Transorbital Sonography and Visual Outcome for the Diagnosis and Monitoring of Optic Neuritis

Introduction: Optic neuritis is one of the common causes of sudden visual impairment. Early diagnosis and treatment with intravenous steroids can hasten visual recovery. Objective: To analyze the demographic pattern, clinical profile, and response to treatment with pulse methylprednisolone in patients presenting with optic neuritis. Methods: A hospital based retrospective analysis of records of patients with optic neuritis presenting at BPKIHS between April 2010 to February 2012 was carried out. Demographic pattern, clinical profile and visual outcome at the time of presentation and discharge were recorded. Results: Thirty-five patients (44 eyes) presented with optic neuritis. A total of 33 eyes (75%) had papillitis and 11 eyes (25%) had retrobulbar optic neuritis. Male to female ratio was 2.18:1. The mean age at presentation was 31.20 ± 17.07 years. Diminution of vision was the commonest mode of presentation. Bilateral involvement was seen in 9 patients (25.71%). The 38 eyes (86.36%) had abnormal pupillary reaction. Eight patients (22.85%) had preceeding history of trauma, 1 (2.85%) had ethmoidal sinusitis and 1 (2.85%) otitis media. At the time of discharge 32 eyes (72.7%) showed recovery in visual acuity after pulse I.V. methylprednisolone therapy. Duration at presentation, visual acuity at presentation and diagnosis did not affect the final visual outcome (p=0.486, p=0.162 and p=0.122 respectively). Conclusion: Majority of patients presented with papillitis of idiopathic origin. Most of the cases were unilateral. Most patients with visual acuity of at least perception of light or better at the time of presentation improved after pulse I.V. methylprednisolone therapy. DOI: http://dx.doi.org/10.3126/hren.v11i3.9641 Health Renaissance 2013;11(3):250-253

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VISUAL FUNCTION AT BASELINE AND 1 MONTH IN ACUTE OPTIC NEURITIS: PREDICTORS OF VISUAL OUTCOME

Neurology ◽

10.1212/01.wnl.0000307676.17971.09 ◽

2008 ◽

Vol 70 (9) ◽

pp. 738-738

Author(s):

O. F. Gout ◽

M. J. Kupersmith ◽

R. Gal ◽

R. Beck ◽

N. Miller

Keyword(s):

Optic Neuritis ◽

Visual Function ◽

Visual Outcome ◽

Acute Optic Neuritis

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Visual outcome following optic neuritis: A 5-year review

Nigerian Journal of Clinical Practice ◽

10.4103/1119-3077.100628 ◽

2012 ◽

Vol 15 (3) ◽

pp. 311 ◽

Cited By ~ 4

Author(s):

CN Pedro-Egbe ◽

B Fiebai ◽

CS Ejimadu

Keyword(s):

Optic Neuritis ◽

Visual Outcome

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Visual field loss and structure–function relationships in optic neuritis associated with myelin oligodendrocyte glycoprotein antibody

Multiple Sclerosis Journal ◽

10.1177/1352458520937281 ◽

2020 ◽

pp. 135245852093728

Author(s):

Romain Deschamps ◽

Manon Philibert ◽

Cedric Lamirel ◽

Jerome Lambert ◽

Vivien Vasseur ◽

...

Keyword(s):

Visual Field ◽

Optic Neuritis ◽

Structural Damage ◽

Structural Changes ◽

Visual Field Loss ◽

Visual Outcome ◽

Myelin Oligodendrocyte Glycoprotein ◽

Mean Deviation ◽

Ophthalmological Examination ◽

Fiber Layer

Background: A paradoxical discrepancy between severe peripapillary retinal nerve fiber layer (pRNFL) atrophy and good visual outcome had been reported in patients with myelin oligodendrocyte glycoprotein-immunoglobulin G (MOG-IgG)-associated optic neuritis (ON). However, only visual acuity (VA) was assessed. Objectives: To study visual field (VF) outcomes of patients with MOG-IgG-associated ON and evaluate the correlation between functional eye outcome and retinal structural changes assessed by optical coherence tomography. Methods: The records of 32 patients with MOG-IgG-associated ON who underwent ophthalmological examination at least 12 months after ON onset were reviewed. Degree of VF disability was determined by mean deviation (MD). Results: At final assessment (median, 35 months), 4.2% of 48 affected eyes (AE) had VA ⩽ 0.1, 40% had abnormal MD, and among AE with final VA ⩾ 1.0, 31% had mild to moderate damage. Thinning of the inner retinal layers was significantly correlated with MD impairment. Analysis demonstrated a threshold of pRNFL thickness (50 µm), below which MD was significantly worse (mean, −2.27 dB vs −17.72 dB; p = 0.0003). ON relapse was significantly associated with poor visual outcome assessed by MD. Conclusion: Functional impairment measured with VF is not rare, and MD assessment better reflects actual structural damage.

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Vision improvement in severe acute isolated optic neuritis after plasma exchange treatment in Chinese population: a prospective case series study

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756286420947977 ◽

2020 ◽

Vol 13 ◽

pp. 175628642094797

Author(s):

Shaoying Tan ◽

Tsz Kin Ng ◽

Quangang Xu ◽

Mo Yang ◽

Yuan Zhuang ◽

...

Keyword(s):

Optic Neuritis ◽

Plasma Exchange ◽

Time Window ◽

Case Series ◽

Visual Outcome ◽

Chinese Patients ◽

High Dose ◽

Visual Outcomes ◽

Double Filtration Plasmapheresis ◽

Case Series Study

Background: Plasma exchange (PE) is often considered as an effective treatment for neuromyelitis optica spectrum disorder (NMOSD) and several inflammatory demyelinating disorders of the central nervous system. This study aimed to evaluate the visual outcomes of Chinese patients with severe acute isolated optic neuritis (ON) who received PE therapy after high-dose intravenous methylprednisolone (IVMP) treatment. Methods: Thirty-seven acute isolated ON patients experiencing their first attack of severe visual impairment without neurological disability were recruited. All subjects received five cycles of double-filtration plasmapheresis. Visual acuity (VA) was documented at onset, 1 day before PE treatment, at each cycle of PE therapy and at the 1-month follow-up visit. Results: This study included 26 female (70.3%) and 11 male (29.7%) subjects, and 18 subjects (48.6%) had bilateral involvement. The time window between onset and PE treatment was 27.3 ± 12.7 days (range: 6–53 days). Mean VA (logMAR) of the studied eyes at onset, 1-day before PE treatment/after IVMP and after the fifth PE treatment were 3.41 ± 1.50, 2.61 ± 1.64 and 1.66 ± 1.52, respectively ( p < 0.001). Nineteen eyes (51.4%) showed no light perception at the onset, and 17 eyes (45.9%) improved to Snellen VA >20/800 after IVMP and PE treatments, among which five eyes (13.5%) recovered to Snellen VA 20/20 ( p < 0.001). Predictors of good visual outcome included body mass index [odds ratio (OR) = 0.734, p = 0.044], serum AQP4 antibody-positive status (OR = 0.004, p = 0.001), bilaterality (OR = 0.042, p = 0.008) and time window from onset to PE therapy per 1 day (OR = 0.79, p = 0.002). Conclusion: This study revealed that PE treatment effectively improves the visual outcomes of patients experiencing their first attack of severe acute isolated ON after high-dose IVMP treatment. Better visual outcomes can be achieved with early PE treatment.

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Multifocal visual evoked potential evaluation for diagnosis of acute optic neuritis and for prediction of visual outcome and ganglion cell layer thinning following optic neuritis

Multiple Sclerosis Journal ◽

10.1177/1352458520975732 ◽

2020 ◽

pp. 135245852097573

Author(s):

Gorm Pihl-Jensen ◽

Benedikte Wanscher ◽

Jette Lautrup Frederiksen

Keyword(s):

Optic Neuritis ◽

Ganglion Cell ◽

Visual Function ◽

Visual Evoked Potential ◽

Evoked Potential ◽

Conduction Block ◽

Visual Outcome ◽

Multifocal Visual Evoked Potential ◽

Visual Evoked

Background:: While damage to the optic nerve following optic neuritis (ON) is readily quantifiable, the evaluation of prognosis for visual function and neuroaxonal loss in the acute ON is challenging. Objective:: The objective of this study is to investigate the value of multifocal visual evoked potential (mfVEP) in acute ON, diagnostically for acute ON and prognostically for visual outcome and subsequent ganglion cell/inner plexiform layer thickness (GCLIPLt). Methods:: A prospective cohort study of mfVEP and full-field visual evoked potential (ffVEP) in acute, unilateral ON (onset < 31 days) was conducted. Comparisons with healthy controls ( n = 30) and association analysis with follow-up optical coherence tomography (OCT) measurements (of the GCLIPLt) and visual function (Sloan low-contrast visual acuity (LCVA)) were conducted. Results:: Seventy-nine ON patients were included (mean: 17 days from onset). Excluding measurements with conduction block, ffVEP ( n = 54) and mfVEP ( n = 44) showed sensitivities of 89% and 84% to a specificity of 97%. 65/79 patients were re-examined (mean: 200 days follow-up). mfVEP amplitude and latency inter-eye asymmetry in acute ON correlated with GCLIPLt ( r = 0.587 and Spearman’s ρ = 0.597, for both, p < 0.001). mfVEP amplitude correlated with LCVA inter-eye asymmetry at follow-up ( r = 0.421, p < 0.001), mfVEP latency did not. Conclusion: mfVEP may support the prognostic evaluation of acute ON patients and prove valuable in future neuroprotective and remyelinating trials. In acute ON, the increase in diagnostic value of mfVEP to ffVEP may be limited due to widespread conduction block.

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Visual function at baseline and 1 month in acute optic neuritis: Predictors of visual outcome

Neurology ◽

10.1212/01.wnl.0000267272.60714.42 ◽

2007 ◽

Vol 69 (6) ◽

pp. 508-514 ◽

Cited By ~ 25

Author(s):

M. J. Kupersmith ◽

R. L. Gal ◽

R. W. Beck ◽

D. Xing ◽

N. Miller ◽

...

Keyword(s):

Optic Neuritis ◽

Visual Function ◽

Visual Outcome ◽

Acute Optic Neuritis

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The Diagnostic and Prognostic Value of Neurofilament Heavy Chain Levels in Immune-Mediated Optic Neuropathies

Multiple Sclerosis International ◽

10.1155/2012/217802 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Axel Petzold ◽

Gordon T. Plant

Keyword(s):

Optic Neuritis ◽

Heavy Chain ◽

Prognostic Value ◽

Visual Outcome ◽

High Serum ◽

Healthy Controls ◽

Prospective Longitudinal Study ◽

Immune Mediated ◽

Prospective Longitudinal ◽

Diagnostic And Prognostic Value

Background. Loss of visual function differs between immune-mediated optic neuropathies and is related to axonal loss in the optic nerve. This study investigated the diagnostic and prognostic value of a biomarker for neurodegeneration, the neurofilament heavy chain (NfH) in three immune-mediated optic neuropathies.Methods. A prospective, longitudinal study including patients with optic neuritis due to multiple sclerosis (MSON,n=20), chronic relapsing inflammatory optic neuritis (CRION,n=19), neuromyelitis optica (NMO,n=9), and healthy controls (n=28). Serum NfH-SMI35 levels were quantified by ELISA.Findings. Serum NfH-SMI35 levels were highest in patients with NMO (mean0.79±1.51 ng/mL) compared to patients with CRION (0.13±0.16 ng/mL,P=0.007), MSON (0.09±0.09,P=0.008), and healthy controls (0.01±0.02 ng/mL,P=0.001). High serum NfH-SMI35 levels were related to poor visual outcome.Conclusions. Blood NfH-SMI35 levels are of moderate diagnostic and more important prognostic value in immune-mediated optic neuropathies. We speculate that longitudinal blood NfH levels may help to identify particular disabling events in relapsing conditions.

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Visual outcome after intravenous dexamethasone therapy for idiopathic optic neuritis in an Indian population: A clinical case series

Indian Journal of Ophthalmology ◽

10.4103/0301-4738.27069 ◽

2006 ◽

Vol 54 (3) ◽

pp. 177 ◽

Cited By ~ 8

Author(s):

Radhika Tandon ◽

HarinderSingh Sethi ◽

Vimla Menon ◽

Pradeep Sharma ◽

Sudarshan Khokhar

Keyword(s):

Optic Neuritis ◽

Clinical Case ◽

Indian Population ◽

Case Series ◽

Visual Outcome ◽

Dexamethasone Therapy

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Visual Outcomes of Adding Erythropoietin to Methylprednisolone for Treatment of Retrobulbar Optic Neuritis

Journal of Ophthalmic and Vision Research ◽

10.18502/jovr.v14i3.4786 ◽

2019 ◽

Author(s):

Mostafa Soltan Sanjari ◽

Farzad Pakdel ◽

Fatemeh Moosavi ◽

Niloofar Pirmarzdashti ◽

Marzieh Nojomi ◽

...

Keyword(s):

Visual Acuity ◽

Pilot Study ◽

Optic Neuritis ◽

Visual Outcome ◽

Primary Outcome Measure ◽

Recombinant Erythropoietin ◽

Human Recombinant Erythropoietin ◽

Retrobulbar Optic Neuritis ◽

Group 2 ◽

Group 1

Purpose: To compare the short-term visual function results and safety of erythropoietin as an add-on to the standard corticosteroid therapy in retrobulbar optic neuritis (RON). Methods: In this prospective pilot study, adult patients with isolated RON with less than 10 days of onset were enrolled. Patients were consecutively assigned to standard intravenous methylprednisolone treatment either in combination with intravenous erythropoietin (20,000 units/day for three days) (group-1) or alone (group-2). Primary outcome measure was best-corrected visual acuity (BCVA), which was assessed up to 120 days from the day the treatment was begun. Systemic evaluations were performed during and after treatment. Results: Sixty-two patients with RON (mean age = 26.6 ± 5.77 years; range = 18–40 years) were enrolled into the study (group-1, n = 35; group-2, n = 27). BCVA three months after the treatment was 0.19 ± 0.55 logMAR and 0.11 ± 0.32 logMAR in group-1 and group-2, respectively (95% CI: –0.61–0.16; P = 0.62). Change in BCVA after three months was 2.84 ± 3.49 logMAR in group-1 and 2.46 ± 1.40 logMAR in group-2 (95% CI: –0.93–1.91; P = 0.57). Pace of recovery was not significantly different between the groups. No complications were detected among patients. Conclusion: Intravenous erythropoietin as an add-on did not significantly improve the visual outcome in terms of visual acuity, visual field, and contrast sensitivity compared to traditional intravenous corticosteroid. This pilot study supports the safety profile of intravenous human recombinant erythropoietin, and it may help formulate future investigations with a larger sample size.

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