A Woman With Subacute Painful Vision Loss

2021 ◽  
pp. 3-6
Author(s):  
Jiraporn Jitprapaikulsan ◽  
M. Tariq Bhatti ◽  
Eric R. Eggenberger ◽  
Marie D. Acierno ◽  
John J. Chen
Keyword(s):  
Optic Neuritis ◽  
Eye Movement ◽  
Immunoglobulin G ◽  
Vision Loss ◽  
Visual Fields ◽  
Corticosteroid Treatment ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Intravenous Methylprednisolone ◽  
Eye Pain

A 51-year-old White woman sought care for vision loss 1 week after a nonspecific upper respiratory tract infection. She reported pain in both eyes exacerbated by eye movement, which lasted for several days, followed by bilateral vision loss to the level of counting fingers–only vision. Optic neuritis was diagnosed, and she was treated with 1 g intravenous methylprednisolone for 3 days. Her vision improved substantially, and the pain resolved during the corticosteroid treatment. However, 1 week later, she woke up with right eye pain and vision loss. She was again treated with 5 days of intravenous methylprednisolone, with visual improvement nearly back to baseline. Two weeks later, she had recurrence of painful vision loss in both eyes. A diagnosis of chronic relapsing inflammatory optic neuropathy was made. Tests for serum angiotensin-converting enzyme, antineutrophil cytoplasmic antibody, antinuclear antibody, Lyme disease, syphilis, tuberculosis, and aquaporin-4-immunoglobulin G antibodies were negative. Serum was definitively positive for myelin oligodendrocyte glycoprotein-immunoglobulin G antibodies at a titer of 1:1,000. Myelin oligodendrocyte glycoprotein-immunoglobulin G–associated recurrent optic neuritis was diagnosed. After her diagnosis of recurrent corticosteroid-dependent optic neuritis associated with myelin oligodendrocyte glycoprotein-immunoglobulin G positivity, the patient was treated with 5 days of intravenous methylprednisolone. The eye pain resolved, and her vision returned to normal. At follow-up evaluation, the patient’s visual acuity, color vision, and visual fields were normal in both eyes, but there was mild bilateral optic disc pallor. She has not had recurrent demyelinating episodes while on chronic immunotherapy. Optic neuritis is an inflammatory demyelination of the optic nerve manifesting as acute to subacute vision loss, classically associated with pain with eye movement. The long-term prevention and prognosis depend on the cause of the optic neuritis.

Myelin Oligodendrocyte Glycoprotein Antibody-Associated Optic Neuritis in Canada

2020 ◽  
pp. 1-6
Author(s):  
Anubhav Garg ◽  
Edward Margolin ◽  
Jonathan A. Micieli
Keyword(s):  
Optic Neuritis ◽  
Clinical Characteristics ◽  
Vision Loss ◽  
Brain Mri ◽  
Visual Fields ◽  
Case Series ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Mean Deviation ◽  
High Dose ◽  
Rnfl Thickness

ABSTRACT: Objective: To describe clinical characteristics of Canadian patients with myelin-oligodendrocyte glycoprotein immunoglobulin-G optic neuritis (MOG-IgG ON). Methods: Retrospective observational case series of MOG-IgG seropositive patients with ON referred to tertiary neuro-ophthalmology practices. Outcome measures included clinical characteristics, radiologic findings, and visual outcomes. Results: Forty-six eyes of 30 patients were included. Twenty-three (76.7%) were women, mean onset age was 40.7 years (range 16–77), and most were Caucasian. Seventeen (56.7%) presented with their first ON episode. Sixteen (53.3%) had bilateral eye involvement. Isolated ON without associated neurological symptoms occurred in 90.0%. In 22 patients with acute ON (seen within 1 month of onset), presenting mean visual acuity (VA) was 20/258 (logMAR 1.11), mean deviation (MD) on Humphrey visual fields was −16.90 ± 10.83 dB, and peripapillary retinal nerve fiber layer (RNFL) thickness on ocular coherence tomography (OCT) was 164.23 ± 46.53 um. Orbital magnetic resonance imaging (MRI) within 1 month of symptom onset for 19 patients demonstrated orbital optic nerve enhancement in 11 (57.9%) and perineural enhancement in 11 (57.9%). Brain MRI was normal in 28 (93.3%) patients. Twenty out of 22 patients with acute presentation were treated with high-dose glucocorticoids and 5 with plasma exchange in addition to corticosteroids. Long-term immunosuppression was utilized in 9 (30%) out of all 30 patients. Final VA was 20/30 (logMAR 0.18), MD was −7.17 ± 8.85 dB, and RNFL thickness was 72.15 ± 20.16 um. Conclusion: MOG-IgG ON in Canada has a variable presentation with most patients having substantial initial vision loss with good recovery. This is the largest characterization of the disease in Canada to date.

scholarly journals Idiopathic Sclerosing Inflammation Presenting as Sinusitis

2012 ◽  
Vol 3 (2) ◽  
pp. ar.2012.3.0031 ◽  
Author(s):  
Henry P. Barham ◽  
Megan K. Dishop ◽  
Jeremy D. Prager
Keyword(s):  
Vision Loss ◽  
Inflammatory Lesion ◽  
Poor Response ◽  
Corticosteroid Treatment ◽  
Sinus Surgery ◽  
Infraorbital Nerve ◽  
High Dose ◽  
Rapid Improvement ◽  
Eye Pain ◽  
Recommended Treatment

Idiopathic sclerosing orbital inflammation is a rare finding that is poorly delineated, immune mediated, and causes severe symptoms and disability. It has been described affecting the orbit in addition to other sites within the head and neck, but has rarely been described presenting as sinusitis. A case report and literature review were performed. A 14-year-old girl with right-sided face and eye pain and pressure for >1 month presented 3 days after endoscopic sinus surgery for presumed acute sinusitis. She subsequently developed ipsilateral vision loss and hypesthesia of the infraorbital nerve. MRI revealed a mildly enhancing soft tissue intensity lesion extending from the right maxillary sinus into the pterygopalatine fossa and orbital apex through the inferior orbital fissure. Biopsy specimens of the lesion were consistent with a sclerosing inflammatory lesion. High-dose steroids led to rapid improvement in vision and pain; however, the patient was unable to tolerate steroid weaning because of recurrence of eye pain and headache. Repeat imaging showed progression of the lesion. Rheumatology was consulted and the patient's steroid therapy was altered and her medications were expanded to include azathioprine. The patient's symptoms improved and subsequent imaging showed a reduction in the size and extent of the lesion. Idiopathic sclerosing inflammation is characterized by primary, chronic, and immunologically mediated fibrosis. Patients typically have a poor response to corticosteroid treatment or radiotherapy. Immunosuppressive therapy in addition to corticosteroids is the recommended treatment.

First Clinical Experience with Anti-myelin Oligodendrocyte Glycoprotein Antibody-Positive Optic Neuritis

2020 ◽  
Vol 237 (04) ◽  
pp. 458-463 ◽  
Author(s):  
Jan Heckmann ◽  
Margarita Todorova ◽  
Stefanie Müller ◽  
Philip Julian Broser ◽  
Veit Sturm
Keyword(s):  
Visual Acuity ◽  
Optic Neuritis ◽  
Pulse Therapy ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Individual Treatment ◽  
Igg Antibodies ◽  
Intravenous Methylprednisolone ◽  
Finger Counting ◽  
The Right

Abstract Background Antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) have been consistently found in a range of demyelinating disorders. In this context, MOG-IgG-associated optic neuritis (ON) has been suggested as a new subset of optic neuropathy. However, clinical manifestations and distinctive characteristics have only rarely been described. Patients and Methods A retrospective case series of three patients with MOG-IgG-associated ON. Clinical morphological features using imaging techniques are presented. Results Three patients (8-year-old boy, 28-year-old female, 48-year-old male) were included. An 8-year-old boy suffered from a bilateral ON with severe visual loss. The best-corrected visual acuity (BCVA) was 0.05 in the right eye and finger counting in the left eye. The patient had a previous episode of acute disseminated encephalomyelitis (ADEM) with a right abducens nerve palsy. Visual acuity recovered after repeated cycles of intravenous methylprednisolone pulse therapy and 10 cycles of plasma exchange. During the last follow-up, BCVA was 0.9 in the right eye and 0.8 in the left eye. A 28-year-old female presented with a bilateral ON. Her BCVA was 0.5 in the right eye and 0.8 in the left eye. She fully recovered with pulse methylprednisolone therapy (1000 mg/d) with tapering after the second cycle and had a BCVA of 1.0 during the last follow-up visit. A 48-year-old male suffered from a relapsing bilateral ON. At first presentation, BCVA was 0.1 in the right eye and finger counting in the left eye. BCVA fully recovered after each pulse therapy with intravenous methylprednisolone (two cycles). Since the first relapse, the patient has been receiving long-term immunosuppression with rituximab. Despite rituximab and low-dose oral prednisone, the patient had another relapse with a left ON. After a third cycle with intravenous methylprednisolone, he partially recovered. BCVA at last follow-up was 1.0 in the right and 0.8 in the left eye. Conclusions MOG-IgG antibodies have been identified in different acquired demyelinating syndromes. The patients reported had an ADEM followed by bilateral ON, an isolated bilateral ON, and a relapsing bilateral ON. Individual treatment strategies led to substantial visual recovery in all patients. We recommend inclusion of MOG-IgG antibodies in the diagnostic workup at least after the first recurrence of ON since they can serve as a diagnostic and potential prognostic tool and might lead to specific therapeutic recommendations.

scholarly journals A comparative evaluation between megadose intravenous dexamethasone and intravenous methyl prednisolone in the treatment outcome of optic neuritis

2017 ◽  
Vol 5 (4) ◽  
pp. 49-54
Author(s):  
P Panjiyar ◽  
A K Sharma ◽  
G B Shrestha ◽  
A Shah
Keyword(s):  
Visual Acuity ◽  
Optic Neuritis ◽  
Visual Fields ◽  
Oral Prednisolone ◽  
Intravenous Methylprednisolone ◽  
Methyl Prednisolone ◽  
Group I ◽  
Retrobulbar Optic Neuritis ◽  
The Mean ◽  
Group Ii

To compare the efficacy of intravenous methylprednisolone and intravenous dexamethasone for the treatment of optic neuritis in terms of visual recovery and side-effects and to evaluate the clinical profile of optic neuritis patients admitted in BPKLCOS. 60 patients of acute idiopathic typical optic neuritis presenting to our centre were included in this prospective, randomized comparative study. Study population was randomly divided into two groups. Group I received intravenous dexamethasone 200 mg once daily for three days and Group II received intravenous methylprednisolone 500 mg/twelve-hourly for three days followed by oral prednisolone for 11 days. Optic neuritis was found to be common in the age group of 21 to 30 years with female preponderance. The most frequent mode of presentation was abrupt loss of vision. Retrobulbar optic neuritis dominated the study group. Both groups were age and sex-matched. The mean presenting visual acuity in group I was 0.065±0.59. The mean presenting visual acuity in group II was 0.1±0.15. On day 90 of steroid therapy, visual acuity improved to 0.98±0.073 in Group I and 0.88±0.16 in Group II (p=0.23). At three months, there was statistically significant improvement in both groups in terms of colour vision, contrast sensitivity and Goldmann visual fields as well but difference between the two groups was statistically insignificant. Intravenous dexamethasone is an effective treatment for optic neuritis, which is comparable to intravenous methylprednisolone. However, larger studies are required to establish it as a safe, inexpensive and effective modality for the treatment of optic neuritis.

scholarly journals Parainfectious optic neuritis followed by microcystic macular oedema

2019 ◽  
Vol 12 (9) ◽  
pp. e231442
Author(s):  
Diogo Hipolito-Fernandes ◽  
Maria Elisa-Luís ◽  
Miguel Trigo ◽  
Joana Tavares-Ferreira
Keyword(s):  
Optic Neuritis ◽  
Optic Disc ◽  
Macular Oedema ◽  
Vision Loss ◽  
Correct Diagnosis ◽  
Visual Fields ◽  
Clinical History ◽  
Ophthalmological Examination ◽  
Upper Respiratory Tract ◽  
Viral Aetiology

Parainfectious optic neuritis is a very rare cause of acute vision loss. We present a case of a 51-year-old man with a recent upper respiratory tract infection, presumably of viral aetiology, who showed up with complains of painless right eye vision loss, followed by the same symptoms on the left eye 3 weeks later. Ophthalmological examination revealed optic disc swelling (sequential in severity) which was confirmed by optic disc imaging. The remaining evaluations (lumbar puncture, MRI, laboratory and genetic testing) were completely normal. Considering a postviral aetiology, 5-day intravenous methylprednisolone treatment was performed. Follow-up examinations revealed slight visual acuity and visual fields recovery, with subsequent optic disc atrophy and microcystic macular oedema, bilaterally. This case illustrates how important a correct clinical history is to guide a correct diagnosis and posterior management.

scholarly journals Myelin Oligodendrocyte Glycoprotein (MOG) Antibody Disease in a 11-year-old child with COVID 19 infection

2020 ◽  
Author(s):  
Archana Khan ◽  
Hiren Panwala ◽  
Divya Ramadoss ◽  
Raju Khubchandani
Keyword(s):  
Optic Neuritis ◽  
Case Reports ◽  
Oral Prednisolone ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Intravenous Methylprednisolone ◽  
Common Presentation

Abstract Optic Neuritis is the most common presentation of MOG Antibody Disease (MOG-AD). We share our experience with a 11-year-old boy who developed MOG associated Optic Neuritis temporally associated with SARS- CoV-2 infection. He responded well to intravenous methylprednisolone therapy followed by oral prednisolone. While various neurological and ophthalmological manifestations of COVID-19 have been described previously, there are few case reports of Optic neuritis associated with COVID-19. Our case further supports the evidence to suggest that SARS CoV-2 is another such virus that triggers MOG-AD.

Clinical features of demyelinating optic neuritis with seropositive myelin oligodendrocyte glycoprotein antibody in Chinese patients

2018 ◽  
Vol 102 (10) ◽  
pp. 1372-1377 ◽  
Author(s):  
Ying Zhao ◽  
Shaoying Tan ◽  
Tommy Chung Yan Chan ◽  
Quangang Xu ◽  
Jie Zhao ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Neuritis ◽  
Clinical Features ◽  
Vision Loss ◽  
Optic Tract ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Autoimmune Disorders ◽  
Chinese Patients ◽  
Mri Findings ◽  
Extensive Lesion

Background/aimsTo investigate the clinical features of Chinese patients with seropositive myelin oligodendrocyte glycoprotein antibody (MOG-Ab) optic neuritis (ON) and patients with seropositive aquaporin-4 antibody (AQP4-Ab) ON.MethodsIn this retrospective observational study, sera from patients with demyelinating ON were tested for MOG-Ab and AQP4-Ab with a cell-based assay. Clinical characteristics were compared between MOG-Ab-related ON (MOG-ON) and AQP4-Ab-related ON (AQP4-ON), including visual performances, serum autoantibodies and features on MRI.ResultsA total of 109 affected eyes from 65 patients with demyelinating ON (20 MOG-ON and 45 AQP4-ON) were included. The onset age of MOG-ON was younger than AQP4-ON (MOG-ON: 20.2±17.4 years old, AQP4-ON: 35.6±15.7 years old, P=0.001). Onset severity was not different between these two groups (P=0.112), but patients with MOG-ON showed better visual outcomes (P=0.004). Half of the MOG-ON had a relapsing disease course. Nineteen per cent of patients with AQP4-ON presented coexisting autoimmune disorders, but there were no coexisting autoimmune disorders among patients with MOG-ON. Optic nerve head swelling was more prevalent in patients with MOG-ON (P<0.01). Retrobulbar segment involvement of the optic nerve were more common in patients with MOG-ON according to our MRI findings (P<0.01). Patients with MOG-ON showed longitudinally extensive lesion in 30% and chiasm and optic tract involvement in 5%.ConclusionsMOG-ON is not rare in Chinese demyelinating patients. It underwent a severe vision loss at onset but had relatively better visual recovery than patients with AQP4-ON. MOG-ON might have an unique pathogenesis different from AQP4-ON.

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