104 Severe unilateral optic neuritis in multiple sclerosis

2018 ◽  
Vol 89 (6) ◽  
pp. A41.2-A41
Author(s):  
Natasha Gerbis ◽  
John Parratt
Keyword(s):  
Multiple Sclerosis ◽  
Visual Acuity ◽  
Optic Neuritis ◽  
Visual Loss ◽  
Case Series ◽  
Retinal Nerve Fibre Layer ◽  
High Dose ◽  
List Type ◽  
The Mean

IntroductionOptic neuritis (ON) results in acute loss of vision with pain on eye movement. It may be the first manifestation of multiple sclerosis (MS) and usually follows a resolving course. Here we describe five patients with MS who developed severe unilateral ON resulting in persistent visual loss without significant resolution.MethodsA retrospective clinical review of five cases identified from a database of 550 patients with MS.ResultsAll patients were female and the mean age was 30 years at onset (range 25–40). All patients had no light perception at diagnosis, and received treatment with high dose intravenous methylprednisolone. Two patients also had plasma exchange. All of the patients were subsequently treated with immunomodulatory therapy. The patients were followed for a mean period of 13.3 years (range 2 months to 31 years). None of the patients had significant improvement in their visual acuity, with most achieving vision of 6/60. The mean retinal nerve fibre layer thickness was 66.33 microns (range 46–98 microns) in the affected eye, compared to 86.7 microns (69–105 microns) in the unaffected eye. All patients were aquaporin-4 antibody negative and oligoclonal band positive, with the MRI brain and spine being diagnostic for MS. Interestingly, none of the patients developed significant symptoms in the contralateral eye with vision of 6/5. All patients had an EDSS score of 4.0 predominantly due to visual impairment.ConclusionSevere unilateral ON is rarely seen in MS. This case series highlights a phenotypically distinct group of female MS patients with severe unilateral ON, and no improvement in visual acuity after prolonged follow-up and despite treatment with steroids and potent immune therapies. In such patients, where the diagnosis of MS is confirmed by MRI and CSF analysis, the patient might be reassured that visual loss in the fellow eye is unlikely.References. Wilhelm H, Schabet M. The diagnosis and treatment of optic neuritis. Deutsches Arzteblatt International2015;112(37):616–626.. Dachsel RM, et al. Optic neuropathy after retrobulbar neuritis in multiple sclerosis: Are optical coherence tomography and magnetic resonance imaging useful and necessary follow-up parameters?Der Nervenarzt2015;86(2):187–96.

scholarly journals Re-evaluating diabetic papillopathy using optical coherence tomography and inner retinal sublayer analysis

Eye ◽  
2021 ◽  
Author(s):  
Josef Huemer ◽  
Hagar Khalid ◽  
Daniel Ferraz ◽  
Livia Faes ◽  
Edward Korot ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Optic Disc ◽  
Case Series ◽  
Retinal Nerve Fibre Layer ◽  
Optical Coherence ◽  
Patients With Diabetes ◽  
Optic Disc Swelling ◽  
The Mean

Abstract Background/Objectives To re-evaluate diabetic papillopathy using optical coherence tomography (OCT) for quantitative analysis of the peripapillary retinal nerve fibre layer (pRNFL), macular ganglion cell layer (mGCL) and inner nuclear layer (mINL) thickness. Subjects/Methods In this retrospective observational case series between June 2008 and July 2019 at Moorfields Eye hospital, 24 eyes of 22 patients with diabetes and optic disc swelling with confirmed diagnosis of NAION or diabetic papillopathy by neuro-ophthalmological assessment were included for evaluation of the pRNFL, mGCL and mINL thicknesses after resolution of optic disc swelling. Results The mean age of included patients was 56.5 (standard deviation (SD) ± 14.85) years with a mean follow-up duration of 216 days. Thinning of pRNFL (mean: 66.26, SD ± 31.80 µm) and mGCL (mean volume: 0.27 mm3, SD ± 0.09) were observed in either group during follow-up, the mINL volume showed no thinning with 0.39 ± 0.05 mm3. The mean decrease in visual acuity was 4.13 (SD ± 14.27) ETDRS letters with a strong correlation between mGCL thickness and visual acuity (rho 0.74, p < 0.001). Conclusion After resolution of acute optic disc swelling, atrophy of pRNFL and mGCL became apparent in all cases of diabetic papillopathy and diabetic NAION, with preservation of mINL volumes. Analysis of OCT did not provide a clear diagnostic distinction between both entities. We suggest a diagnostic overlay with the degree of pRNFL and mGCL atrophy of prognostic relevance for poor visual acuity independent of the semantics of terminology.

scholarly journals The clinical profile of childhood optic neuritis

2001 ◽  
Vol 59 (2B) ◽  
pp. 311-317 ◽  
Author(s):  
Marco Aurélio Lana-Peixoto ◽  
Gustavo Cardoso de Andrade
Keyword(s):  
Multiple Sclerosis ◽  
Optic Neuritis ◽  
Clinical Features ◽  
Medical Records ◽  
Visual Loss ◽  
Visual Outcome ◽  
The Mean ◽  
Group 2 ◽  
Group 1

PURPOSE: To report the clinical features and outcome of a series of children with optic neuritis. METHODS: We reviewed the medical records of patients up to 16 years old with optic neuritis. Group 1 comprised children seen up to two weeks after the onset of visual loss; Group 2 comprised patients already harboring optic atrophy. RESULTS: There were 15 boys and 12 girls. The mean age was 10.9 years. Bilateral optic neuritis occurred in 10. Optic disc pallor was found in 35%, edema in 46%, and 19% had normal fundus. During follow-up visual acuity improved in all but one eye in Group 1, and in six of seven eyes in children in Group 2. Just one child converted to multiple sclerosis. CONCLUSIONS: This study shows that the clinical features of childhood optic neuritis differ from those observed in adults. In children it has a better visual outcome and a lower conversion rate to multiple sclerosis than in adults.

scholarly journals Aphakia Correction by Injection of Foldable Intra Ocular Lens in the Anterior Chamber

2013 ◽  
Vol 5 ◽  
pp. OED.S12672
Author(s):  
Kagmeni Giles ◽  
Moukouri Ernest ◽  
Domngang Christelle ◽  
Nguefack-Tsague Georges ◽  
Cheuteu Raoul ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Teaching Hospital ◽  
Case Series ◽  
University Teaching ◽  
Case Series Study ◽  
The Mean ◽  
The University

We assessed the outcomes of the use of anterior chamber foldable lens for unilateral aphakia correction at the University Teaching Hospital of Yaounde. In this retrospective, non-comparative, consecutive case series study, we reviewed the records of patients who underwent an operation for aphakia correction by the means of injection of an angular supported foldable lens between January 2009 and December 2011 in the University Teaching Hospital Yaounde. Student's paired t-test was carried out to compare preoperative and postoperative visual acuity (VA) and intraocular pressure (TOP). P-values less than 0.05 were considered statistically significant. Twenty-one patients were included in the study; twelve were male (57.1%) and nine were female (42.9%). The mean age was 55.38 ± 17.67 years (range 9–75 years). The mean follow-up duration was 5.95 ± 3.14 months (range 2–12 months). The mean logMAR visual acuity was 1.26 ± 0.46 pre-operatively and 0.78 ± 0.57 post-operatively ( P = 0.003). The change in intraocular pressure was not statistically significant. Complications included intraocular hypertension (over 21 mmHg) in 3 patients (14.3%) and macular edema, pupillar ovalization, and retinal detachment in one patient each. The results indicate that injection of an angular support foldable lens in the anterior chamber is a useful technique for the correction of aphakia in eyes without capsular support. More extended follow-up, however, and a larger series of patients are needed to ascertain the effectiveness and safety of this procedure.

scholarly journals 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 ◽  
Vol 32 (7) ◽  
pp. 661-672 ◽  
Author(s):  
Ayman Tourbah ◽  
Olivier Gout ◽  
Alain Vighetto ◽  
Véronique Deburghgraeve ◽  
Jean Pelletier ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Optic Neuritis ◽  
Visual Loss ◽  
Controlled Study ◽  
High Dose ◽  
Double Blind ◽  
Double Blind Placebo

Efficacy of High-dose Steroids for Visual Acuity Improvement in Methanol-induced Toxic Optic Neuropathy

2019 ◽  
Vol 44 (2) ◽  
pp. 60
Author(s):  
Theresia Yinski ◽  
Syntia Nusanti
Keyword(s):  
Visual Acuity ◽  
Optic Neuropathy ◽  
Alcohol Intoxication ◽  
Age Distribution ◽  
Case Series ◽  
High Dose ◽  
Retrospective Case ◽  
Toxic Optic Neuropathy ◽  
Sudden Blindness

Introduction : Methanol-induced toxic optic neuropathy (TON) is defined as a visual impairment due to optic nerve damage by methanol poisoning. Not only is this disease entity underdiagnosed at times, this sudden blindness is also often diagnosed at a stage where recovery of vision is no longer possible. Materials and Methods : A literature search was conducted using PubMed, ClinicalKey, Google Scholar and ScienceDirect by combining the keywords ‘methanol’ or ‘methyl alcohol’, ‘intoxication’ or ‘poisoning’, ‘toxic optic neuropathy’, and ‘visual acuity’ with ‘high-dose steroid’. Results : The total amount of subjects in each article varied from 2 to 37, with mean age distribution of 26.34 to 55 years old, where most patients were male. The follow up duration varied from 1 week to 1 year. Four articles do not mention high-dose steroids treatment as therapy while the other four mention use of 1000 mg of intravenous methylprednisolone per day with divided doses of either 2x500 mg or 4x250 mg. Improvement percentages show 100% improvement in all studies that used high-dose steroids, while in the non-high-dose steroids studies the improvement percentages range from 33.33% to 90%. Summary : High-dose steroids are showing efficacy in improving visual acuity and reducing the inflammation in methanol-induced TON. The period of how fast the therapy takes effect is inconclusive, as the mean follow-up time differs widely per study. However, because most of the reviewed studies here are retrospective case series, a larger, more comprehensive study is required to acknowledge more of the efficacy profile.

WED 143 Chronic relapsing inflammatory optic neuritis (CRION) in the neuroinflammatory clinic

2018 ◽  
Vol 89 (10) ◽  
pp. A16.4-A17
Author(s):  
Cousins Oliver ◽  
Khan Hina ◽  
Harikrishnan Sreedharan
Keyword(s):  
Multiple Sclerosis ◽  
Visual Acuity ◽  
Optic Nerve ◽  
Optic Neuritis ◽  
Visual Loss ◽  
Correct Diagnosis ◽  
Corticosteroid Treatment ◽  
Oligoclonal Bands ◽  
Short Course

CRION is a rare cause of optic neuritis. It is usually bilateral, painful and associated with profound visual loss. Significant response to corticosteroid treatment is typical but relapse is common when treatment is withdrawn. We present 2 cases of possible CRION and discuss the diagnostic and management considerations.Case 1: 50-year-old woman presented with right optic neuritis which spontaneous recovered. A year later she had left painful visual loss which improved with a short course of corticosteroids. MRI neuroaxis revealed left optic nerve enhancement. Non-specific, faint unmatched OCBs were detected. AQP4-IgG was negative. Nine months later she had further visual loss in her left eye. Prednisolone and azathioprine were commenced.Case 2: 55-year-old woman with bilateral, painless visual acuity deterioration over two weeks. Investigations revealed negative anti-aquaporin 4 antibodies (AQP4-IgG), normal MRI of the neuroaxis, negative oligoclonal bands (OCBs) and visual evoked potentials showed bilateral delay. Serum ACE was slightly elevated. She was started on a tapering course of steroids and had significant visual acuity improvement.The diagnosis of CRION involves the exclusion of other causes of optic neuritis, particularly multiple sclerosis (MS), Neuromyelitis Optica (NMO) and sarcoidosis. Correct diagnosis is important as aggressive and long-term immunosuppression is required.

A Case of Relapsing Visual Loss

2018 ◽  
pp. 149-152
Author(s):  
Aaron E. Miller ◽  
Tracy M. DeAngelis ◽  
Michelle Fabian ◽  
Ilana Katz Sand
Keyword(s):  
Multiple Sclerosis ◽  
Optic Neuritis ◽  
Visual Loss ◽  
Diagnostic Testing ◽  
High Dose ◽  
Inflammatory Condition ◽  
Steroid Dependence ◽  
Eye Pain ◽  
Clinical Stability

Chronic relapsing optic neuritis (CRION) is a rare inflammatory condition that is characterized by repeated episodes of optic neuritis. Diagnostic testing for all other causes of optic neuropathy is negative in CRION, and the diagnosis is made on clinical grounds. At some point in the condition, both optic nerves are commonly affected. Eye pain often precedes the visual symptoms. Visual loss can be more severe than in optic neuritis from multiple sclerosis. Steroid dependence is usual, with a rebound in symptoms upon steroid discontinuation. Treatment involves high-dose steroids followed by a long taper. Most patients require long-term immunosuppression to maintain clinical stability.

scholarly journals Outcomes of implantable collamer lens V4 and V4c for correction of high myopia – a case series

2016 ◽  
Vol 7 (2) ◽  
pp. 164-172 ◽  
Author(s):  
Smita Karandikar ◽  
Vipul Bhandari ◽  
Jagdeesh Reddy
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
High Myopia ◽  
Case Series ◽  
Visual Outcome ◽  
Visual Disability ◽  
Implantable Collamer Lens ◽  
Distant Visual Acuity ◽  
The Mean

Objective: To evaluate the visual outcomes and intraocular pressure changes after Visian Implantable Collamer Lens (ICL) implantation V4b and V4c (with centraflow technology) for correction of myopia. Materials and methods: A prospective, consecutive, comparative interventional case series of V4b and V4c ICL implantation done for correction of high myopia (>-6 diopter D) in patients unsuitable for laser vision correction. The outcome measures that were evaluated included preoperative and postoperative uncorrected distant visual acuity (UDVA), best spectacle corrected distant visual acuity (CDVA), endothelial cell count (ECC), presence of lens opacification, intraocular pressure (IOP) and ICL vaulting. A follow-up of upto 1 year was done. A questionnaire was given at the end of follow-up period. Results: A total of 30 eyes (24.56±4.8 years) underwent V4b ICL implantation (10 non-toric, 20 toric ICL-TICL) with intraoperative peripheral iridectomy (PI) and 34 eyes (26.13±3.8 years) had implantation of V4c ICL with centraflow (12 non-toric, 22 TICL). The mean preoperative manifest spherical equivalent (MSE) was 8.98±2.8 D and 9.24±2.4 D in the V4b and V4c groups respectively which reduced to postoperative values of -0.28±1.3 D and -0.19±1.18 D respectively. The mean preoperative astigmatism was -1.8±1.2 diopter cylinder (Dcyl) and -1.9±1.6 Dcyl which respectively reduced to -0.8±0.8 Dcyl and -0.9±0.3 Dcyl. At the end of 1 year follow up, mean ECC loss was 7.6% and 7.1%, mean vault was 583.12±231.12 μ and 602±241.24μ respectively in the V4b and V4c groups. Anterior subcapsular opacities were present in 6.66% and 2.94% of eyes with V4b and V4c groups respectively. Two eyes from both V4b (10%) and V4c (8.33%) had rotation of more than 30 degrees and required re-rotation surgery done successfully. Two eyes (6.66%) with V4b ICL implantation had high postoperative IOP (>35 mm Hg) and required Nd:Yag laser iridotomy later done with successful control of IOP. The safety indices were 1.12 and 1.15 and efficacy indices were 1.5 and 1.6 in the V4b and V4c groups respectively at the end of 1 year. The most common visual complaint was glare and haloes in 24% and 27% in the two groups respectively. However, they were not annoying enough to cause visual disability. Conclusions: Both V4b and V4c Visian ICL implantations are comparable in terms of visual outcome and safety profile for correction of high myopia. However, V4c ICL offers these advantages without the requirement of an additional PI. 

Visual improvement in amblyopic eye following treatment-induced vision loss in dominant eye with uveal melanoma

2019 ◽  
Vol 104 (2) ◽  
pp. 202-207
Author(s):  
Aldo Vagge ◽  
Carol L Shields ◽  
Jerry A Shields ◽  
Renelle Pointdujour-Lim ◽  
Bruce Schnall
Keyword(s):  
Visual Acuity ◽  
Uveal Melanoma ◽  
Visual Loss ◽  
Vision Loss ◽  
Case Series ◽  
Retrospective Case ◽  
Corrected Visual Acuity ◽  
Visual Improvement ◽  
Dominant Eye ◽  
The Mean

ObjectiveTo determine the frequency and amount of visual improvement in amblyopic eyes of adults following visual loss in the dominant eye resulting from treatment of uveal melanoma.Methods and analysisRetrospective case series of adult patients with amblyopia and dominant eye visual loss resulting from treatment of uveal melanoma. Review of best-corrected visual acuity (BCVA) in each eye (amblyopia eye vs melanoma eye) at date first seen and over time following treatment of uveal melanoma. BCVA in each eye was graded as improved (>2 logarithm of minimal angle of resolution (logMAR) lines) or unimproved (<2 logMAR lines).ResultsTwenty-one patients that met the inclusion criteria. Mean age at presentation was 56 years (range 39–73 years). Following treatment of the uveal melanoma and decline of BCVA in the dominant, the BCVA in the amblyopic eye improved in 11/21 (52%; 95% CI 30% to 74 %) patients. The degree of visual loss in the melanoma eye was to the level of the amblyopic eye or worse in 14 patients. In this group, BCVA improved in the amblyopic eye in 9/14 (64%; 95% CI 35% to 87 %) patients. Of these nine with improved eyes, the mean starting visual acuity was logMAR 0.6 (20/80) with mean improvement of logMAR 0.4 (4 lines±0.13 (range 0.2–0.6). Eight of nine eyes achieved a BCVA of 20/25 (n=3) or 20/20 (n=5).ConclusionVisual acuity in the amblyopic eye of adults can improve following visual loss in the contralateral dominant eye associated with treatment for uveal melanoma.

scholarly journals Effects of Intravitreal Aflibercept in Patients with Central Serous Chorioretinopathy

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Ali Afzal Bodla ◽  
Muhammad Afzal Bodla ◽  
Syeda Minahil Kazmi ◽  
Ayema Moazzam
Keyword(s):  
Visual Acuity ◽  
Intravitreal Injection ◽  
Central Serous Chorioretinopathy ◽  
Retinal Thickness ◽  
Case Series ◽  
Central Retinal Thickness ◽  
Chronic Central Serous Chorioretinopathy ◽  
Intravitreal Aflibercept ◽  
The Mean

Purpose:  The purpose of this study is to assess the efficacy of intravitreal injection of Afliberceptin patients with chronic central serous chorioretinopathy (CSCR). Study Design:  Interventional case series. Place and Duration of Study: Multan Medical and Dental Centre and Bodla Eye Care from February 2019 to February 2020. Methods:  This study was conducted on fifteen eyes with sub-acute to chronic central serous chorioretinopathy. All patients who had undergone previous treatment with laser photocoagulation, intravitreal triamcinolone, or bevacizumab in past 3 months, history of glaucoma (intraocular pressure > 21 mmHg), patients who lost to follow-up, and those with previously vitrectomized eyes were excluded. Patients were treated with a single dose of intravitreal injection of Aflibercept (0.5 mg/0.05 ml). Visual acuity with Log MAR chart and central retinal thickness were studied before and after the injection. Results:  The mean age of the patients was 30.46 years ± 9 years. After one month of intravitreal Aflibercept injection, visual acuity improved from 0.32 Log MAR to 0.173 log MAR and at 3 months (the last follow-up) it was 0.206 Log MAR. Central retinal thickness (CRT) improved from 437 ± 82 µm (at the time of presentation) to 349 ± 67 µm at 1 month post injection. At the last follow-up the mean CRT decreased to 309 ± 121 µm. Except for two eyes, all eyes showed visual improvement. These two eyes had a higher CRT as compared to other participants. Conclusion:  Intravitreal injection of Afliberceptis effective in improving BCVA and decreasing the central retinal thickness in patients central serous chorioretinopathy. Key Words:  Central retinal thickness, Central Serous chorioretinopathy, Aflibercept.

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