1
|
Wang HC, Lin CC, Chang CH, Tsai JJ. Case report: dengue fever associated acute macular neuroretinopathy. Front Med (Lausanne) 2024; 11:1379429. [PMID: 38585152 PMCID: PMC10995331 DOI: 10.3389/fmed.2024.1379429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
Dengue fever (DF), which is caused by the dengue virus (DENV) and transmitted through Aedes mosquitoes, is well recognized for its systemic manifestations, with its ocular involvement gaining recent attention. We present a case of a 41-year-old Taiwanese female who developed acute macular neuroretinopathy (AMN) following a DF diagnosis related to DENV-1, emphasizing the need for awareness of this complication. The patient, with a history of completely resolved optic neuritis (ON) and comorbidities, experienced blurred vision on day 10 after the onset of DF. The ophthalmic examination revealed macular edema, ellipsoid zone (EZ) infiltration, and choriocapillaris involvement. Despite pulse therapy with corticosteroids, visual disturbances persisted, highlighting the challenge of managing ocular complications. Ocular manifestations in DF include hemorrhages, inflammation, and vascular complications. DF-associated AMN, a rare presentation, poses challenges in diagnosis and treatment response evaluation. While most patients recover spontaneously, some face persistent visual impairment, especially with AMN. Our case emphasizes the importance of recognizing ocular complications in DF, necessitating a multidisciplinary approach for optimal management and further research to delineate treatment strategies and outcomes.
Collapse
Affiliation(s)
- How-Chen Wang
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Ching Lin
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chia-Hsin Chang
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jih-Jin Tsai
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| |
Collapse
|
2
|
Cooper AC, Tchernykh M, Shmuel A, Mendola JD. Diffusion tensor imaging of optic neuropathies: a narrative review. Quant Imaging Med Surg 2024; 14:1086-1107. [PMID: 38223128 PMCID: PMC10784057 DOI: 10.21037/qims-23-779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/21/2023] [Indexed: 01/16/2024]
Abstract
Background and Objective Diffusion tensor imaging (DTI) has been implemented in a breadth of scientific investigations of optic neuropathies, though it has yet to be fully adopted for diagnosis or prognosis. This is potentially due to a lack of standardization and weak replication of results. The aim of this investigation was to review DTI results from studies specific to three distinct optic neuropathies in order to probe its current clinical utility. Methods We reviewed the DTI literature specific to primary open-angle glaucoma (POAG), optic neuritis (ON), and traumatic optic neuropathy (TON) by systematically searching the PubMed database on March 1st, 2023. Four distinct DTI metrics are considered: fractional anisotropy (FA), along with mean diffusivity (MD, axial diffusivity (AD), and radial diffusivity (RD). Results from within-group, between-group, and correlational studies were thoroughly assessed. Key Content and Findings POAG studies most consistently report a decrease in FA, especially in the optic radiations, followed in prevalence by an increase in RD and then MD, whilst AD yields conflicting results between studies. It is notable that there is not an equal distribution of investigated DTI metrics, with FA utilized the most, followed by MD, RD, and AD. Studies of ON are similar in that the most consistent findings are specific to FA, RD, and MD. These results are specific to the optic nerve and radiation since only one study measured the intermediary regions. More studies are needed to assess the effect that ON has on the tracts of the visual system. Finally, only three studies assessing DTI of TON have been performed to date, displaying low to moderate replicability of results. To improve the level of agreement between studies assessing each optic neuropathy, an increased level of standardization is recommended. Conclusions Both POAG and ON studies have yielded some prevalent DTI findings, both for contrast and correlation-based assessments. Although the clinical need is high for TON, considering the limitations of the current diagnostic tools, too few studies exist to make confident conclusions. Future use of standardized and longitudinal DTI, along with the foreseen methodological and technical improvements, is warranted to effectively study optic neuropathies.
Collapse
Affiliation(s)
- Austin C. Cooper
- McGill Vision Research and Department of Ophthalmology, McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Maxim Tchernykh
- McGill Vision Research and Department of Ophthalmology, McGill University, Montréal, QC, Canada
| | - Amir Shmuel
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Departments of Physiology and Biomedical Engineering, McGill University, Montreal, QC, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Janine D. Mendola
- McGill Vision Research and Department of Ophthalmology, McGill University, Montréal, QC, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| |
Collapse
|
3
|
Alkharusi F, Sabt B, Al-Mujaini AS. Incidence of Optic Neuritis among Omani Patients with Multiple Sclerosis at the Sultan Qaboos University Hospital, Muscat, Oman. Sultan Qaboos Univ Med J 2023; 23:472-478. [PMID: 38090249 PMCID: PMC10712390 DOI: 10.18295/squmj.5.2023.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/02/2023] [Accepted: 04/04/2023] [Indexed: 12/18/2023] Open
Abstract
Objectives Multiple sclerosis (MS) is a chronic, multifaceted, heterogeneous autoimmune disease, with optic neuritis (ON) being a common early manifestation among those with MS. This study aimed to estimate the incidence of ON among Omani patients with MS. Methods This retrospective cross-sectional study included all Omani patients diagnosed with MS at the Sultan Qaboos University Hospital, Muscat, Oman, between January 1991 and December 2019. The data were collected from the neurology registry and electronic medical records and analysed descriptively using univariant and multivariant statistical techniques. Results Out of the 185 patients diagnosed with MS during the study period, 170 were included in the analysis. The male-to-female ratio was 1:2 and the mean age was 28 years. The incidence of ON in the population was 28.8%, with 83.7% of ON patients presenting with relapse-remitting MS (RRMS). Overall, 28.6% of patients presented with O N as an initial manifestation of MS, whereas 42.8% developed ON at a later stage. Most patients (49.4%) were from higher-latitude regions of Oman such as Muscat and Al Batinah. Conclusions The incidence of both MS and ON increased over the study period. While the overall incidence was low in comparison with Western data, it was similar to the rates reported elsewhere in the Arabian Peninsula. Overall, ON was the most common manifestation of MS in the cohort, with younger female patients more frequently presenting with both MS and ON. A significant association was found between the RRMS subtype and ON presentation.
Collapse
Affiliation(s)
- Fatma Alkharusi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Buthaina Sabt
- Department of Ophthalmology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Abdullah S. Al-Mujaini
- Department of Ophthalmology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| |
Collapse
|
4
|
Jamali Dogahe S, Pakravan P, Pakravan M. Acute Optic Neuritis: An Update on Approach and Management. J Ophthalmic Vis Res 2023; 18:433-440. [PMID: 38250236 PMCID: PMC10794797 DOI: 10.18502/jovr.v18i4.14556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/17/2023] [Indexed: 01/23/2024] Open
Abstract
This review discusses the physical examination and diagnostic tests necessary to diagnose optic neuritis (ON) and provides an update on the approach and management of acute ON. A comprehensive search of the PubMed database was conducted, limited to English-language journals and recent publications. A total of 160 articles were initially screened by title, of which 73 articles were included in the narrative synthesis. ON is an inflammation of the optic nerve that can be caused by different systemic and neurological disorders. It is commonly presented as a subacute unilateral painful vision loss, and based on its clinical manifestation, it can be classified as typical or atypical. Atypical ON is bilateral with visual acuity of worse than 20/200 or has an atypical demographic presentation for demyelination, such as a non-Caucasian male with optic disc swelling, for which neuromyelitis optica spectrum disorder (NMOSD), myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD), or other etiologies should be considered. Steroids and immunosuppressants are the main treatment options for ON, and timely treatment initiation is critical to preventing irreversible vision loss, especially in atypical cases.
Collapse
|
5
|
Kaya P, Özdal PÇ. A Case of Syphilis with a Rare Finding: Subretinal Hypopyon. Ocul Immunol Inflamm 2023; 31:1315-1319. [PMID: 36735755 DOI: 10.1080/09273948.2023.2168702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE To report clinical features and follow-up of a case with subretinal hypopyon due to syphilis infection. CASE PRESENTATION We present a case of syphilis admitted with optic neuritis and treated with intravenous pulse steroids without antibiotics. The patient was referred to the uvea clinic in the follow-up because of decreased vision and the onset of multiple retinitis foci. We determined subretinal hypopyon in the left eye and a positive TPHA test. A significant regression was observed in retinitis and hypopyon with antibiotic therapy. CONCLUSION Before starting a steroid treatment, infective etiologies should be considered in patients with optic neuritis. Treating with a high dosage of steroids without antibiotics in syphilis would worsen the clinical features and prognosis.
Collapse
Affiliation(s)
- Pınar Kaya
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Pınar Çakar Özdal
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
6
|
Wei J, Mu J, Tang Y, Qin D, Duan J, Wu A. Next-generation nanomaterials: advancing ocular anti-inflammatory drug therapy. J Nanobiotechnology 2023; 21:282. [PMID: 37598148 PMCID: PMC10440041 DOI: 10.1186/s12951-023-01974-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/29/2023] [Indexed: 08/21/2023] Open
Abstract
Ophthalmic inflammatory diseases, including conjunctivitis, keratitis, uveitis, scleritis, and related conditions, pose considerable challenges to effective management and treatment. This review article investigates the potential of advanced nanomaterials in revolutionizing ocular anti-inflammatory drug interventions. By conducting an exhaustive analysis of recent advancements and assessing the potential benefits and limitations, this review aims to identify promising avenues for future research and clinical applications. The review commences with a detailed exploration of various nanomaterial categories, such as liposomes, dendrimers, nanoparticles (NPs), and hydrogels, emphasizing their unique properties and capabilities for accurate drug delivery. Subsequently, we explore the etiology and pathophysiology of ophthalmic inflammatory disorders, highlighting the urgent necessity for innovative therapeutic strategies and examining recent preclinical and clinical investigations employing nanomaterial-based drug delivery systems. We discuss the advantages of these cutting-edge systems, such as biocompatibility, bioavailability, controlled release, and targeted delivery, alongside potential challenges, which encompass immunogenicity, toxicity, and regulatory hurdles. Furthermore, we emphasize the significance of interdisciplinary collaborations among material scientists, pharmacologists, and clinicians in expediting the translation of these breakthroughs from laboratory environments to clinical practice. In summary, this review accentuates the remarkable potential of advanced nanomaterials in redefining ocular anti-inflammatory drug therapy. We fervently support continued research and development in this rapidly evolving field to overcome existing barriers and improve patient outcomes for ophthalmic inflammatory disorders.
Collapse
Affiliation(s)
- Jing Wei
- School of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Jinyu Mu
- School of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Yong Tang
- Sichuan Key Medical Laboratory of New Drug Discovery and Druggability Evaluation, Education Ministry Key Laboratory of Medical Electrophysiology, School of Pharmacy, Southwest Medical University, Luzhou, 646000, China
| | - Dalian Qin
- Sichuan Key Medical Laboratory of New Drug Discovery and Druggability Evaluation, Education Ministry Key Laboratory of Medical Electrophysiology, School of Pharmacy, Southwest Medical University, Luzhou, 646000, China
| | - Junguo Duan
- School of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
| | - Anguo Wu
- Sichuan Key Medical Laboratory of New Drug Discovery and Druggability Evaluation, Education Ministry Key Laboratory of Medical Electrophysiology, School of Pharmacy, Southwest Medical University, Luzhou, 646000, China.
| |
Collapse
|
7
|
Skerswetat J, He J, Shah JB, Aycardi N, Freeman M, Bex PJ. AIM (Angular Indication Measurement)- Visual Acuity: An adaptive, self-administered, and generalizable vision assessment method used to measure visual acuity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.25.529586. [PMID: 36909639 PMCID: PMC10002620 DOI: 10.1101/2023.02.25.529586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
This proof-of-concept study introduces Angular Indication Measurement and applies it to VA (AIM-VA). First, we compared the ability of AIM-VA and ETDRS to detect defocus and astigmatic blur in 22 normally-sighted adults. Spherical and cylindrical lenses (±0.00D, +0.25D, +0.50D, +0.75D, +1.00D, +2.00D and +0.50D, +1.00D, +2.00D each at 0°, 90°, 135°, respectively) in the dominant eye induced blur. Second, we compared repeatability over two tests of AIM-VA and ETDRS. A 2-way-ANOVA showed a main effect for defocus-blur and test with no interaction. A 3-way-ANOVA for the astigmatism experiment revealed main effects for test type, blur, and direction and with no interactions. Planned multiple comparisons showed AIM had greater astigmatic-induced VA loss than ETDRS. Bland-Altman plots showed small bias and no systematic learning effect for either test type and improved repeatability with >2 adaptive steps for AIM-VA. AIM-VA's ability to detect defocus was comparable with that of an ETDRS letter chart and showed greater sensitivity to astigmatic blur, and AIM-VA's repeatability is comparable with ETDRS when using 2 or more adaptive steps. AIM's self-administered orientation judgment approach is generalizable to interrogate other visual functions, e.g., contrast, color, motion, stereo-vision.
Collapse
|
8
|
Lucena-Neto FD, Falcão LFM, Moraes ECDS, David JPF, Vieira-Junior ADS, Silva CC, de Sousa JR, Duarte MIS, Vasconcelos PFDC, Quaresma JAS. Dengue fever ophthalmic manifestations: A review and update. Rev Med Virol 2023; 33:e2422. [PMID: 36658757 DOI: 10.1002/rmv.2422] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/23/2022] [Accepted: 01/08/2023] [Indexed: 01/21/2023]
Abstract
Dengue fever, the most common arbovirus disease, affects an estimated 390 million people annually. Dengue virus (DENV) is an RNA virus of the Flaviviridae family with four different serotypes. Dengue haemorrhagic fever is the deadliest form of dengue infection and is characterised by thrombocytopaenia, hypotension, and the possibility of multi-system organ failure. The mechanism hypothesised for DENV viral replication is intrinsic antibody-dependent enhancement, which refers to Fcγ receptor-mediated viral amplification. This hypothesis suggests that the internalisation of DENV through the Fcγ receptor inhibits antiviral genes by suppressing type-1 interferon-mediated antiviral responses. DENV NS1 antibodies can promote the release of various inflammatory mediators in the nuclear transcription factor pathway (NF-κB-dependent), including monocyte chemoattractant protein (MCP)-1, interleukin (IL)-6, and IL-8. As a result, MCP-1 increases ICAM-1 expression and facilitates leukocyte transmigration. In addition, anti-DENV NS1 antibodies induce endothelial cell apoptosis via a nitric oxide-regulated pathway. A chain reaction involving pre-existing DENV heterotypic antibodies and innate immune cells causes dysfunction in complement system activity and contributes to the action of autoantibodies and anti-endothelial cells, resulting in endothelial cell dysfunction, blood-retinal barrier breakdown, haemorrhage, and plasma leakage. A spectrum of ocular diseases associated with DENV infection, ranging from haemorrhagic to inflammatory manifestations, has been reported in the literature. Although rare, ophthalmic manifestations can occur in both the anterior and posterior segments and are usually associated with thrombocytopenia. The most common ocular complication is haemorrhage. However, ophthalmic complications, such as anterior uveitis and vasculitis, suggest an immune-mediated pathogenesis.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Juarez Antônio Simões Quaresma
- State University of Pará, Belém, Pará, Brazil.,Federal University of Pará, Belém, Pará, Brazil.,School of Medicine, São Paulo University, São Paulo, São Paulo, Brazil.,Virology Section, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| |
Collapse
|
9
|
Song K, Lv YL, Yang LJ, Lv P, Ren B, Tian J, Wei DQ, Li H, Shao Y. Alternations of interhemispheric functional connectivity in patients with optic neuritis using voxel-mirrored homotopic connectivity: A resting state fMRI study. Brain Imaging Behav 2023; 17:1-10. [PMID: 36437427 DOI: 10.1007/s11682-022-00719-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE We used the voxel-mirrored homotopic connectivity (VMHC) method to investigate brain interhemispheric functional connectivity changes in patients with optic neuritis (ON). METHODS A total of 22 ON patients and 22 healthy controls (HCs) closely matched in age, sex, and weight were enrolled. All participants underwent resting-state functional magnetic resonance imaging (rs-fMRI). Functional interaction between the hemispheres was assessed with the VMHC method. Correlation analysis was applied to explore the association between altered VMHC values in different brain areas and cognitive features. Receiver operating characteristic (ROC) curve analysis was applied to distinguish ON patients from HCs. RESULTS Compared with HCs, ON patients had obviously reduced VMHC values in the right superior temporal gyrus, left margin superior gyrus, right superior motor cortex, and left middle cingulate gyrus. a negative relationship between best-corrected visual acuity and VMHC values in left margin superior gyrus was found, besides, the VMHC values within the right superior motor cortex and the right superior temporal gyrus were also anti-correlated with the Hamilton Depression Scales. The ROC curve displayed high diagnostic values in those altered regions. CONCLUSION Abnormal VMHC values may reflect the underlying neuropathologic mechanism of ON.
Collapse
Affiliation(s)
- Ke Song
- Scientific Research Department, Xi'an People's Hospital (Xi'an Fourth Hospital), 710004, Xi'an, Shaanxi Province, China
| | - Ya-Li Lv
- Department of Neurology, Xi'an People's Hospital (Xi'an Fourth Hospital), 710004, Xi'an, Shaanxi Province, China
| | - Li-Juan Yang
- Department of Radiology, Xi'an People's Hospital (Xi'an Fourth Hospital), 710004, Xi'an, Shaanxi Province, China
| | - Peng Lv
- Department of Radiology, Xi'an People's Hospital (Xi'an Fourth Hospital), 710004, Xi'an, Shaanxi Province, China
| | - Bo Ren
- Department of Radiology, Xi'an People's Hospital (Xi'an Fourth Hospital), 710004, Xi'an, Shaanxi Province, China
| | - Jun Tian
- Department of Radiology, Xi'an People's Hospital (Xi'an Fourth Hospital), 710004, Xi'an, Shaanxi Province, China
| | - Dao-Qing Wei
- Department of Radiology, Xi'an People's Hospital (Xi'an Fourth Hospital), 710004, Xi'an, Shaanxi Province, China
| | - Huan Li
- Department of Obstetrics, Xi'an People's Hospital (Xi'an Fourth Hospital), 710004, Xi'an, Shaanxi Province, China.
| | - Yi Shao
- Department of ophthalmology , The First Affiliated Hospital of Nanchang University, 330006, Nanchang, Shaanxi Province, China.
| |
Collapse
|
10
|
Sujanthan S, Shmuel A, Mendola JD. Visually driven functional MRI techniques for characterization of optic neuropathy. Front Hum Neurosci 2022; 16:943603. [PMID: 36158617 PMCID: PMC9500431 DOI: 10.3389/fnhum.2022.943603] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Abstract
Optic neuropathies are conditions that cause disease to the optic nerve, and can result in loss of visual acuity and/or visual field defects. An improved understanding of how these conditions affect the entire visual system is warranted, to better predict and/or restore the visual loss. In this article, we review visually-driven functional magnetic resonance imaging (fMRI) studies of optic neuropathies, including glaucoma and optic neuritis (ON); we also discuss traumatic optic neuropathy (TON). Optic neuropathy-related vision loss results in fMRI deficit within the visual cortex, and is often strongly correlated with clinical severity measures. Using predominantly flickering checkerboard stimuli, glaucoma studies indicated retinotopic-specific cortical alteration with more prominent deficits in advanced than in early glaucoma. Some glaucoma studies indicate a reorganized visual cortex. ON studies have indicated that the impacted cortical areas are briefly hyperactive. For ON, brain deficits are greater in the acute stages of the disease, followed by (near) normalization of responses of the LGN, visual cortex, and the dorsal visual stream, but not the ventral extrastriate cortex. Visually-driven fMRI is sensitive, at least in ON, in discriminating patients from controls, as well as the affected eye from the fellow eye within patients. The use of a greater variety of stimuli beyond checkerboards (e.g., visual motion and object recognition) in recent ON studies is encouraging, and needs to continue to disentangle the results in terms of change over time. Finally, visually-driven fMRI has not yet been applied in TON, although preliminary efforts suggest it may be feasible. Future fMRI studies of optic neuropathies should consider using more complex visual stimuli, and inter-regional analysis methods including functional connectivity. We suggest that a more systematic longitudinal comparison of optic neuropathies with advanced fMRI would provide improved diagnostic and prognostic information.
Collapse
Affiliation(s)
- Sujeevini Sujanthan
- Department of Ophthalmology and Visual Sciences, McGill University, Montreal, QC, Canada
- *Correspondence: Sujeevini Sujanthan
| | - Amir Shmuel
- Departments of Neurology, Neurosurgery, Physiology and Biomedical Engineering, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Janine Dale Mendola
- Department of Ophthalmology and Visual Sciences, McGill University, Montreal, QC, Canada
| |
Collapse
|
11
|
Ciapă MA, Șalaru DL, Stătescu C, Sascău RA, Bogdănici CM. Optic Neuritis in Multiple Sclerosis—A Review of Molecular Mechanisms Involved in the Degenerative Process. Curr Issues Mol Biol 2022; 44:3959-3979. [PMID: 36135184 PMCID: PMC9497878 DOI: 10.3390/cimb44090272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022] Open
Abstract
Multiple sclerosis is a central nervous system inflammatory demyelinating disease with a wide range of clinical symptoms, ocular involvement being frequently marked by the presence of optic neuritis (ON). The emergence and progression of ON in multiple sclerosis is based on various pathophysiological mechanisms, disease progression being secondary to inflammation, demyelination, or axonal degeneration. Early identification of changes associated with axonal degeneration or further investigation of the molecular processes underlying remyelination are current concerns of researchers in the field in view of the associated therapeutic potential. This article aims to review and summarize the scientific literature related to the main molecular mechanisms involved in defining ON as well as to analyze existing data in the literature on remyelination strategies in ON and their impact on long-term prognosis.
Collapse
Affiliation(s)
| | - Delia Lidia Șalaru
- Cardiology Clinic, Institute of Cardiovascular Diseases, 700503 Iași, Romania
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
- Correspondence:
| | - Cristian Stătescu
- Cardiology Clinic, Institute of Cardiovascular Diseases, 700503 Iași, Romania
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
| | - Radu Andy Sascău
- Cardiology Clinic, Institute of Cardiovascular Diseases, 700503 Iași, Romania
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
| | - Camelia Margareta Bogdănici
- Department of Surgical Specialties (II), University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
- Ophthalmology Clinic, Saint Spiridon Hospital, Iași 700111, Romania
| |
Collapse
|
12
|
Wang J, Xiao X, Dong X, Wu G, Wang X, Zhang R. Anti-PD-1 sintilimab-induced bilateral optic neuropathy in non-small cell lung cancer: A case report and literature review. Front Oncol 2022; 12:931074. [PMID: 36016624 PMCID: PMC9396260 DOI: 10.3389/fonc.2022.931074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/15/2022] [Indexed: 01/03/2023] Open
Abstract
Anti-PD-1/PD-L1 immunotherapy reactivates T-cell activity to boost the antitumor effect and may trigger autoimmune toxicity in various organ systems involving eyeball and periocular structures at the same time. The rarity of ocular immune-related adverse events should not prevent us from paying attention to this issue because of the bad consequences of visual impairment. This is the first case report of anti-PD-1 sintilimab-induced bilateral optic neuropathy in a 76-year-old man with squamous non-small cell lung cancer (NSCLC). The patient presented with sudden vision blurring without pain in both eyes after three therapeutic cycles of sintilimab plus chemotherapy. Based on the ophthalmic examination, laboratory, and radiological results, our patient was diagnosed with optic neuropathy complication secondary to anti-PD-1 sintilimab treatment. Consequently, sintilimab was held and systemic steroids were administered. The follow-up review showed that the vision recovered and the size of the primary tumor continued to decrease with the response assessment as the partial response. In conclusion, this case report suggested that patients with NSCLC undergoing anti-PD-1/PD-L1 therapy should be closely monitored for ophthalmic assessment and alert to the occurrence of sintilimab-induced optic neuropathy.
Collapse
Affiliation(s)
- Jian Wang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyue Xiao
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaorong Dong
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinghua Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xinghua Wang, ; Ruiguang Zhang,
| | - Ruiguang Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xinghua Wang, ; Ruiguang Zhang,
| |
Collapse
|
13
|
Lu Y, Zand R. Characteristics of Lyme optic neuritis: a case report of Lyme associated bilateral optic neuritis and systematic review of the literature. BMC Neurol 2022; 22:113. [PMID: 35321665 PMCID: PMC8941763 DOI: 10.1186/s12883-022-02627-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
Optic Neuritis is rare in Lyme borreliosis. The current knowledge of optic nerve involvement in Lyme borreliosis relies solely on case reports. The aim of this systematic review was to characterize and investigate the associated factors of optic neuritis in Lyme borreliosis. We further presented a very rare case of isolated bilateral optic neuritis in a Lyme seropositive patient.
Collapse
Affiliation(s)
- Yezhong Lu
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Ramin Zand
- Department of Neurology, Neuroscience Institute, Geisinger Health System, Danville, PA, USA.
| |
Collapse
|
14
|
Yan K, Shi WQ, Su T, Liao XL, Wu SN, Li QY, Yu J, Shu HY, Zhang LJ, Pan YC, Shao Y. Brain Activity Changes in Slow 5 and Slow 4 Frequencies in Patients With Optic Neuritis: A Resting State Functional MRI Study. Front Neurol 2022; 13:823919. [PMID: 35265028 PMCID: PMC8900534 DOI: 10.3389/fneur.2022.823919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective We used the amplitude of low-frequency fluctuation (ALFF) method to investigate spontaneous brain activity in patients with optic neuritis (ON) in specific frequency bands. Data and Methods A sample of 21 patients with ON (13 female and eight male) and 21 healthy controls (HCs) underwent functional magnetic resonance imaging (fMRI) scans in the resting state. We analyzed the ALFF values at different frequencies (slow-4 band: 0.027–0.073 Hz; slow-5 band: 0.01–0.027 Hz) in ON patients and HCs. Results In the slow-4 frequency range, compared with HCs, ON patients had apparently lower ALFF in the insula and the whack precuneus. In the slow-5 frequency range, ON patients showed significantly increased ALFF in the left parietal inferior and the left postcentral. Conclusion Our results suggest that ON may be involved in abnormal brain function and can provide a basis for clinical research.
Collapse
Affiliation(s)
- Kai Yan
- Department of Radiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Wen-Qing Shi
- Department of Ophthalmology, Jiangxi Centre of National Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ting Su
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Xu-Lin Liao
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Shi-Nan Wu
- Department of Ophthalmology, Jiangxi Centre of National Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiu-Yu Li
- Department of Ophthalmology, Jiangxi Centre of National Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jing Yu
- Department of Acupuncture and Moxibustion, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Hui-Ye Shu
- Department of Ophthalmology, Jiangxi Centre of National Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li-Juan Zhang
- Department of Ophthalmology, Jiangxi Centre of National Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi-Cong Pan
- Department of Ophthalmology, Jiangxi Centre of National Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi Shao
- Department of Ophthalmology, Jiangxi Centre of National Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
15
|
Yang X, Li X, Lai M, Wang J, Tan S, Chan HHL. Pain Symptoms in Optic Neuritis. FRONTIERS IN PAIN RESEARCH 2022; 3:865032. [PMID: 35498555 PMCID: PMC9046587 DOI: 10.3389/fpain.2022.865032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/21/2022] [Indexed: 02/05/2023] Open
Abstract
Signs and symptoms of optic neuritis (ON), an autoimmune disorder of the central nervous system (CNS), differ between patients. Pain, which is commonly reported by ON patients, may be the major reason for some patients to visit the clinic. This article reviews the presence of pain related to ON with respect to underlying disorders, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein associated disease (MOGAD). The aim of this review is to provide an overview of pain symptoms in accordance with the context of various pathophysiological explanations, assist in differential diagnosis of ON patients, especially at the onset of disease, and make recommendations to aid physicians make decisions for follow up diagnostic examinations.
Collapse
Affiliation(s)
- Xiayin Yang
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Department of Ophthalmology, The First Affiliated Hospital of the Medical College of Shantou University, Shantou, China
| | - Xuefen Li
- Department of Vascular Neurosurgery, The First Affiliated Hospital of the Medical College of Shantou University, Shantou, China
- Shantou University Medical College, Guangdong, China
| | - Mengying Lai
- Shantou University Medical College, Guangdong, China
- Department of Ophthalmology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jincui Wang
- Shantou University Medical College, Guangdong, China
| | - Shaoying Tan
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Center for Eye and Vision Research (CEVR), Hong Kong, Hong Kong SAR, China
- *Correspondence: Shaoying Tan
| | - Henry Ho-lung Chan
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Center for Eye and Vision Research (CEVR), Hong Kong, Hong Kong SAR, China
- University Research Facilities in Behavioral and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Henry Ho-lung Chan
| |
Collapse
|
16
|
Waisberg E, Micieli JA. Neuro-Ophthalmological Optic Nerve Cupping: An Overview. Eye Brain 2021; 13:255-268. [PMID: 34934377 PMCID: PMC8684388 DOI: 10.2147/eb.s272343] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/02/2021] [Indexed: 11/23/2022] Open
Abstract
Optic nerve cupping or enlargement of the cup-to-disc ratio is widely recognized as a feature of glaucoma, however it may also occur in non-glaucomatous optic neuropathies. The most well-recognized non-glaucomatous optic neuropathies that cause cupping include compressive optic neuropathies, arteritic anterior ischemic optic neuropathies, hereditary optic neuropathies, and optic neuritis. Cupping is thought to consist of two main components: prelaminar and laminar thinning. The former is a shallow form of cupping and related to loss of retinal ganglion cells, whereas the latter involves damage to the lamina cribrosa and peripapillary scleral connective tissue. Differentiating glaucomatous and non-glaucomatous optic nerve cupping remains challenging even for experienced observers. Classically, the optic nerve in non-glaucomatous causes has pallor of the neuroretinal rim, but the optic nerve should not be examined in isolation. The patient’s medical history, history of presenting illness, visual function (visual acuity, color vision and visual field testing) and ocular examination also need to be considered. Ancillary testing such as optical coherence tomography of the retinal nerve fiber layer and ganglion cell layer-inner plexiform layer may also be helpful in localizing the disease. In this review, we review the non-glaucomatous causes of cupping and provide an approach to evaluating a patient that presents with an enlarged cup-to-disc ratio.
Collapse
Affiliation(s)
- Ethan Waisberg
- UCD School of Medicine, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Jonathan A Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Kensington Vision and Research Centre, Toronto, Ontario, Canada
| |
Collapse
|
17
|
E. Eren O, Wilhelm H, J. Schankin C, Straube A. Visual Phenomena Associated With Migraine and Their Differential Diagnosis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:647-653. [PMID: 34636719 PMCID: PMC8762590 DOI: 10.3238/arztebl.m2021.0287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 04/29/2021] [Accepted: 06/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Visual phenomena are of many different kinds; their differential diagnosis is usually possible with directed history-taking. In this review, we describe common visual phenomena that must be distinguished from a migraine aura. METHODS This review is based on publications retrieved by a selective search in PubMed and the Web of Knowledge/Science, with special attention to the current classification of the International Headache Society and the recommendations of the German Migraine and Headache Society. The following search terms were used: "visual phenomena/phenomenon," "migraine aura," and "persistent/complication/ long-lasting/ongoing." RESULTS The most helpful questions for differential diagnosis are whether the symptoms are present in one eye only or in both, whether their onset was sudden or over minutes or days, and whether the phenomenon has occurred only once or repeatedly, or is persistently present. A visual aura associated with migraine must be distinguished, in rare cases, from an isolated epileptic aura, from cerebral/retinal ischemia, or from visual snow. Further differential diagnoses include a persisting perceptual disturbance after hallucinogen use (HPPD, "hallucinogen persisting perception disorder") and the Charles Bonnet syndrome (CBS); the latter arises as a consequence of severely impaired vision. Posterior reversible encephalopathy syndrome (PRES) is rare and generally reveals itself over its further course through the appearance of additional clinical manifestations. Primary ophthalmological causes can usually be readily identified and classified by ophthalmological examination. CONCLUSION Patients with visual phenomena typically consult physicians from various medical specialties. A correct differential diagnosis can be made based on the history if the physician views the symptoms in their overall context to determine the particular disease entity that is responsible.
Collapse
Affiliation(s)
- Ozan E. Eren
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Andreas Straube
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
18
|
Abro AA, Falamarzi A, Shaikh MY. Unilateral Acute Idiopathic Optic Neuritis With Superior Altitudinal Visual Field Defect as a Presenting Feature. Cureus 2021; 13:e17011. [PMID: 34540412 PMCID: PMC8424058 DOI: 10.7759/cureus.17011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 11/05/2022] Open
Abstract
Patients with acute optic neuritis typically present with acute loss of vision. We describe a case of a young lady of 25 years of age with blurring of vision in the upper visual field of the right eye with otherwise intact visual acuity as the only presenting symptom. Although altitudinal visual field defect is not unknown to be associated with acute optic neuritis, it is generally considered a relatively uncommon occurrence. Our case illustrates an unusually unique occurrence of upper altitudinal visual field defect in association with unaffected visual acuity as the sole presenting symptom of acute idiopathic unilateral optic neuritis. When an altitudinal visual field defect is a presenting feature, besides the usual vascular and compressive causes, optic neuritis should be remembered in the list of differential diagnoses.
Collapse
Affiliation(s)
- Ali Anwar Abro
- Eye and Laser Centre, Royal Medical Services / Bahrain Defense Force Hospital, East Riffaa, BHR
| | - Aysha Falamarzi
- Eye and Laser Centre, Royal Medical Services / Bahrain Defense Force Hospital, East Riffaa, BHR
| | - Mohamed Yusuf Shaikh
- Eye and Laser Centre, Royal Medical Services / Bahrain Defense Force Hospital, East Riffaa, BHR
| |
Collapse
|
19
|
Zhou L, Wei X. Ocular Immune-Related Adverse Events Associated With Immune Checkpoint Inhibitors in Lung Cancer. Front Immunol 2021; 12:701951. [PMID: 34504488 PMCID: PMC8421677 DOI: 10.3389/fimmu.2021.701951] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) are novel immunotherapy-based drugs that have become increasingly popular in the treatment of lung cancer. Researchers have recognized ocular immune-related adverse events (irAEs) secondary to ICIs because of their vision-threatening characteristics. However, they are incompletely characterized and no studies have reported the ICI-related ocular irAEs in lung cancer. Therefore, we aimed to comprehensively illustrate the clinical characteristics, contributory factors, diagnosis, and management of ICI-related ocular irAEs in lung cancer, based on previously reported 79 patients. Ophthalmoplegia (40.51%), uveitis (20.25%), and dry eye (17.72%) were the most common ICI-related ocular irAEs in lung cancer. Ptosis was the most common (36.71%) and the highest mortality (23.33%) of ophthalmoplegia. Patients in Asia and patients who underwent combination therapy with programmed cell death-1 and cytotoxic T-lymphocyte-associated antigen 4 inhibitors demonstrated significantly higher frequency of ophthalmoplegia than other ocular irAEs. Most ICI-related ophthalmoplegia and uveitis in lung cancer were observed in the first 10 weeks following the initiation of ICIs. Furthermore, the onset time of dry eye and other ocular irAEs was much longer. In addition, 92.31% of the patients with ocular irAEs other than ophthalmoplegia could be remised. In conclusion, ocular irAEs secondary to ICIs in lung cancer are non-negligible, particularly ophthalmoplegia. Ethnicity and the type of ICIs play important roles in the distribution of ocular irAEs. ICI-related ophthalmoplegia in lung cancer presented with early onset and worse prognosis features, thus necessitating further attention.
Collapse
Affiliation(s)
- Lin Zhou
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Wei
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
20
|
Altered Small-World Functional Network Topology in Patients with Optic Neuritis: A Resting-State fMRI Study. DISEASE MARKERS 2021; 2021:9948751. [PMID: 34221189 PMCID: PMC8219459 DOI: 10.1155/2021/9948751] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/26/2021] [Accepted: 05/26/2021] [Indexed: 12/17/2022]
Abstract
Aim This study investigated changes in small-world topology and brain functional connectivity in patients with optic neuritis (ON) by resting-state functional magnetic resonance imaging (rs-fMRI) and based on graph theory. Methods A total of 21 patients with ON (8 males and 13 females) and 21 matched healthy control subjects (8 males and 13 females) were enrolled and underwent rs-fMRI. Data were preprocessed and the brain was divided into 116 regions of interest. Small-world network parameters and area under the integral curve (AUC) were calculated from pairwise brain interval correlation coefficients. Differences in brain network parameter AUCs between the 2 groups were evaluated with the independent sample t-test, and changes in brain connection strength between ON patients and control subjects were assessed by network-based statistical analysis. Results In the sparsity range from 0.08 to 0.48, both groups exhibited small-world attributes. Compared to the control group, global network efficiency, normalized clustering coefficient, and small-world value were higher whereas the clustering coefficient value was lower in ON patients. There were no differences in characteristic path length, local network efficiency, and normalized characteristic path length between groups. In addition, ON patients had lower brain functional connectivity strength among the rolandic operculum, medial superior frontal gyrus, insula, median cingulate and paracingulate gyri, amygdala, superior parietal gyrus, inferior parietal gyrus, supramarginal gyrus, angular gyrus, lenticular nucleus, pallidum, superior temporal gyrus, and cerebellum compared to the control group (P < 0.05). Conclusion Patients with ON show typical "small world" topology that differed from that detected in HC brain networks. The brain network in ON has a small-world attribute but shows reduced and abnormal connectivity compared to normal subjects and likely causes symptoms of cognitive impairment.
Collapse
|
21
|
Detecting retinal cell stress and apoptosis with DARC: Progression from lab to clinic. Prog Retin Eye Res 2021; 86:100976. [PMID: 34102318 DOI: 10.1016/j.preteyeres.2021.100976] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 12/15/2022]
Abstract
DARC (Detection of Apoptosing Retinal Cells) is a retinal imaging technology that has been developed within the last 2 decades from basic laboratory science to Phase 2 clinical trials. It uses ANX776 (fluorescently labelled Annexin A5) to identify stressed and apoptotic cells in the living eye. During its development, DARC has undergone biochemistry optimisation, scale-up and GMP manufacture and extensive preclinical evaluation. Initially tested in preclinical glaucoma and optic neuropathy models, it has also been investigated in Alzheimer, Parkinson's and Diabetic models, and used to assess efficacy of therapies. Progression to clinical trials has not been speedy. Intravenous ANX776 has to date been found to be safe and well-tolerated in 129 patients, including 16 from Phase 1 and 113 from Phase 2. Results on glaucoma and AMD patients have been recently published, and suggest DARC with an AI-aided algorithm can be used to predict disease activity. New analyses of DARC in GA prediction are reported here. Although further studies are needed to validate these findings, it appears there is potential of the technology to be used as a biomarker. Much larger clinical studies will be needed before it can be considered as a diagnostic, although the relatively non-invasive nature of the nasal as opposed to intravenous administration would widen its acceptability in the future as a screening tool. This review describes DARC development and its progression into Phase 2 clinical trials from lab-based research. It discusses hypotheses, potential challenges, and regulatory hurdles in translating technology.
Collapse
|
22
|
Schroeder A, Van Stavern G, Orlowski HLP, Stunkel L, Parsons MS, Rhea L, Sharma A. Detection of Optic Neuritis on Routine Brain MRI without and with the Assistance of an Image Postprocessing Algorithm. AJNR Am J Neuroradiol 2021; 42:1130-1135. [PMID: 33737263 DOI: 10.3174/ajnr.a7068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/20/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE At times, there is a clinical need for using routine brain MR imaging performed close to the time of onset of patients' visual symptoms to firmly establish the diagnosis of optic neuritis. Our aim was to assess the diagnostic performance of radiologists in detecting optic neuritis on routine brain MR images and whether this performance could be enhanced using a postprocessing algorithm. MATERIALS AND METHODS In this retrospective case-control study of 60 patients (37 women, 23 men; mean age, 47.2 [SD, 17.9] years), 2 blinded neuroradiologists evaluated T2-weighted FLAIR and contrast-enhanced T1WI from brain MR imaging for the presence of imaging evidence of optic neuritis. Images were processed using an image-processing algorithm that aimed to selectively accentuate the signal intensity of diseased optic nerves. We assessed the effect of image processing on the contrast-to-noise ratio between the optic nerves and normal-appearing white matter and on the diagnostic performance of the neuroradiologists, including the interobserver reliability. RESULTS The average sensitivity of readers was 55%, 56.5%, and 30.0% on FLAIR, coronal contrast-enhanced T1WI, and axial contrast-enhanced T1WI, respectively. Sensitivities were lower in the absence of fat saturation on FLAIR (P = .001) and coronal contrast-enhanced T1WI (P = .04). Processing increased the contrast-to-noise ratio of diseased (P value range = .03 to <.001) but not of control optic nerves. Processing did not improve the sensitivity but improved the specificity and positive predictive value. Interobserver agreement improved from slight to good. CONCLUSIONS Detection of optic neuritis on routine brain MR imaging is challenging. Specificity, positive predictive value, and interobserver agreement can be improved by postprocessing of MR images.
Collapse
Affiliation(s)
- A Schroeder
- Washington University in Saint Louis School of Medicine, (A. Schroeder), Washington University in Saint Louis School of Medicine, St. Louis, Missouri
| | - G Van Stavern
- Departments of Ophthalmology and Visual Sciences (G.V.S., L.S.), Washington University in Saint Louis School of Medicine, St. Louis, Missouri.,Department of Neurology (G.V.S., L.S.), Washington University in Saint Louis School of Medicine, St. Louis, Missouri
| | - H L P Orlowski
- Mallinckrodt Institute of Radiology (H.L.P.O., M.S.P., A. S.), Washington University in Saint Louis School of Medicine, St. Louis, Missouri
| | - L Stunkel
- Departments of Ophthalmology and Visual Sciences (G.V.S., L.S.), Washington University in Saint Louis School of Medicine, St. Louis, Missouri.,Department of Neurology (G.V.S., L.S.), Washington University in Saint Louis School of Medicine, St. Louis, Missouri
| | - M S Parsons
- Mallinckrodt Institute of Radiology (H.L.P.O., M.S.P., A. S.), Washington University in Saint Louis School of Medicine, St. Louis, Missouri
| | - L Rhea
- Department of Biostatistics (L.R.), Washington University in Saint Louis School of Medicine, St. Louis, Missouri
| | - A Sharma
- Mallinckrodt Institute of Radiology (H.L.P.O., M.S.P., A. S.), Washington University in Saint Louis School of Medicine, St. Louis, Missouri.
| |
Collapse
|
23
|
Senthil S, Nakka M, Sachdeva V, Goyal S, Sahoo N, Choudhari N. Glaucoma Mimickers: A major review of causes, diagnostic evaluation, and recommendations. Semin Ophthalmol 2021; 36:692-712. [PMID: 33689583 DOI: 10.1080/08820538.2021.1897855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Glaucoma is characterized by chronic progressive optic neuropathy with corresponding visual field changes, with or without raised intraocular pressure (IOP). When diagnosing glaucoma or monitoring its progression, the examiner has to rely on the appearance of the optic disc, characteristic retinal nerve fiber layer defects, and corresponding visual field defects. However, similar changes and symptoms may be observed in several other disorders of the optic nerve and retina that may mimic glaucoma, often leading to misdiagnosis. Methods and result: The consequences of misdiagnosis not only result in improper treatment that may impact vision but also would negatively affect the overall health, psychological well-being of the patient, and may have considerable economic implications.Conclusion: The current review describes various conditions that mimic glaucoma and the features that help differentiate these conditions from glaucoma.
Collapse
Affiliation(s)
- Sirisha Senthil
- VST Glaucoma Center, L V Prasad Eye Institute, Hyderabad, India
| | - Mamata Nakka
- VST Glaucoma Center, L V Prasad Eye Institute, Hyderabad, India
| | - Virender Sachdeva
- Nimmagada Prasad Children's Eye Care Centre, GMRV Campus, L V Prasad Eye Institute, Visakhapatnam, India
| | - Shaveta Goyal
- VST Glaucoma Center, L V Prasad Eye Institute, Hyderabad, India
| | - Nibedita Sahoo
- MTC Campus, L V Prasad Eye Institute, Bhubaneswar, India
| | | |
Collapse
|
24
|
Türay S, Kabakuş N, Hancı F, Ulaş F, Dilek M, Cihan B. The role of clinical signs in the diagnosis of papilledema: development of an algorithm. Childs Nerv Syst 2021; 37:599-605. [PMID: 32839852 DOI: 10.1007/s00381-020-04869-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was not only to emphasize the role of clinical signs as well as ophthalmologic evaluation for accurate and differential diagnosis of papilledema (PE), but also to present an instructive algorithm that would help to eliminate unnecessary examinations and treatments. METHOD The files of 43 patients (ages 0-18) diagnosed with PE were retrospectively reviewed. The study included 25 patients from our pediatric neurology outpatient clinic, who were thought to have PE, and 18 patients, who were referred from the external centers to our hospital with a pre-diagnosis of PE. RESULTS Of the 43 patients, 28 had PE, 8 had pseudopapilledema (PPE), and 7 had optic nerve pathologies (ONP). For patients who applied directly to our pediatric neurology unit, a margin of error of 8% was detected based on only a simple ophthalmologic examination and an evaluation of clinical findings. For the patients who were forwarded to our pediatric neurology unit from the external centers without examining any clinical findings and with no details, the margin of error was 72%. CONCLUSION For patients with suspected PE, advanced ophthalmologic opinion is a necessary requirement before invasive radiological examinations are used. When the ophthalmologic evaluation is properly elaborated, the distinction can be made more clearly by using noninvasive methods. In order to determine the gold standard in terms of the methods used in the evaluation of patients who are not clinically diagnosed, new prospective studies with more patients should be planned.
Collapse
Affiliation(s)
- Sevim Türay
- Department of Pediatric Neurology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey.
| | - Nimet Kabakuş
- Department of Pediatric Neurology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Fatma Hancı
- Department of Pediatric Neurology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Fatih Ulaş
- Department of Ophthalmology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Mustafa Dilek
- Department of Pediatrics, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Büşra Cihan
- Department of Pediatrics, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| |
Collapse
|
25
|
Punyte V, Vilkeviciute A, Gedvilaite G, Kriauciuniene L, Liutkeviciene R. Association of VEGFA, TIMP-3, and IL-6 gene polymorphisms with predisposition to optic neuritis and optic neuritis with multiple sclerosis. Ophthalmic Genet 2020; 42:35-44. [PMID: 33121296 DOI: 10.1080/13816810.2020.1839916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The etiology of the inflammatory ON is multifactorial. Much attention is paid to the inflammatory and immune processes that are likely to contribute to the demyelination and MS development. IL-6, VEGFA, and TIMP-3 genes are thought to be involved in the inflammatory processes and manifestation of CNS demyelination, so we aimed to determine the relationship between VEGFA rs1413711, TIMP-3 rs9621532, IL-6 rs1800796 gene polymorphisms and ON, and ON with MS. MATERIALS AND METHODS Patients with ON, ON with MS, and a random sample of healthy population were enrolled. The genotyping of VEGFA rs1413711, TIMP-3 rs9621532, and IL-6 rs1800796 polymorphisms was carried out using the real-time polymerase chain reaction method. RESULTS T/C and C/C genotypes of VEGFA rs1413711 were associated with about threefold increased odds of developing ON in the dominant and codominant models. Each allele C at VEGFA rs1413711 was associated with 1.7-fold increased odds of ON development. IL-6 rs1800796 allele C was more frequent in the ON with MS group compared to the control: 17.6% vs. 7.5%, respectively (p = .040). No statistically significant associations were found between TIMP-3 rs9621532 and the ON development. CONCLUSION: VEGFA rs1413711 is associated with the ON development.
Collapse
Affiliation(s)
- Vaida Punyte
- Lithuanian University of Health Sciences, Medical Academy , Kaunas, Lithuania
| | - Alvita Vilkeviciute
- Lithuanian University of Health Sciences, Medical Academy , Kaunas, Lithuania.,Neuroscience Institute, Lithuanian University of Health Sciences, Medical Academy , Kaunas, Lithuania
| | - Greta Gedvilaite
- Lithuanian University of Health Sciences, Medical Academy , Kaunas, Lithuania.,Neuroscience Institute, Lithuanian University of Health Sciences, Medical Academy , Kaunas, Lithuania
| | - Loresa Kriauciuniene
- Lithuanian University of Health Sciences, Medical Academy , Kaunas, Lithuania.,Neuroscience Institute, Lithuanian University of Health Sciences, Medical Academy , Kaunas, Lithuania
| | - Rasa Liutkeviciene
- Lithuanian University of Health Sciences, Medical Academy , Kaunas, Lithuania.,Neuroscience Institute, Lithuanian University of Health Sciences, Medical Academy , Kaunas, Lithuania
| |
Collapse
|
26
|
Manasewitsch NT, Morrison L, Antwi-Amoabeng D, Dave MG, Chahal GS. Deaf and Mute Patient Developing Recurrent Idiopathic Bilateral Optic Neuritis: A Case for Early Treatment With Plasmapheresis? Cureus 2020; 12:e10663. [PMID: 33005553 PMCID: PMC7522191 DOI: 10.7759/cureus.10663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Bilateral idiopathic optic neuritis is an uncommon presentation of optic neuritis, and the initial treatment options are limited to corticosteroids with consideration for plasma exchange therapy as second-line therapy. We present the case of a 43-year-old deaf and mute patient whose ability to communicate via American Sign Language was severely impaired by her recurrent idiopathic bilateral optic neuritis. She was treated early and aggressively with both plasma exchange and corticosteroids within days of presentation and experienced rapid improvement in her vision. Early treatment with plasma exchange should be considered in patients whose impairment presents a significant communication barrier.
Collapse
|
27
|
Govindarajan V, de Rivero Vaccari JP, Keane RW. Role of inflammasomes in multiple sclerosis and their potential as therapeutic targets. J Neuroinflammation 2020; 17:260. [PMID: 32878648 PMCID: PMC7469327 DOI: 10.1186/s12974-020-01944-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023] Open
Abstract
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS), and it remains the most common immune-mediated disorder affecting the CNS. While the cause of MS is unclear, the underlying pathomechanisms are thought to be either destruction by autoimmune T cells or dysfunction of myelin-producing cells. Recent advances have indicated that inflammasomes contribute the etiology of MS. Inflammasomes are multiprotein complexes of the innate immune response involved in the processing of caspase-1, the activation of pro-inflammatory cytokines interleukin (IL)-1β and IL-18 as well as the cell death-mediated mechanism of pyroptosis and the activation of the adaptive immune response. Here we review the literature to date on the role of different inflammasome signaling pathways in the pathogenesis of MS and how these pathways may be targeted to reduce deleterious inflammatory processes and improve outcomes in this patient population.
Collapse
Affiliation(s)
- Vaidya Govindarajan
- Department of Physiology and Biophysics, University of Miami Miller School of Medicine, 1600 NW 10th Ave RMSB 5058, Miami, FL, 33136, USA
| | - Juan Pablo de Rivero Vaccari
- Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Robert W Keane
- Department of Physiology and Biophysics, University of Miami Miller School of Medicine, 1600 NW 10th Ave RMSB 5058, Miami, FL, 33136, USA. .,Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
| |
Collapse
|
28
|
Herrero-Morant A, Álvarez-Reguera C, Martín-Varillas JL, Calvo-Río V, Casado A, Prieto-Peña D, Atienza-Mateo B, Maiz-Alonso O, Blanco A, Vicente E, Rúa-Figueroa Í, Cáceres-Martin L, García-Serrano JL, Callejas-Rubio JL, Ortego-Centeno N, Narváez J, Romero-Yuste S, Sánchez J, Estrada P, Demetrio-Pablo R, Martínez-López D, Castañeda S, Hernández JL, González-Gay MÁ, Blanco R. Biologic Therapy in Refractory Non-Multiple Sclerosis Optic Neuritis Isolated or Associated to Immune-Mediated Inflammatory Diseases. A Multicenter Study. J Clin Med 2020; 9:E2608. [PMID: 32796717 PMCID: PMC7464396 DOI: 10.3390/jcm9082608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/31/2020] [Accepted: 08/07/2020] [Indexed: 01/24/2023] Open
Abstract
We aimed to assess the efficacy of biologic therapy in refractory non-Multiple Sclerosis (MS) Optic Neuritis (ON), a condition more infrequent, chronic and severe than MS ON. This was an open-label multicenter study of patients with non-MS ON refractory to systemic corticosteroids and at least one conventional immunosuppressive drug. The main outcomes were Best Corrected Visual Acuity (BCVA) and both Macular Thickness (MT) and Retinal Nerve Fiber Layer (RNFL) using Optical Coherence Tomography (OCT). These outcome variables were assessed at baseline, 1 week, and 1, 3, 6 and 12 months after biologic therapy initiation. Remission was defined as the absence of ON symptoms and signs that lasted longer than 24 h, with or without an associated new lesion on magnetic resonance imaging with gadolinium contrast agents for at least 3 months. We studied 19 patients (11 women/8 men; mean age, 34.8 ± 13.9 years). The underlying diseases were Bechet's disease (n = 5), neuromyelitis optica (n = 3), systemic lupus erythematosus (n = 2), sarcoidosis (n = 1), relapsing polychondritis (n = 1) and anti-neutrophil cytoplasmic antibody -associated vasculitis (n = 1). It was idiopathic in 6 patients. The first biologic agent used in each patient was: adalimumab (n = 6), rituximab (n = 6), infliximab (n = 5) and tocilizumab (n = 2). A second immunosuppressive drug was simultaneously used in 11 patients: methotrexate (n = 11), azathioprine (n = 2), mycophenolate mofetil (n = 1) and hydroxychloroquine (n = 1). Improvement of the main outcomes was observed after 1 year of therapy when compared with baseline data: mean ± SD BCVA (0.8 ± 0.3 LogMAR vs. 0.6 ± 0.3 LogMAR; p = 0.03), mean ± SD RNFL (190.5 ± 175.4 μm vs. 183.4 ± 139.5 μm; p = 0.02), mean ± SD MT (270.7 ± 23.2 μm vs. 369.6 ± 137.4 μm; p = 0.03). Besides, the median (IQR) prednisone-dose was also reduced from 40 (10-61.5) mg/day at baseline to. 2.5 (0-5) mg/day after one year of follow-up; p = 0.001. After a mean ± SD follow-up of 35 months, 15 patients (78.9%) achieved ocular remission, and 2 (10.5%) experienced severe adverse events. Biologic therapy is effective in patients with refractory non-MS ON.
Collapse
Affiliation(s)
- Alba Herrero-Morant
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Carmen Álvarez-Reguera
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | | | - Vanesa Calvo-Río
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Alfonso Casado
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Diana Prieto-Peña
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Belén Atienza-Mateo
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Olga Maiz-Alonso
- Rheumatology and Ophtalmology, Hospital de Donostia, Paseo Dr. Begiristain, 117, 20080 Donostia, Spain; (O.M.-A.); (A.B.)
| | - Ana Blanco
- Rheumatology and Ophtalmology, Hospital de Donostia, Paseo Dr. Begiristain, 117, 20080 Donostia, Spain; (O.M.-A.); (A.B.)
| | - Esther Vicente
- Rheumatology, Hospital Universitario de La Princesa, C/Diego de León, 62, 28006 Madrid, Spain; (E.V.); (S.C.)
| | - Íñigo Rúa-Figueroa
- Rheumatology, Hospital Universitario de Gran Canaria Doctor Negrín, C/Plaza Barranco de la Ballena, s/n, 35010 Las Palmas de Gran Canaria, Spain; (Í.R.-F.); (L.C.-M.)
| | - Laura Cáceres-Martin
- Rheumatology, Hospital Universitario de Gran Canaria Doctor Negrín, C/Plaza Barranco de la Ballena, s/n, 35010 Las Palmas de Gran Canaria, Spain; (Í.R.-F.); (L.C.-M.)
| | - José L. García-Serrano
- Internal Medicine and Ophtalmology, Hospital San Cecilio, Av. del Conocimiento, s/n, 18016 Granada, Spain; (J.L.G.-S.); (J.L.C.-R.); (N.O.-C.)
| | - José Luis Callejas-Rubio
- Internal Medicine and Ophtalmology, Hospital San Cecilio, Av. del Conocimiento, s/n, 18016 Granada, Spain; (J.L.G.-S.); (J.L.C.-R.); (N.O.-C.)
| | - Norberto Ortego-Centeno
- Internal Medicine and Ophtalmology, Hospital San Cecilio, Av. del Conocimiento, s/n, 18016 Granada, Spain; (J.L.G.-S.); (J.L.C.-R.); (N.O.-C.)
| | - Javier Narváez
- Rheumatology, Hospital de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Spain;
| | - Susana Romero-Yuste
- Rheumatology, Complejo Hospitalario Universitario de Pontevedra, Loureiro Crespo, 2, 36002 Pontevedra, Spain;
| | - Julio Sánchez
- Rheumatology, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain;
| | - Paula Estrada
- Rheumatology, Hospital de Sant Joan Despí Moisès Broggi, Carrer de Jacint Verdaguer, 90, 08970 Sant Joan Despí, Spain;
| | - Rosalía Demetrio-Pablo
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - David Martínez-López
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Santos Castañeda
- Rheumatology, Hospital Universitario de La Princesa, C/Diego de León, 62, 28006 Madrid, Spain; (E.V.); (S.C.)
| | - José L. Hernández
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Miguel Á. González-Gay
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Ricardo Blanco
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| |
Collapse
|
29
|
Abstract
Mumps is a contagious viral illness that classically presents with fever, parotid gland swelling, headache, and vomiting in unimmunized children. The complications of mumps most commonly include orchitis, pancreatitis, encephalitis, and meningitis. Optic neuritis, which refers to the inflammation of the optic nerve, in rare cases, can present after mumps meningoencephalitis and causes pain in the eye, and a decrease in visual acuity. We report and discuss a case of bilateral optic neuritis following mumps meningoencephalitis in a child. The patient was managed with short-term steroid therapy.
Collapse
Affiliation(s)
- Beenish Khan
- Ophthalmology, United Medical and Dental College, Creek General Hospital, Karachi, PAK
| | - Saad Nasir
- Internal Medicine, United Medical and Dental College, Creek General Hospital, Karachi, PAK
| | - Shahina Hanif
- Pediatrics, United Medical and Dental College, Creek General Hospital, Karachi, PAK
| |
Collapse
|
30
|
Posporis C, Beltran E, Dunning M, Espadas I, Gillespie S, Barry AT, Wessmann A. Prognostic Factors for Recovery of Vision in Canine Optic Neuritis of Unknown Etiology: 26 Dogs (2003-2018). Front Vet Sci 2019; 6:415. [PMID: 31824972 PMCID: PMC6882734 DOI: 10.3389/fvets.2019.00415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 11/07/2019] [Indexed: 12/03/2022] Open
Abstract
Optic neuritis (ON) is a recognized condition, yet factors influencing recovery of vision are currently unknown. The purpose of this study was to identify prognostic factors for recovery of vision in canine ON of unknown etiology. Clinical databases of three referral hospitals were searched for dogs with presumptive ON based on clinicopathologic, MRI/CT, and fundoscopic findings. Twenty-six dogs diagnosed with presumptive ON of unknown etiology, isolated (I-ON) and MUE-associated (MUE-ON), were included in the study. Their medical records were reviewed retrospectively, and the association of complete recovery of vision with signalment, clinicopathologic findings, and treatment was investigated. Datasets were tested for normality using the D'Agostino and Shapiro-Wilk tests. Individual datasets were compared using the Chi-squared test, Fisher's exact test, and the Mann-Whitney U-test. For multiple comparisons with parametric datasets, the one-way analysis of variance (ANOVA) was performed, and for non-parametric datasets, the Kruskal-Wallis test was performed to test for independence. For all data, averages are expressed as median with interquartile range and significance set at p < 0.05. Twenty-six dogs met the inclusion criteria. Median follow-up was 230 days (range 21–1901 days, mean 496 days). Six dogs (23%) achieved complete recovery and 20 dogs (77%) incomplete or no recovery of vision. The presence of a reactive pupillary light reflex (p = 0.013), the absence of fundoscopic lesions (p = 0.0006), a younger age (p = 0.038), and a lower cerebrospinal fluid (CSF) total nucleated cell count (TNCC) (p = 0.022) were statistically associated with complete recovery of vision. Dogs with I-ON were significantly younger (p = 0.046) and had lower CSF TNCC (p = 0.030) compared to the MUE-ON group. This study identified prognostic factors that may influence complete recovery of vision in dogs with ON. A larger cohort of dogs is required to determine whether these findings are robust and whether additional parameters aid accurate prognosis for recovery of vision in canine ON.
Collapse
Affiliation(s)
| | - Elsa Beltran
- Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, United Kingdom
| | - Mark Dunning
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, United Kingdom.,Willows Veterinary Centre and Referral Service, Shirley, United Kingdom
| | - Irene Espadas
- Neurology/Neurosurgery Service, Pride Veterinary Centre, Derby, United Kingdom.,Small Animal Teaching Hospital, School of Veterinary Sciences, University of Liverpool, Neston, United Kingdom
| | - Sabrina Gillespie
- Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, United Kingdom
| | - Amy Teresa Barry
- Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, United Kingdom
| | - Annette Wessmann
- Neurology/Neurosurgery Service, Pride Veterinary Centre, Derby, United Kingdom
| |
Collapse
|
31
|
Skorupka N, Miclea A, Jalowiec KA, Bocksrucker C, Kamber N, Chan A, Mansouri Taleghani B, Hoepner R, Salmen A. Visual Outcomes of Plasma Exchange Treatment of Steroid-Refractory Optic Neuritis: A Retrospective Monocentric Analysis. Transfus Med Hemother 2019; 46:417-422. [PMID: 31933571 DOI: 10.1159/000504027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/10/2019] [Indexed: 12/28/2022] Open
Abstract
Introduction In acute inflammatory optic neuritis (ON) as a typical onset of multiple sclerosis (MS), only few studies have investigated plasma exchange (PLEX) as a sequential treatment after insufficient response to high-dose intravenous glucocorticosteroids. Therefore, we aimed to investigate treatment outcome on visual acuity (VA) with PLEX in patients with steroid-refractory ON. Methods In our retrospective monocentric study, medical records were screened for patients with acute ON as their first relapse with sequential MS diagnosis or with an established MS diagnosis from the Bern University Hospital (Switzerland) that were treated with PLEX between 2016 and 2018 due to lacking steroid response. VA prior to steroid administration, and before and after PLEX were assessed and compared using the Friedman multiple comparison test. Results In total, 18 patients were included in the analysis. Interval from symptom onset to PLEX was 20.3 days (mean, 95% CI 14.8-25.9). Relevant functional improvement (VA of ≥0.5, after a mean of 15.9 (13.3-18.5) days after start of PLEX) was detected in 16/18 (88.9%) with a significant amelioration as compared to VA before glucocorticosteroids and before PLEX (p < 0.0001). VA improvement at a later time point (38.1 weeks, 25.2-51.0) was present in 15/16 (93.8%) patients. No serious adverse events were detected. PLEX could be performed via peripheral access in 13/18 patients (72.2%). Conclusion Our study demonstrates significant improvements of VA with PLEX in a cohort of MS patients with steroid-refractory ON. High response rates may be due to the timely treatment initiation. Despite the small sample size, our data support the early use of PLEX in steroid-refractory ON with a favorable safety profile.
Collapse
Affiliation(s)
- Nic Skorupka
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrei Miclea
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Christoph Bocksrucker
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicole Kamber
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
32
|
Heckmann JG, Vachalova I, Lang CJG, Pitz S. Neuro-Ophthalmology at the Bedside: A Clinical Guide. J Neurosci Rural Pract 2019; 9:561-573. [PMID: 30271051 PMCID: PMC6126320 DOI: 10.4103/jnrp.jnrp_145_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Neuro-ophthalmological signs and symptoms are common in the emergency department but are a frequent source of diagnostic uncertainties. However, neuro-ophthalmological signs often allow a precise neuro-topographical localization of the clinical problem. A practical concept is presented how to perform a neuro-ophthalmological examination at the bedside and to interpret key findings under the aspect of emergency medicine with limited resources.
Collapse
Affiliation(s)
- Josef G Heckmann
- Department of Neurology, Municipal Hospital, Landshut, Bavaria, Germany
| | - Ivana Vachalova
- Department of Neurology, Municipal Hospital, Landshut, Bavaria, Germany
| | - Christoph J G Lang
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Susanne Pitz
- Orbital Center, Bürgerhospital, Frankfurt, Germany
| |
Collapse
|
33
|
Edo A, Harada Y, Kiuchi Y. Usefulness of B-scan ocular ultrasound images for diagnosis of optic perineuritis. Am J Ophthalmol Case Rep 2018; 12:45-48. [PMID: 30182069 PMCID: PMC6120595 DOI: 10.1016/j.ajoc.2018.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 07/11/2018] [Accepted: 08/28/2018] [Indexed: 11/21/2022] Open
Abstract
Purpose This study was performed to examine the usefulness of B-scan ocular ultrasound images for the diagnosis of optic perineuritis. Observations A 72-year-old woman developed nonpainful blurred vision in her left eye. At the first ophthalmological consultation, she had optic disc swelling and choroidal folds in both eyes and subretinal fluid in the left eye. She was referred to our clinic 1 month after symptom onset. At the first visit to our clinic, she still complained of blurred vision. She was found to have mild vitreous cells in the left eye and optic disc swelling in both eyes. However, the choroidal folds had already resolved in both eyes. B-scan ultrasound images displayed the optic nerve sheath as a highly reflective circle with shadowing around the optic disc in both eyes and scleral thickening in the left eye with fluid in sub-Tenon's space. Bilateral optic perineuritis with posterior scleritis seemed highly plausible. Magnetic resonance imaging with intravenous contrast revealed increased signal intensity around the optic nerve (i.e., the “tram track sign”) in both eyes, which was consistent with optic perineuritis. Conclusion and importance Optic perineuritis is a rare inflammatory disorder involving the optic nerve sheath. Although magnetic resonance imaging is reportedly useful for diagnosis of this disease, no previous reports have described B-scan ultrasound imaging for this purpose. We herein provide the first report of a patient suspected to have optic perineuritis based on B-scan images. B-scan ultrasound may be useful for diagnosis of optic perineuritis, especially with inflammation surrounding the optic nerve.
Collapse
Affiliation(s)
- Ayaka Edo
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
| |
Collapse
|
34
|
Comparison of field-of-view optimized and constrained undistorted single-shot diffusion-weighted imaging and conventional diffusion-weighted imaging of optic nerve and chiasma at 3T. Neuroradiology 2018; 60:903-912. [DOI: 10.1007/s00234-018-2058-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
|
35
|
Tourbah A, Gout O, Vighetto A, Deburghgraeve V, Pelletier J, Papeix C, Lebrun-Frenay C, Labauge P, Brassat D, Toosy A, Laplaud DA, Outteryck O, Moreau T, Debouverie M, Clavelou P, Heinzlef O, De Sèze J, Defer G, Sedel F, Arndt C. MD1003 (High-Dose Pharmaceutical-Grade Biotin) for the Treatment of Chronic Visual Loss Related to Optic Neuritis in Multiple Sclerosis: A Randomized, Double-Blind, Placebo-Controlled Study. CNS Drugs 2018; 32:661-672. [PMID: 29808469 PMCID: PMC6061426 DOI: 10.1007/s40263-018-0528-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Chronic visual loss is a disabling feature in patients with multiple sclerosis (MS). It was recently shown that MD1003 (high-dose pharmaceutical-grade biotin or hdPB) may improve disability in patients with progressive MS. OBJECTIVE The aim of this study was to evaluate whether MD1003 improves vision compared with placebo in MS patients with chronic visual loss. METHODS The MS-ON was a 6-month, randomized, double-blind, placebo-controlled study with a 6-month open-label extension phase. Adult patients with MS-related chronic visual loss of at least one eye [visual acuity (VA) below 0.5 decimal chart] were randomized 2:1 to oral MD1003 300 mg/day or placebo. The selected eye had to show worsening of VA within the past 3 years following either acute optic neuritis (AON) or slowly progressive optic neuropathy (PON). The primary endpoint was the mean change from baseline to month 6 in VA measured in logarithm of the minimum angle of resolution (logMAR) at 100% contrast of the selected eye. Visually evoked potentials, visual field, retinal nerve fiber layer (RNFL) thickness, and health outcomes were also assessed. RESULTS Ninety-three patients received MD1003 (n = 65) or placebo (n = 28). The study did not meet its primary endpoint, as the mean change in the primary endpoint was nonsignificantly larger (p = 0.66) with MD1003 (- 0.061 logMAR, + 3.1 letters) than with placebo (- 0.036 logMAR, + 1.8 letters). Pre-planned subgroup analyses showed that 100% contrast VA improved by a mean of + 2.8 letters (- 0.058 logMAR) with MD1003 and worsened by - 1.5 letters (+ 0.029 logMAR) with placebo (p = 0.45) in the subgroup of patients with PON. MD1003-treated patients also had nonsignificant improvement in logMAR at 5% contrast and in RNFL thickness and health outcome scores when compared with placebo-treated patients. There was no superiority of MD1003 vs placebo in patients with AON. The safety profile of MD1003 was similar to that of placebo. CONCLUSIONS MD1003 did not significantly improve VA compared with placebo in patients with MS experiencing chronic visual loss. An interesting trend favoring MD1003 was observed in the subgroup of patients with PON. Treatment was overall well tolerated. TRIAL REGISTRATION EudraCT identifier 2013-002112-27. ClinicalTrials.gov Identifier: NCT02220244 FUNDING: MedDay Pharmaceuticals.
Collapse
Affiliation(s)
- Ayman Tourbah
- Department of Neurology, Faculty of Medicine, CHU de Reims, URCA, Reims, France.
- LPN EA 2027, Université Paris 8, Saint-Denis, France.
| | - Olivier Gout
- Department of Neurology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Alain Vighetto
- Lyon Neuroscience Research Center (CRNL), ImpAct, INSERM U1028, CNRS, UMR5292, Lyon 1 University, Lyon, France
- Department of Neurology, Hopital Neurologigue, Hospices Civils de Lyon, Bron, France
| | | | - Jean Pelletier
- Department of Neurology, APHM, Hôpital de la Timone, Marseille, France
- UMR 7339, CRMBM, CNRS, Aix-Marseille Université, Marseille, France
| | - Caroline Papeix
- Department of Neurology, GH Pitié Salpêtrière, Paris, France
| | | | - Pierre Labauge
- Department of Neurology, CHU de Montpellier, Montpellier, France
| | - David Brassat
- INSERM U1043, Centre de Resource et de Competence SEP, Hopital Pierre Paul Riquet, Université de Toulouse, Toulouse, France
| | - Ahmed Toosy
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square Multiple Sclerosis Centre, University College London, London, UK
| | - David-Axel Laplaud
- UMR 1064, INSERM, Centre de Recherche en Transplantation et Immunologie, Université de Nantes, Nantes, France
- Service Neurologie, CHU Nantes, Nantes, France
| | - Olivier Outteryck
- Department of Neurology, CHU de Lille, University of Lille, Lille, France
| | - Thibault Moreau
- Department of Neurology, University Hospital of Dijon, Dijon, France
| | | | - Pierre Clavelou
- Department of Neurology, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Olivier Heinzlef
- Department of Neurology, Centre Hospitalier de Poissy, Saint Germain, France
| | - Jérôme De Sèze
- INSERM 1434, Department of Neurology, Clinical Investigation Center, CHU de Strasbourg, Strasbourg, France
| | - Gilles Defer
- Department of Neurology, CHU de Caen, Caen, France
| | | | - Carl Arndt
- Department of Ophthalmology, Faculty of Medicine, CHU de Reims, URCA, Reims, France
| |
Collapse
|
36
|
Notfälle in der Augenheilkunde. Notf Rett Med 2018. [DOI: 10.1007/s10049-018-0430-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
37
|
Seeger A, Schulze M, Schuettauf F, Ernemann U, Hauser TK. Advanced diffusion-weighted imaging in patients with optic neuritis deficit - value of reduced field of view DWI and readout-segmented DWI. Neuroradiol J 2018; 31:126-132. [PMID: 29417865 DOI: 10.1177/1971400918757711] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective The objective of this article is to evaluate advanced techniques of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) measurements of the optic nerve in patients with optic neuritis. Methods In this prospective and institutional review board-approved trial, we examined 15 patients with acute visual loss and clinical signs of optic neuritis including thin-slice multi-shot segmented readout of long variable echo trains (rs-EPI, RESOLVE) DWI and reduced field-of view DWI using a parallel transmit system (rFOV-EPI). Conventional single-shot echo-planar DWI (ss-EPI) of the whole brain was available in 13 patients. Subjective image quality was compared using a four-point scale and objective ADC measurements were performed in comparison with the non-affected side. Results In the intraorbital segment, subjective image quality was significantly higher in rFOV-EPI (score 3.3 ± 0.8) compared with rs-EPI (score 2.1 ± 0.8) and ss-EPI (score 0.9 ± 0.8). Diagnosis was hampered in the canalicular segment ( n = 3) and the intracranial segment ( n = 1) in all applied DWI techniques. ADC measurements of the affected side differed significantly in all DWI sequences ss-EPI (sensitivity 54%, accuracy 77%), rs-EPI (sensitivity 71%, accuracy 86%), and rFOV-EPI (sensitivity 73%, accuracy 87%). Conclusion Optic neuritis in the intraorbital segment can be detected with high sensitivity without the need for contrast application. Using rFOV-EPI improves subjective image quality compared with rs-EPI and ss-EPI. Due to its higher spatial resolution, rFOV-EPI was the preferred technique in our study and can ensure the diagnosis in the intraorbital segment. However, artefacts occur in the canalicular and intracranial segment of the optic nerve, therefore contrast-enhanced T1-weighted images must still be considered as the gold standard.
Collapse
Affiliation(s)
- Achim Seeger
- 1 Diagnostic and Interventional Neuroradiology, University Hospital of Tübingen, Germany.,2 Radiologiepraxis Tübingen, Germany
| | - Maximilian Schulze
- 1 Diagnostic and Interventional Neuroradiology, University Hospital of Tübingen, Germany
| | - Frank Schuettauf
- 3 Department of Ophthalmology, University Hospital Hamburg-Eppendorf, Germany
| | - Ulrike Ernemann
- 1 Diagnostic and Interventional Neuroradiology, University Hospital of Tübingen, Germany
| | - Till-Karsten Hauser
- 1 Diagnostic and Interventional Neuroradiology, University Hospital of Tübingen, Germany
| |
Collapse
|
38
|
Alamgir MJ, Ali SA, Hamdy NA, Khan MZ, Mohammad EE. Optic neuritis: Observation and experience at a tertiary care hospital in Qassim region, Saudi Arabia. Int J Health Sci (Qassim) 2017; 11:30-34. [PMID: 29114192 PMCID: PMC5669509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES Optic neuritis (ON) can occur in isolation or association with multiple sclerosis (MS) or neuromyelitis optica. ON, is seen more commonly in Caucasians and interaction is found to exist between ethnic origin and the latitude at which the patient grows up. At present limited information is available about the profile of ON in Saudi patients. We aimed to analyze the records of ON patients, in regard to their presentation, natural history, treatment outcome, and risk and association with MS. Whether, ON in Saudi patients behaves differently from the Western and Asian patients? METHODS In this retrospective observational study; we retrieved the data from the medical records of the patients with ON, who attended the ophthalmology and neurology services of King Fahad Specialist Hospital Buraidah, Al Qassim, Saudi Arabia, from period 2006 to 2012. RESULTS We recorded data of 60 patients of ON; 38 females (63.3%) and 22 males (36.7%). Color vision was affected in 66.7% of cases. Vision in the affected eye was 20/200 or worse in 74.97 % of our cases. Magnetic resonance imaging (MRI) brain revealed multiple lesions in 55% of cases; most of them developed MS on follow-up. Only 48.3% of patients had received systemic steroids. Vision improved in 85% of our cases. CONCLUSION Most of our patients had idiopathic ON, and almost 85% had good visual recovery, in this regard our study is comparable with such studies done in other Asian countries. On the other hand, 55% of our patients had multiple MRI brain lesions, a high risk and association of MS, almost similar to the Western Europe and North American ON patients.
Collapse
Affiliation(s)
- Mohammad Jawad Alamgir
- Faculty of Neurology, Department of Medicine, College of Medicine, Qassim University (QU) Saudi Arabia,Address for correspondence: Mohammad Jawad Alamgir, Department of Medicine, Faculty of Neurology, College of Medicine, Qassim University (QU), Saudi Arabia. E-mail:
| | - Syed Abrar Ali
- Ophthalmology Department, King Fahad Specialist Hospital Buraidah Al Qassim, Saudi Arabia
| | | | - Moin Zafar Khan
- Faculty of Medicine Department of Medicine, College of Medicine QU Saudi Arabia
| | - Elgamri E Mohammad
- Ophthalmology Department, King Fahad Specialist Hospital Buraidah Al Qassim, Saudi Arabia
| |
Collapse
|
39
|
Huang X, Zhang Q, Hu PH, Zhong YL, Zhang Y, Wei R, Xu TT, Shao Y. White and Gray Matter Volume Changes and Correlation with Visual Evoked Potential in Patients with Optic Neuritis: A Voxel-Based Morphometry Study. Med Sci Monit 2016; 22:1115-23. [PMID: 27045330 PMCID: PMC4824464 DOI: 10.12659/msm.897837] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The aim of this study was to investigate potential morphological alterations of gray and white matter in patients with optic neuritis (ON) and their relationship with behavioral performance, using voxel-based morphometry (VBM). Material/Methods Twelve (4 males, 8 females) patients with ON and 12 (4 males, 8 females) age-, sex-, and education-matched healthy controls (HCs) underwent magnetic resonance imaging (MRI). Imaging data were analyzed using two-sample t tests to identify group differences in gray and white matter volume (GMV, WMV). Correlation analysis was used to explore relationships between observed GMV and WMV of different areas and visual evoked potential (VEP) in ON. Results Compared with HCs, ON patients had: significantly decreased GMV in the left postcentral gyrus, left inferior frontal gyrus, left anterior cingulate, left and right middle frontal gyrus, and right inferior parietal lobule; decreased WMV in the left middle frontal gyrus, right superior frontal gyrus, left precentral gyrus and right inferior parietal lobule; and increased WMV in the left fusiform gyrus and left inferior parietal lobule. VEP latency of the right eye in ON correlated positively with WMV signal value of the left fusiform gyrus (r=0.726, p=0.008), and negatively with GMV signal value of the right inferior parietal lobule (r=−0.611, p=0.035). Duration of ON correlated negatively with WMV signal value of the right superior frontal gyrus (r=−0.662, p=0.019), while best-corrected visual acuity (VA) of the right eye correlated negatively with WMV signal value of the left middle frontal gyrus (r=−0.704, p=0.011). Conclusions These results suggest significant brain involvement in ON, which may reflect the underlying pathologic mechanism. Correlational results demonstrate that VEP in ON is closely associated with WMV and GMV atrophy in many brain regions.
Collapse
Affiliation(s)
- Xin Huang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province clinical ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi, China (mainland)
| | - Qiang Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province clinical ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi, China (mainland)
| | - Pei-Hong Hu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province clinical ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi, China (mainland)
| | - Yu-Lin Zhong
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province clinical ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi, China (mainland)
| | - Ying Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province clinical ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi, China (mainland)
| | - Rong Wei
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province clinical ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi, China (mainland)
| | - Ting-Ting Xu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province clinical ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi, China (mainland)
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province clinical ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi, China (mainland)
| | -
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province clinical ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi, China (mainland)
| |
Collapse
|
40
|
Müller-York A. Additional New Therapeutic Options. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:136. [PMID: 26976715 PMCID: PMC4800160 DOI: 10.3238/arztebl.2016.0136b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
41
|
Wilhelm H, Schabet M. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:136. [PMID: 26976716 PMCID: PMC4800161 DOI: 10.3238/arztebl.2016.0136c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
42
|
Wedig MP. Important: Asking Patients About Lead Symptoms. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:136. [PMID: 26976714 PMCID: PMC4800159 DOI: 10.3238/arztebl.2016.0136a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|