Assessing the Correlation Between Visual Acuity and Critical Fusion Frequency in Acute Optic Neuritis Before and After Steroid Therapy

Background Optic nerve diseases include inflammatory optic nerve diseases such as vasculitis, metabolic optic neuropathy, ischemic optic neuropathy, and optic neuritis. In this study, patients with acute optic neuritis are classified with better and poor visual acuity based on visual acuity after one month of steroid pulse therapy. To determine prognosis, initial visual acuity and critical fusion frequency (CFF) values will be compared with those recorded one month after treatment and at the last visit. Methods Visual acuity and CFF were evaluated one month after the start of treatment in patients diagnosed with acute optic neuritis, and follow-up was available for at least three months at Hiroshima University Hospital. Results All patients received steroid pulse therapy as initial treatment. After one month of treatment, visual acuity and CFF at the last visit were significantly improved in the group with improved visual acuity compared to the group with impaired visual acuity. Conclusions Visual acuity at the initial visit did not affect treatment outcome, and final visual acuity and CFF after one month of treatment for acute optic neuritis were better in patients with better visual acuity. Therefore, visual acuity values one month after treatment initiation may affect treatment outcomes.

A Case of Acute Pancreatitis in a Patient Receiving High-Dose Steroids for Optic Neuritis

Although rare, drug-induced pancreatitis is an important cause of acute pancreatitis. The diagnosis of drug-induced pancreatitis remains a challenge for clinicians. Steroids are one of the frequently used drugs in hospitals for many acute illnesses. Patients presenting with signs and symptoms of acute pancreatitis, with a recent history of steroid use, in the absence of other potential causes, should be approached with a high suspicion for steroid-induced pancreatitis to ensure a timely diagnosis. We describe a case of a 57-year-old female treated for optic neuritis of the left eye with high doses of Methylprednisolone for five days, who presented to the emergency room with acute abdominal pain within 24 hours of discharge. A detailed evaluation of the patient's medical history and exclusion of other probable etiologies confirmed the diagnosis of steroid-induced pancreatitis. Withdrawal of the offending agent and supportive care resolved the underlying acute pancreatitis.

Unilateral Acute Idiopathic Optic Neuritis With Superior Altitudinal Visual Field Defect as a Presenting Feature

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.

Factors Associated with Changes in Retinal Layers Following Acute Optic Neuritis: A Longitudinal Study Using Optical Coherence Tomography

This study aimed to analyze longitudinal changes in retinal microstructures following acute optic neuritis and to identify the factors that affect those changes using spectral-domain optical coherence tomography (OCT). Forty-eight eyes of 37 patients with a first episode of optic neuritis and 48 eyes of 48 healthy controls were enrolled. Patients underwent serial OCT and visual function testing for more than six months. Individual layers from macular OCT were segmented with an automated algorithm. The total retinal layer (TRL), nerve fiber layer (NFL), ganglion cell layer (GCL) and inner plexiform layer (IPL) of optic neuritis eyes showed significant thinning with time over 6–15 months (p < 0.001 for all). The outer nuclear layer (ONL) showed a later decrease in thickness (p = 0.007). The outer retinal layer (ORL) showed an increase (p = 0.007) in thickness at two to five months which was sustained over time. Low visual acuity and neuromyelitis optica (NMO) immunoglobulin (Ig) G were associated with changes in the thickness of the GCL, IPL, and ONL over time (p < 0.05 for all). Low visual acuity was also associated with changes in the thickness of the NFL over time (p = 0.033). Dynamic changes of retinal microstructures varied according to the retinal layer examined after an optic neuritis attack. Initial visual acuity and NMO-IgG were found to be significant factors affecting the changes in thickness of each retinal layer. These results will lead to a better understanding of the pathologic changes that occur in eyes with optic neuritis.

Retinal Nerve Fiber Layer Thickness and Higher Relapse Frequency May Predict Poor Recovery after Optic Neuritis in MS Patients

Optic neuritis (ON) is a common manifestation of multiple sclerosis (MS). Aiming to evaluate the retinal nerve fiber layer (RNFL) with optical coherence tomography (OCT), patients with relapsing-remitting (RR) MS experiencing ON were consecutively enrolled. RNFL, ganglion cell layer (GCL), foveal thickness, and macular volume were evaluated in both the ON and unaffected (nON) eye within six days from the relapse onset (T0) and after six months (T1). Ninety patients were enrolled. At T0, ON eyes showed a significantly increased RNFL when compared to the nON eyes (129.1 ± 19.5 vs. 100.5 ± 10.1, p < 0.001). At T1 versus T0, the ON eyes showed a thinner RNFL (129.1 ± 19.5 vs. 91.6 ± 20.2, p < 0.001) and a significantly decreased GCL (80.4 ± 8.8 vs. 73.8 ± 11.6; p < 0.005). No differences were found in the nON group in retinal parameters between T0 and T1. A multivariate logistic regression analysis showed that a higher number of relapses (not ON) and a greater swelling of RNFL at T0 were associated with poor recovery. The assessment of RNFL through OCT during and after ON could be used to predict persistent visual disability.

Acute Optic Neuritis Diagnosed by Bedside Ultrasound in an Emergency Department

BACKGROUND

Transorbital ultrasound was used to diagnose acute optic neuritis (AON) at bedside in an emergency department (ED).

CASE REPORT

A 59-year-old female patient presented to an ED after 7 days of progressive unilateral visual loss while she was receiving outpatient treatment for relapsing-remitting multiple sclerosis. Transorbital ultrasound revealed a disparity between the optic nerve sheath diameters of the affected and nonaffected eyes and striking optic nerve edema in the affected eye. These findings led to a diagnosis of AON and early definitive treatment. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Given an absence of reliable diagnostic criteria for AON, comorbidity with multiple sclerosis, and limitations inherent to magnetic resonance imaging, transorbital sonography may facilitate diagnosis of this condition in emergent presentations.