate without assistance. The proportion of MS was relatively low in Korean ON patients.
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Affiliation(s)
- HyoJeong Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ju Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Cheung SSL, Lau GKK, Chan KH, Wong IYH, Lai JSM, Tang WK, Shih KC. Optic neuritis as the initial clinical presentation of limbic encephalitis: a case report. J Med Case Rep 2018; 12:357. [PMID: 30509326 PMCID: PMC6276199 DOI: 10.1186/s13256-018-1893-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/23/2017] [Accepted: 10/25/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Limbic encephalitis is characterized by rapid onset of working memory deficit, mood changes, and often seizures. The condition has a strong paraneoplastic association, but not all cases are invariably due to tumors. CASE PRESENTATION We present a case of limbic encephalitis in a Chinese patient who initially presented to our hospital with optic neuritis and no other neurological symptoms. The diagnosis was made radiologically, and cognitive and neurological symptoms did not occur until 5 months later. Extensive investigations for autoimmune, infective, and neoplastic causes were all negative. A working diagnosis of paraneoplastic neurological syndrome was made, and the patient is being managed with high-dose steroid therapy according to the Optic Neuritis Treatment Trial protocol during relapses, as well as with tumor surveillance. CONCLUSIONS This case highlights ocular symptoms as important clues for diagnosing neurological diseases, as well as autoimmune encephalitis as an important differential diagnosis in the management of "idiopathic" optic neuritis in the Chinese population.
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Affiliation(s)
- Stephanie S L Cheung
- Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong SAR
| | - Gary K K Lau
- Department of Medicine, Li Ka Shing Faculty of Medicine, 21 Sassoon Road, Pokfulam, Hong Kong SAR
| | - Koon-Ho Chan
- Department of Medicine, Li Ka Shing Faculty of Medicine, 21 Sassoon Road, Pokfulam, Hong Kong SAR
| | - Ian Y H Wong
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR
| | - Jimmy S M Lai
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR
| | - Wai Kiu Tang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong SAR
| | - Kendrick C Shih
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR.
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Hansapinyo L, Vivattanaseth C. Clinical Characteristics, Treatment Outcomes and Predictive Factors in Optic Neuritis. Open Ophthalmol J 2018; 12:247-255. [PMID: 30258505 PMCID: PMC6131319 DOI: 10.2174/1874364101812010247] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/17/2018] [Accepted: 07/24/2018] [Indexed: 01/31/2023] Open
Abstract
Background: The causes, clinical presentations and treatment outcomes of optic neuritis are distinct among different populations. Early diagnosis based on clinical presentations plays an important role in treating optic neuritis patients. Objective:
The study aimed to determine clinical characteristics, treatment outcomes and predictive factors of treatment outcomes in optic neuritis patients with and without demyelinating disease. Methods: A retrospective descriptive study of optic neuritis patients carried out between January 2009 and December 2016 was done. Univariate analysis and multivariate logistic regression analysis were used to evaluate the predictive factors of treatment outcomes. Results: Among 150 patients with optic neuritis, 58 patients were diagnosed with Neuromyelitis Optica Spectrum Disease (NMOSD), 23 patients were diagnosed with Multiple Sclerosis (MS) and 69 patients were idiopathic. The age at presentation in the NMOSD group was significantly younger than the MS group and the idiopathic group. The female:male ratio was significantly lower in the idiopathic group than in the NMOSD group. The initial Best Corrected Visual Activity (BCVA) of 20/20-20/60 (p = 0.001) and the idiopathic group (p =0.030) was associated with good visual outcomes. Initial BCVA of < 20/200 (p = 0.009) and the NMOSD group (p < 0.001) was associated with poor visual outcomes. Conclusion: NMOSD is a more common cause of optic neuritis than MS in Thai population. Female patients with poor initial VA, poor response to steroids treatment, and presenting recurrent attacks are highly suspicious for NMOSD. Optic neuritis without associated demyelinating disease has a better visual outcome and lower recurrence rate.
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Affiliation(s)
- Linda Hansapinyo
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chayanee Vivattanaseth
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
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Affiliation(s)
- Tae-Seen Kang
- Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Woohyuk Lee
- Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Yeon-Hee Lee
- Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Korea
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Karti O, Karti DT, Kilic İH, Gokcay F, Celebisoy N. Baseline demographics, clinical features, and treatment protocols of 240 patients with optic neuropathy: experiences from a neuro-ophthalmological clinic in the Aegean region of Turkey. Int Ophthalmol 2017; 39:155-166. [PMID: 29260500 DOI: 10.1007/s10792-017-0799-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze the demographic patterns, clinical characteristics, and treatment protocols of optic neuropathies. MATERIALS AND METHODS The hospital data of patients with optic neuropathy admitted to the Department of Neuro-ophthalmology in a tertiary referral center in Turkey between January 2010 to January 2017 were retrospectively analyzed. Demographic patterns, clinical features, treatment protocols, and the natural disease courses were assessed. RESULTS The total number of patients with optic neuropathy seen over this period was 240, which consist of 43 with idiopathic optic neuritis (17.9%), 40 with multiple sclerosis-related optic neuritis (16.7%), 12 with chronic relapsing inflammatory optic neuritis (5.0%), 12 with atypical optic neuritis (5.0%), 11 with neuromyelitis optica spectrum disorders-related optic neuritis (4.6%), 90 with non-arteritic ischemic optic neuropathy (37.5%), 4 with arteritic ischemic optic neuropathy (1.7%), 10 with traumatic optic neuropathy (4.1%), 6 with compressive optic neuropathy (2.5%), and 12 with mitochondrial optic neuropathy [9 with toxic optic neuropathy (3.7%) and 3 with Leber's hereditary optic neuropathy (1.2%)]. There were 101 males (42%) and 139 females (58%). The mean age was 43.34 ± 15.86 years. CONCLUSION This study reported the demographics, clinical characteristics, and treatment protocols of optic neuropathies in a neuro-ophthalmology specialty clinic at a tertiary referral center in Turkey during the past decade. The data may be useful in assessing the global status of optic neuropathies.
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Affiliation(s)
- Omer Karti
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Saim Cıkrıkcı cad. No: 59, Bozyaka, Izmir, Turkey.
| | - Dilek Top Karti
- Department of Neurology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - İlay Hilal Kilic
- Department of Neurology, Ege University Medical Faculty, Izmir, Turkey
| | - Figen Gokcay
- Department of Neurology, Ege University Medical Faculty, Izmir, Turkey
| | - Nese Celebisoy
- Department of Neurology, Ege University Medical Faculty, Izmir, Turkey
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Khadse R, Ravindran M, Pawar N, Maharajan P, Rengappa R. Clinical profile and neuroimaging in pediatric optic neuritis in Indian population: A case series. Indian J Ophthalmol 2017; 65:242-245. [PMID: 28440255 PMCID: PMC5426131 DOI: 10.4103/ijo.ijo_939_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose of the study: The purpose of this study was to report clinical features, neuroimaging, and visual outcome in pediatric optic neuritis (ON) in Indian population. Materials and Methods: This is a retrospective study of children up to the age of 16 years, diagnosed with ON, that presented at pediatric and neuroophthalmology clinic of a tertiary eye care center, in South India, within the period of 2010–2015. Results: We identified 62 eyes of 40 children diagnosed as ON within the study period. The mean age was 11.15 ± 3.24 years (1–15 years) with mean follow-up of 13 months. In this series, there was female preponderance (67%). Mean logarithm of the minimum angle of resolution visual acuity at presentation was 1.14 ± 0.93, which after treatment recovered to 0.10 ± 0.26 at final visit (P < 0.001). Involvement was bilateral in 22 children (55%) and recurrent in 3 eyes of 3 children. Preceding febrile illness was reported in seven cases (18%). Four (10%) cases were diagnosed as multiple sclerosis (MS), one with neuromyelitis optica, and one with acute disseminated encephalomyelitis. One case was associated with tuberculous meningitis, 1 with septicemia, and 1 with bilateral maxillary sinusitis. Neuroimaging studies of optic nerve in 14 children demonstrated isolated optic nerve enhancement. Magnetic resonance imaging brain revealed white matter T2 hyperintense lesions separate from optic nerve in ten cases, of which four cases were diagnosed as MS. Conclusions: Bilateral presentation was common, association with MS was low. Papillitis was more frequent than retrobulbar neuritis and prognosis was good in pediatric ON in Indian population.
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Affiliation(s)
- Rutika Khadse
- Department of Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Meenakshi Ravindran
- Department of Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Neelam Pawar
- Department of Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Padmavathy Maharajan
- Department of Neurophthalmology, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Ramakrishnan Rengappa
- Department of Neurophthalmology, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
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Kang H, Chen T, Li H, Xu Q, Cao S, Wei S. Prognostic factors and disease course in aquaporin-4 antibody-positive Chinese patients with acute optic neuritis. J Neurol 2017; 264:2130-2140. [PMID: 28879451 DOI: 10.1007/s00415-017-8606-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 06/23/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 11/27/2022]
Abstract
The objective is to assess the frequency of AQP4-Ab in Chinese patients with optic neuritis (ON) and to investigate the prognostic implications of AQP4-Ab seropositivity in such patients. The presence of aquaporin-4 (AQP4) antibodies in human AQP4-transfected cells was determined by indirect immunofluorescence, and the diagnostic and prognostic relevance of AQP4 antibodies in 215 Chinese patients with optic neuritis was evaluated. The patients were enrolled from the Chinese People's Liberation Army General Hospital (PLAGH) and followed up to 1-228 months. Kaplan-Meier survival analysis was used to investigate the visual outcomes and prognostic characteristics of 70 patients who were aquaporin-4 antibody seropositive, and altogether 115 eyes were involved. AQP4-Ab was detectable in 70/215 (32.6%) patients with acute monosymptomatic optic neuritis. These AQP4-Ab seropositive patients were diagnosed as sufferers of neuromyelitis optica (NMO) (n = 10), NMO spectrum disease (NMOSD) (n = 41), multiple sclerosis (MS) (n = 1), and acute optic neuritis (AON) (n = 18). Moreover, AQP4-Ab levels did not vary between seropositive AON and NMO-ON and did not correlate with disease severity. Finally, the male gender, older age at onset, number of relapses, concomitant autoimmune antibodies, and optic lesions in magnetic resonance imaging (MRI) were associated with the AQP4-Ab seropositive status and the risk of developing permanent visual disability. Acute optic neuritis has a higher incidence of anti-aquaporin-4 antibody in China than in Western countries, and AQP4 antibody is a sensitive and specific biomarker for discriminating NMO-ON from other types of optic neuritis during the early stage of the disease course.
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Affiliation(s)
- Hao Kang
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Tingjun Chen
- Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Fuxing Road No. 28, Haidian District, Beijing, 100853, China
| | - Hongyang Li
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Quangang Xu
- Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Fuxing Road No. 28, Haidian District, Beijing, 100853, China
| | - Shanshan Cao
- Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Fuxing Road No. 28, Haidian District, Beijing, 100853, China
| | - Shihui Wei
- Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Fuxing Road No. 28, Haidian District, Beijing, 100853, China.
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Hata M, Miyamoto K. Causes and Prognosis of Unilateral and Bilateral Optic Disc Swelling. Neuroophthalmology 2017; 41:187-191. [PMID: 29344057 DOI: 10.1080/01658107.2017.1299766] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 02/22/2017] [Accepted: 02/22/2017] [Indexed: 10/19/2022] Open
Abstract
The authors reviewed 93 consecutive cases with optic disc swelling (ODS) to compare clinical manifestations and prognosis among the causes. Among unilateral ODS patients ≥50 years old and without pain, anterior ischaemic optic neuropathy accounted for 87.5%. Furthermore, papilloedema (PE) presented unilateral ODS with an atrophic or hypoplastic disc in the opposite eye. Despite no differences for age and initial visual acuity between PE and pseudopapilloedema, the two main causes of bilateral ODS, some PE patients showed poor visual prognosis. Understanding differences in frequencies and clinical features of ODS related to cause and age group can help to accurately determine cause and predict outcome.
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Affiliation(s)
- Masayuki Hata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, Japan
| | - Kazuaki Miyamoto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, Japan
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Son DY, Park KA, Seok SS, Lee JY, Oh SY. Initial Pattern of Optic Nerve Enhancement in Korean Patients with Unilateral Optic Neuritis. Korean J Ophthalmol 2017; 31:71-79. [PMID: 28243026 PMCID: PMC5327177 DOI: 10.3341/kjo.2017.31.1.71] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 07/03/2016] [Accepted: 08/10/2016] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to demonstrate whether the pattern of optic nerve enhancement in magnetic resonance imaging (MRI) can help to differentiate between idiopathic optic neuritis (ON), neuromyelitis
optica (NMO), and multiple sclerosis (MS) in unilateral ON. Methods An MRI of the brain and orbits was obtained in patients with acute unilateral ON. Patients with ON were divided into three groups: NMO, MS, and idiopathic ON. The length and location of the abnormal optic nerve enhancement were compared for ON eyes with and without NMO or MS. The correlation between the pattern of optic nerve enhancement and the outcome of visual function was analyzed. Results Of the 36 patients with ON who underwent an MRI within 2 weeks of the onset, 19 were diagnosed with idiopathic ON, 9 with NMO, and 8 with MS. Enhancement of the optic nerve occurred in 21 patients (58.3%) and was limited to the orbital segment in 12 patients. Neither the length nor the location of the optic nerve enhancement was significantly correlated with visual functions other than contrast sensitivity or the diagnosis of idiopathic ON, MS, or NMO. Patients with greater extent of optic nerve sheath enhancement and more posterior segment involvement showed higher contrast sensitivity. Conclusions Our data revealed that the pattern of optic nerve enhancement was not associated with diagnosis of idiopathic ON, NMO, or MS in Korean patients with unilateral ON. We believe further studies that include different ethnic groups will lead to a more definitive answer on this subject.
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Affiliation(s)
- Dae Yong Son
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Sie Seok
- Center for Clinical Specialty, Department of Ophthalmology, National Cancer Center, Goyang, Korea
| | - Ju-Yeun Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee TH, Ji YS, Park SW, Heo H. Retinal ganglion cell and axonal loss in optic neuritis: risk factors and visual functions. Eye (Lond) 2017; 31:467-74. [PMID: 27858936 DOI: 10.1038/eye.2016.253] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/26/2016] [Indexed: 01/23/2023] Open
Abstract
PurposeThe peripapillary retinal nerve fiber layer (pRNFL) and the macular ganglion cell-inner plexiform layer (GCIPL) are important predictive factors for the prognosis of optic neuritis (ON). We investigated the risk factors for pRNFL and GCIPL thinning in ON and its relationship with visual function.Patients and methodsWe analyzed 33 eyes of 33 patients with a first attack of unilateral ON. Patients were divided into two groups according to pRNFL and GCIPL thinning, using spectral-domain optical coherence tomography. We evaluated patients' age, sex, color vision, visual acuity (VA), optic nerve findings on MRI, elapsed period from onset of visual symptoms to steroid treatment, visual field (VF) mean deviation (MD), average pRNFL thickness, and GCIPL thickness.ResultsThere was no patient with residual VF defect in the groups without pRNFL or GCIPL thinning. Significant correlations were found between pRNFL (some sectors) and GCIPL (all sectors) thickness and BCVA and VF MD (P<0.03 for all). Multivariate logistic regression analysis revealed that only worse initial VF MD was a significant risk factor of pRFNL and GCIPL thinning after ON (OR, 0.841; 95% CI, 0.730-0.970; P=0.017 and OR, 0.871; 95% CI, 0.761-0.998; P=0.046, respectively).ConclusionRetinal ganglion cell and axonal losses occurred in ON cases showing severe initial VF loss. Therefore, it is necessary to pay more attention to the degree of initial VF loss in ON while considering the possibility of residual VF loss accompanying pRNFL and GCIPL thinning.
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Saxena R, Phuljhele S, Menon V, Gadaginamath S, Sinha A, Sharma P. Clinical profile and short-term outcomes of optic neuritis patients in India. Indian J Ophthalmol 2015; 62:265-7. [PMID: 24722269 PMCID: PMC4061659 DOI: 10.4103/0301-4738.121131] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: To evaluate the clinical profile and short-term visual outcome of optic neuritis (ON) patients in India. Materials and Methods: In this prospective study carried out over a period of 3 years, 99 eyes of 83 ON patients were examined and followed up for 10.8 ± 8.2 months for type of presentation, recurrence rate, and visual outcome. Results: Mean age was 27.6 ± 8.8 years. Female preponderance was seen (70% of cases). Papillitis (53.5% of eyes) was more common than retrobulbar neuritis (46.5% of eyes). Bilateral presentation was seen in 19.3% cases. Baseline median logMAR visual acuity (VA) was 1.6 ± 0.8, which improved to 0.2 ± 0.6, with approximately 64% of eyes retaining VA of 20/40 or more. Two patients had previous diagnosis of multiple sclerosis (MS). MS was newly diagnosed in two patients. Recurrence was seen in 16% of eyes and was more common in cases of retrobulbar neuritis. Conclusion: The clinical profile of ON in Indian patients is different from that in the Western population. Unlike reported in the Western literature, papillitis is frequent in the Indian setup, with lower recurrence rates but poorer outcomes.
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Affiliation(s)
- Rohit Saxena
- Department of Neuro-Ophthalmology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Peng JT, Cong HR, Yan R, Kong XY, Jiang HQ, Wei WB, Zhang XJ. Neurological outcome and predictive factors of idiopathic optic neuritis in China. J Neurol Sci 2014; 349:94-8. [PMID: 25577315 DOI: 10.1016/j.jns.2014.12.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 08/20/2014] [Revised: 12/16/2014] [Accepted: 12/19/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND The neurological outcome and predictive factors of idiopathic optic neuritis (ION) in China are largely unknown. OBJECTIVE The aim of this paper is to study the neurological outcome of Chinese ION and to investigate the early predictors for multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). METHOD Retrospective medical record review and supplementary follow-up of 107 ION patients was performed. Statistical analysis of the baseline characteristics as risk factors for ION patients converting into MS or NMOSD was performed. RESULTS With an average disease course of 9.5years, 19 of the 107 (17.7%) ION patients developed either MS (9, 8.4%) or NMOSD (10, 9.3%). The estimated 5-year and 10-year combined accumulative risk rates were 14.1% and 26.0%, respectively. Significantly higher estimated accumulative conversion risk was found in female versus male (P=0.047), adult versus children (P=0.032), patients with brain MRI lesions versus patients without leasions (P=0.026), patients with CSF positive oligoclonal bands and/or elevated IgG index versus without (P=0.003) and patients with poor visual recovery versus patients with good recovery (P=0.007). Furthermore, brain white matter lesions and good visual recovery were statistically more common typically in MS converters compared with the NMOSD converters (P=0.01 and P=0.006, respectively). CONCLUSION The combined conversion rate for ION to MS/NMO in Chinese population was lower than the reported rate for Western countries. In addition to some previously reported high risk factors, white matter lesions on the brain MRI at baseline and good visual recovery were found to be good predictors for Chinese ION converting into MS whereas poor visual recovery with a normal brain MRI suggested a higher likelihood of the ION converting into NMOSD.
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Affiliation(s)
- Jing-ting Peng
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing 100730, China.
| | - Heng-ri Cong
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing 100730, China.
| | - Rong Yan
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing 100730, China.
| | - Xiu-yun Kong
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing 100730, China.
| | - Han-qiu Jiang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing 100730, China.
| | - Wen-bin Wei
- Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing 100730, China.
| | - Xiao-jun Zhang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing 100730, China.
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Abstract
Optic neuritis is an inflammatory condition of the optic nerve characterized by a sudden onset of unilateral visual loss, usually affecting young females. Demyelination associated with multiple sclerosis (MS) is the most common cause in regions where MS is prevalent; while in other places, there are a substantial proportion of cases where infective or autoimmune causes are seen. Optic Neuritis Treatment Trial (ONTT) was the first major study that provided information on the natural history, role of steroids in treatment and risk of development of MS. Subsequently, numerous clinical trials have evaluated different modalities of management of optic neuritis and MS. The Controlled High-Risk Subjects Avonex Multiple Sclerosis Prevention Study (CHAMPS); the Prevention of Relapses and Disability by Interferon β-1a Subcutaneously in Multiple Sclerosis (PRISMS) Trial; and, most recently, the Betaferon in Newly Emerging Multiple Sclerosis for Initial Treatment (BENEFIT) Study have provided large amount of information on the natural history of optic neuritis and management options available. However, due to the low prevalence of MS reported in Asian studies, high cost of therapy and indefinite time period of treatment, it may not be cost effective to start interferon therapy in most cases.
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Affiliation(s)
- Vimla Menon
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Woung LC, Chung HC, Jou JR, Wang KC, Peng PH. A Comparison of Optic Neuritis in Asian and in Western Countries. Neuroophthalmology 2011; 35:65-72. [PMID: 30151023 DOI: 10.3109/01658107.2011.557851] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 10/27/2010] [Accepted: 11/03/2010] [Indexed: 11/13/2022] Open
Abstract
Acute demyelinating optic neuritis is a common optic neuropathy in young adults. There is usually satisfactory visual recovery. However, some patients convert to multiple sclerosis (MS) with potential sequelae of neurological disability. The Optic Neuritis Treatment Trial in the United States was conducted prospectively for 15 years and provided valuable data about clinical course, efficacy of steroid treatment, and risk of conversion to MS. Compared to the many studies in Western countries, research concerning optic neuritis in Asia has so far not been extensive. However, cumulative evidence shows that various features of this disorder differ between patients of Caucasian and Oriental descent. In this article we review up-to-date studies on optic neuritis in Asia and compare the results with prior literature. Prospective and multi-centre studies are currently underway in these regions to increase our understanding of optic neuritis in Asia.
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Affiliation(s)
| | - Hui-Chuan Chung
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - Jieh-Ren Jou
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kai-Chen Wang
- Department of Neurology, Cheng-Hsin General Hospital, Taipei, Taiwan
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Abstract
PURPOSE To investigate the clinical manifestations and diagnoses of optic disc swelling. METHODS The medical records of 49 patients who experienced optic disc swelling between March 2008 and June 2009 were retrospectively reviewed. The characteristics of non-arteritic anterior ischemic optic neuropathy (NA-AION) and optic neuritis (ON), which showed optic disc swelling most commonly, were compared. RESULTS NA-AION was the most common disorder (34.7%) that presented with optic disc swelling. ON was identified in 15 patients (30.6%). Seven out of 49 patients (14.3%) had intracranially associated diseases, such as papilledema and compressive optic neuropathy. Pseudopapilledema was noted in four patients (8.2%). Other diseases (e.g., papillophlebitis, neuroretinitis, and diabetic papillopathy) were seen in six patients (12.2%). Ocular pain was observed more commonly in patients with ON (p = 0.001). Patients with ON expected a better visual prognosis than patients with NA-AION (0.12 ± 0.32 vs. 0.49 ± 0.35, p = 0.001). CONCLUSIONS NA-AION and ON should be considered in the differential diagnosis when patients with optic disc swelling present to the neuro-ophthalmology clinic. Detailed history taking and supportive examinations, such as visual field, color-vision and imaging tests, should also be performed as indicated. Regular follow-up of such exams is necessary for the differential diagnosis of these diseases.
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Affiliation(s)
- Jong Jin Jung
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
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Cha DM, Kim SJ, Kim JH, Choung HK, Yu YS. Clinical Features and the Effect of High-Dose Steroid Therapy in Korean Optic Neuritis Patients. J Korean Ophthalmol Soc 2011. [DOI: 10.3341/jkos.2011.52.9.1083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Dong Min Cha
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Seong Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Jeong Hun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Ho Kyung Choung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul Metropolitan Boramae Hospital, Seoul, Korea
| | - Young Suk Yu
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
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Wang XL, Yu T, Xia DZ, Zhang JS, Yan QC, Luo YH. Measurement of retinal nerve fiber layer thickness in optic atrophy eyes of patients with optic neuritis using optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 2010; 248:1013-8. [PMID: 20191363 DOI: 10.1007/s00417-010-1326-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 01/19/2010] [Accepted: 02/04/2010] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To measure the retinal nerve fiber layer (RNFL) thickness using optical coherence tomography (OCT) in optic atrophy eyes of patients with optic neuritis and investigate the correlation between the RNFL thickness and the visual function. METHODS To compare the RNFL thickness using StratusOCT, three groups of the subjects were enrolled, including 72 patients with optic atrophy with definite demyelinating optic neuritis history (the neuritis group), 47 patients with advanced POAG atrophic neuropathy (the POAG group), and 47 healthy subjects (the control group). The correlation between the RNFL thickness and visual function parameters were investigated in the neuritis group, including the best-corrected visual acuity (BCVA), the visual field mean deviation (MD), pattern standard deviation (PSD), and P(100) latency of visual evoked potentials (VEP). RESULTS The average RNFL thickness, superior, nasal and inferior thicknesses were significantly thinner in both the neuritis group and the POAG group than those in the control group (p < 0.05), while they were higher in the neuritis group than the POAG group (p < 0.05). The significant correlations were found both between the average RNFL thickness and BCVA (r = 0.35, p < 0.05), MD (r = 0.43, p < 0.05), and PSD (r = 0.39, p < 0.05). CONCLUSION In comparison to the advanced POAG and normal eyes, the RNFL thickness was decreased moderately in the optic atrophy eyes resulting from demyelinating optic neuritis and was quantitatively correlated with the visual function parameters.
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Lim SA, Sitoh YY, Chng SM, Yi BP, Goh KY. Magnetic Resonance Imaging in Acute Optic Neuritis in Singapore. Ann Acad Med Singap 2009. [DOI: 10.47102/annals-acadmedsg.v38n9p821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction: The Optic Neuritis Treatment Trial (ONTT) has established that the magnetic resonance imaging (MRI) findings at the time of presentation of optic neuritis (ON) is the strongest indicator of the development of multiple sclerosis (MS). Reports from Singapore as well as other Asian countries have indicated that these abnormalities are less frequently encountered compared to that reported by the ONTT. This paper aims to describe systematically the brain MRI as well as the optic nerve abnormalities in patients after an episode of acute optic neuritis.
Materials and Methods: Patients who presented with acute optic neuritis were retrieved from our prospective optic neuritis study and their MRI scans were reviewed and graded in accordance with the standardised classification employed in the ONTT.
Results: Fifteen of 24 patients had MRI brain and optic nerves performed during the acute episode. In the evaluation of brain abnormalities, 40% were classified as grade 0, 20% grade I, 20% grade II, 6.7% grade III and 13.3% grade IV. Optic nerve abnormalities were observed in 80% of cases. At study entry, 10 patients had idiopathic (monosymptomatic) ON, 3 had multiple sclerosis (MS), one each with infective and autoimmune optic neuritis, respectively. The single patient who developed MS at study completion presented with grade II brain abnormalities at the initial MRI. For those with idiopathic ON, our study revealed a higher percentage of grade 0-I brain changes as well as a lower lesion load compared to the ONTT. Lesion load and grade was also lower in anterior optic neuritis compared with retrobulbar disease.
Conclusion: Our study revealed a lower percentage of grade II-IV brain MRI abnormalities as well as less lesion load in idiopathic ON compared to the ONTT. This may be related to the lower prevalence of MS in our predominantly Asian population. As diagnostic tests and understanding of neuromyelitis optica or Devic’s disease improves, we may see more patients being diagnosed with this condition, which may also explain our findings. Our data also showed that MRI grade and lesion load in cases of anterior ON was lower than for retrobulbar disease. MRI in ON has an essential role in characterising the disease, evaluating for associated brain lesions, and assessing prognosis in retrobulbar disease but may be less useful in anterior disease.
Key words: Multiple sclerosis, Optic nerve enhancement, Periventricular plaques
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Zhang X, Wang W, Wei W, Wang Q, Wei Y, Kermode AG. Etiological profile of presumptive optic neuritis in China. J Clin Neurosci 2008; 15:1346-9. [PMID: 18954987 DOI: 10.1016/j.jocn.2008.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 01/13/2008] [Accepted: 01/15/2008] [Indexed: 11/17/2022]
Abstract
To determine the diagnoses in a population of patients with presumed optic neuritis (ON) in China and compare the spectrum of etiologies with those in western countries, we studied a group of 204 patients referred to a teaching hospital with a presumptive diagnosis of ON. We conducted detailed medical and family history, thorough ophthalmologic and neurological examinations, and laboratory tests including neuroimaging. Patients were diagnosed using international diagnostic criteria. One hundred and thirteen patients (55.4%) met ON criteria, among whom 83 patients (73.5%) were diagnosed with idiopathic demyelinating optic neuritis (IDON). Brain MRI white matter lesions were found in 11 of 78 (14.1%) clinically "isolated" IDON patients. Tuberculosis meningitis was found in 2 patients and syphilis in 1 patient. The cause of ON in 26 patients (23.0%) remained uncertain, but it was still likely to be IDON accompanied by secondary axonal degeneration. Leber's hereditary optic neuropathy (LHON) was found in 38 patients (18.6%), confirmed by mitochondrial DNA point mutation screening. Seventeen patients (8.3%) had ischemic optic neuropathy. A spectrum of other entities mimicked ON. Therefore, idiopathic demyelinating ON was the most common type of optic neuropathy in our group. Despite minor differences regarding the causes and prognosis, the etiology of ON in our population is similar to that reported in Western countries.
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Affiliation(s)
- Xiaojun Zhang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Woung LC, Lin CH, Tsai CY, Tsai MT, Jou JR, Chou P. Optic Neuritis among National Health Insurance Enrollees in Taiwan, 2000–2004. Neuroepidemiology 2008; 29:250-4. [DOI: 10.1159/000112858] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Shin SY, Cheon JE, Hwang JM, Kim JS. Ocular Manifestations in Korean Patients with Multiple Sclerosis. Neuroophthalmology 2008. [DOI: 10.1080/01658100801952038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Abstract
BACKGROUND/PURPOSE To evaluate the clinical manifestations, prognosis, recurrence rate and development of multiple sclerosis between papillitis group and retrobulbar group in Taiwanese patients with isolated acute optic neuritis (AON) after treatment with intravenous methylprednisolone pulse therapy. METHODS We retrospectively reviewed patients with AON who had received intravenous methylprednisolone pulse therapy. These patients were classified into retrobulbar or papillitis groups. Demographic characteristics, responsiveness to pulse therapy, recurrence rate and incidence of multiple sclerosis were compared between these two groups. RESULTS Of the 43 patients enrolled in this study, 19 patients (44%) were in the retrobulbar group and 24 patients (56%) were in the papillitis group. Seven cases (16%) showed periventricular plaque on magnetic resonance imaging (MRI). Among these seven patients, five developed definite or probable multiple sclerosis. The incidence of multiple sclerosis in patients with positive brain MRI findings was significantly higher than in patients with negative MRI findings (p = 0.002). There was no statistical difference in final visual acuity between the two group (p = 0.353). Sixteen patients suffered from recurrence of AON (21% in the papillitis group and 58% in the retrobulbar group, p = 0.029). Two patients (8%) in the papillitis group and six patients (32%) in the retrobulbar group developed multiple sclerosis (p = 0.061) with a mean interval of 21.6 +/- 11.2 months. CONCLUSION AON in Taiwan has a relatively lower percentage of development of multiple sclerosis than in Western countries. The presence of periventricular plaque on MRI is significantly associated with the later development of multiple sclerosis. The retrobulbar group had a stronger association with recurrence and development of multiple sclerosis.
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Affiliation(s)
- Yo-Chen Chang
- Department of Ophthalmology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Affiliation(s)
- Madhura Tamhankar
- Hospital of the University of Pennsylvania, Scheie Eye Institute, Philadelphia 19104, USA
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