Acute Unilateral Visual Loss Research Articles

NEURORETINITIS ASSOCIATED WITH COVID-19 INFECTION AND VARICELLA-ZOSTER VIRUS REACTIVATION

Purpose: To report a case of neuroretinitis as the presenting manifestation of COVID-19 infection alongside VZV reactivation, in the absence of other systemic symptoms. Methods: A case report. Results: A previously healthy 15-year-old male presented with a one-week history of acute unilateral visual loss and clinical findings consistent with neuroretinitis. Diagnostic work-up revealed a positive nasopharyngeal swab PCR for COVID-19 and serology showed the presence of IgM and IgG antibodies for VZV. Following a comprehensive treatment regimen involving intravenous acyclovir, high-dose intravenous steroids and oral doxycycline, rapid and remarkable improvements were observed. The macular star and optic disc swelling regressed, and visual acuity improved from 20/200 to 20/20. Conclusion: This case offers valuable insights into the neuroretinitis associated with COVID-19 infection and VZV reactivation.

Leber’s idiopathic stellate neuroretinitis - A clinical case

Neuroretinitis is a type of optic neuropathy characterized by an acute unilateral visual loss with optic disc swelling and macular star. A 26-year-old male presented with sudden blurring of vision in the right eye for 15 days. There were no other constitutional symptoms. On examination, visual acuity and color vision were impaired in the right eye. Visual-evoked potential showed a lower amplitude with increased latency on the right side. Perimetry showed centrocaecal scotoma. The right eye fundus showed a distinct neuroretinitis pattern Despite extensive investigation, no specific cause was identified, hence diagnosed as Leber’s idiopathic stellate neuroretinitis. The patient was started on oral prednisolone. Follow-up showed significant improvement.

Frosted branch angiitis in a patient with systemic juvenile idiopathic arthritis: a case report

BackgroundFrosted branch angiitis is a retinal vascular condition that is associated with a viral infection or autoimmune disorders like Crohn’s disease, systemic lupus erythematosus, and Behcet’s disease. Frosted branch angiitis presents with vascular inflammation, retinal edema, and severe retinal vascular sheathing. We present a case of systemic juvenile idiopathic arthritis, an autoinflammatory disease, presenting with frosted branch angiitis.Report of CaseA 14-year-old female with systemic juvenile idiopathic arthritis and a history of bilateral anterior uveitis developed acute unilateral vision loss and was found to have frosted branch angiitis complicated by branch retinal vein occlusion. She underwent an extensive serology workup and aqueous viral PCR to rule out other possible autoimmune and viral etiologies for forested branch angiitis. She received systemic and intravitreal antiviral treatment due to positive CMV IgM initially. However, the clinical picture improved following the use of a higher dose of oral steroids and the switch of the immunosuppressive agent to a TNF-a inhibitor.ConclusionTo our knowledge, this would be the first case in the literature demonstrating a systemic juvenile idiopathic arthritis patient presenting with frosted branch angiitis. Infectious causes still must be ruled out, especially CMV, as it is the most common cause of secondary frosted branch angiitis.

Toxic retrobulbar neuritis due to recurrent nonsteroidal antiinflammatory drug-exacerbated respiratory disease-based chronic sinusitis in the left sphenoid sinus: a case report

BackgroundAbrupt visual impairment constitutes a medical urgency, necessitating an interdisciplinary diagnostic and therapeutic approach owing to the broad spectrum of potential etiologies, thereby engaging numerous medical specialties.Case presentationA 21-year-old Mixed White and Asian female patient, with medical history of nonsteroidal antiinflammatory drug-exacerbated respiratory disease necessitating previous sinus surgery, reported sudden monocular vision loss. Unremarkable ophthalmological examination of the fellow eye and hematological parameters, save for a slight elevation in lymphocytes and eosinophils, were observed. Imaging studies indicated recurrence of bilateral chronic rhinosinusitis with nasal polyps and a mucocele in the left sphenoid sinus, accompanied by bony structural deficits. Emergency revision sinus surgery, guided by navigation, was promptly performed. The patient received treatment with methylprednisolone, ceftriaxone, cyanocobalamin, pyridoxine, thiamine, and acetylsalicylic acid. During the hospital stay, she developed steroid-induced glaucoma, which was subsequently managed successfully. Negative microbiological swabs, along with pathohistological evidence of increased tissue eosinophilia and the patient’s clinical history, led to the diagnosis of toxic retrobulbar neuritis secondary to recurrent nonsteroidal antiinflammatory drug-exacerbated respiratory disease-associated chronic rhinosinusitis of the left sphenoid sinus.ConclusionsIn cases of acute unilateral vision loss, optic neuritis is a highly probable differential diagnosis and may be induced by pathologies of the paranasal sinuses. Nonsteroidal antiinflammatory drug-exacerbated respiratory disease, a subtype of chronic rhinosinusitis, is associated with type 2 inflammation, which is increasingly recognized for its role in the pathogenesis of bronchial asthma, eosinophilic esophagitis, and atopic eczema. Clinicians should consider chronic rhinosinusitis as a potential differential diagnosis in unilateral visual loss and be cognizant of the rising significance of type 2 inflammations, which are relevant to a variety of diseases.

A Case Report on Neuro-Retinitis

Neuroretinitis is an inflammation of the neural retina and optic nerve. It was originally described by Leber in 1916 as a "stellate maculopathy," but this definition was challenged by Don Gass in 1977, citing that disc oedema precedes macular exudates. Subsequently, Gass confirmed optic disc leakage by fluorescein angiography and suggested the term "neuro retinitis." More recent retinal and optic nerve imaging has supported Gass' description. The condition was renamed Leber’s idiopathic stellate neuroretinitis. Neuroretinitis is characterized by an optic disc vasculature inflammation with fluid exudation into the peripapillary retina. The lipid-rich component of the exudate is further able to penetrate the outer plexiform layer, creating what is clinically seen as a macular star pattern. Only the aqueous phase is then able to pass through the external limiting membrane to accumulate beneath the neurosensory retina. Neuroretinitis is a type of optic neuropathy characterized by an acute unilateral visual loss in the setting of optic disc swelling accompanied by hard exudates characteristically arranged in a star shape around the fovea. It is classified as one form of optic neuritis, the other forms being the more common retrobulbar neuritis and papillitis. Funduscopically, neuroretinitis is often confused with hypertensive, renal and infiltrative retinopathies as well as with papillitis, papilledema, anterior ischemic optic neuropathy and retinal vein occlusion. It is an entity that physicians, paediatricians and neurologists are poorly exposed to since the diagnosis and management are almost exclusively performed by the ophthalmologist. Pathogenesis and aetiology of neuroretinitis are distinctly different from other funduscopic ally-resembling conditions often encountered by neurologists during their training and clinical practice; further, these have different principles of management and prognosis. The prognosis for visual recovery is reported to be excellent, although not uniform. It affects persons of all ages, more often in the third and fourth decades of life, with no gender predilection. Visual acuity at the time of initial examination ranges from 6/6 to light perception (PL). It can manifest either due to systemic infections, autoimmune diseases or as idiopathic.

Macular and Optic Disc Head Morphology on OCT and Visual Prognosis in Non-Arteritic Anterior Ischemic Optic Neuropathy

Introduction: Non-arteritic anterior ischemic optic neuropathy (NAION) shows an acute painless unilateral visual loss due to a reduced perfusion of the optic nerve head (ONH). Aim of this study was to analyse ONH respective macula morphology after NAION by optical coherence tomography and the correlation to visual acuity.

Acute Unilateral Vision Loss and Optic Perineuritis (OPN) Associated with Mucormycosis Sinusitis in Geriatric Patient

Acute Unilateral Vision Loss and Optic Perineuritis (OPN) Associated with Mucormycosis Sinusitis in Geriatric Patient

Acute Unilateral Vision Loss and Optic Perineuritis (OPN) in Geriatric Patients, a Series of Three Cases

Acute Unilateral Vision Loss and Optic Perineuritis (OPN) in Geriatric Patients, a Series of Three Cases

Acute Unilateral Vision Loss and Dermal Necrosis after Nose Filler Injection.

Acute Unilateral Vision Loss and Dermal Necrosis after Nose Filler Injection.

Child Neurology: Bartonella henselae Neuroretinitis in 2 Patients.

Neuroretinitis due to Bartonella henselae infection is a rare cause of vision loss in children. Two pediatric cases of acute unilateral vision loss accompanied by edema of the optic nerve on fundoscopic examination are presented. Severe causes of vision loss were excluded. During the course of the disease, macular stellate exudates emerged on control fundoscopic examinations, and diagnosis of neuroretinitis was made. A causative agent was confirmed by serologic examination, as high titers of IgM and IgG antibodies to Bartonella henselae were detected. Both patients significantly recovered after oral antibiotic treatment.

What's new in neuromyelitis optica spectrum disorder treatment?

Optic neuritis, an optic nerve inflammatory disease presenting with acute unilateral or bilateral visual loss, is one of the core symptoms of neuromyelitis optica spectrum disorder (NMOSD). The diagnosis of NMOSD-related optic neuritis is challenging, and it is mainly based on clinical presentation, optical coherence tomography, magnetic resonance imaging scans, and the status of serum aquaporin-4 antibodies. In the pathogenesis, aquaporin-4 antibodies target astrocytes in the optic nerves, spinal cord and some specific regions of the brain eliciting a devastating autoimmune response. Current pharmacological interventions are directed against various steps within the immunological response, notably the terminal complement system, B-cells, and the pro-inflammatory cytokine Interleukin 6 (IL6). Conventional maintenance therapies were off-label uses of the unspecific immunosuppressants azathioprine and mycophenolate mofetil as well as the CD20 specific antibody rituximab and the IL6 receptor specific antibody tocilizumab. Recently, four phase III clinical trials demonstrated the safety and efficacy of the three novel biologics eculizumab, inebilizumab, and satralizumab. These monoclonal antibodies are directed against the complement system, CD19 B-cells and the IL6 receptor, respectively. All three have been approved for NMOSD in the US and several other countries worldwide and thus provide convincing treatment options.

Permanent Unilateral Vision Loss From Allergic Fungal Sinusitis.

In the absence of trauma, sudden unilateral painless visual loss is an uncommon condition in the pediatric population requiring emergent medical evaluation. In the acute care setting, clinicians face the challenge of accurately assessing the patient and determining the initial diagnostic workup. A careful history alone helps guide diagnosis with sudden visual loss that is unilateral and persistent. Several neuro-ophthalmological conditions that present with these characteristics include retinal artery or vein occlusion, diseases affecting the cavernous sinus or orbital apex region, and optic neuropathy. Simple eye examination techniques have crucial diagnostic value in helping localize the disease process, determining the level of urgency, and need for timely intervention. Here we present an adolescent patient with nontraumatic, acute unilateral visual loss who had concerning ophthalmological examination findings and was subsequently diagnosed with optic neuropathy secondary to allergic fungal sinusitis.

Случай задней ишемической нейропатии у пациентки с рассеянным склерозом

A case of posterior ischemic optic neuropathy (PION) in a 41-year-woman with 19 years remission of multiple sclerosisis presented.She had complaints of acute unilateral loss of vision and underwent complex clinical and instrumental examination including B-scan of orbit, color duplex sonography (CDS) of orbital vessels and brachiocephalic arteries, magnetic resonance imaging (MRI). The significant stenosis of internal carotid artery due to its dissection was detected on the affected eye side. The results of ultrasound examinations and MRI excluded demyelinative retrobulbar neuritis (RBN) and determined the signs of blood flow impairment in vessels of orbital part of the optic nerve. Differential diagnostics of PION and RBN required the investigations of blood flow in orbital vessels and brachiocephalic arteries. Key words: posterior ischemic optic neuropathy, multiple sclerosis, retrobulbar neuritis, color duplex sonography, internal carotid artery.

Acute unilateral loss of vision after intravitreal injection of a VEGF inhibitor

Acute unilateral loss of vision after intravitreal injection of a VEGF inhibitor

B-cell related biomarkers associated with severity of the first demyelinating event of acute optic neuritis.

Optic neuritis (ON) is the most common cause of acute unilateral visual loss in young adults and frequently occurs as the presenting symptom of multiple sclerosis (MS). Recently, we reported activation of peripheral blood CD19 + ‏ B-cells in the early stage of ON. In the current study we aimed to identify peripheral blood ‏B-cell molecular markers associated with ON severity and visual outcome. Expression of B-cell related biomarkers were analysed in patients with the first clinical presentation of acute unilateral ON. Logarithm of the Minimum Angle of Resolution (LogMAR). visual acuity, Optical Coherence Tomography (OCT) imaging, Expanded Disability Status Scale (EDSS) visual score and visual evoked responses were evaluated at onset and visual acuity and EDSS visual score were repeated at 6 months post-ON. Thirty patients with acute unilateral ON, 77% female, mean age 33 ± 2.0 years, were enroled in the study. Expression of CD19, CD79A and CD20 B-cell markers significantly correlated with LogMAR visual acuity of the affected eye (r = 0.44, p = 0.01, r = 0.37, p = 0.01 and r = 0.36, p = 0.04, respectively). The marker levels were elevated between 1.5 and 2.2-folds in the group with worse visual acuity (LogMAR>1.0) at onset (CD79A:×1.5, p = 0.013; CD19:×2.25, p = 0.007; CD20:×1.5, p = 0.015)and not correlated with 6 month visual outcome. Among patient with a first event of acute ON, expression of B-cell biomarkers correlated with the severity of the disease. These results could add information on the role of B-cell dysfunction in the early stages of ON.

Progressive idiopathic unilateral corneal endothelial failure of unknown aetiology in phakic eyes

AimTo describe a cohort of patients with irreversible unilateral bullous keratopathy (BK) of undetermined aetiology.MethodRetrospective, single-centre case series in a tertiary corneal referral centre.ResultsEleven consecutive patients (nine females; mean age...

Unilateral Multiple Serous Retinal Detachments in Polycythemia Vera Patient

Purpose: To report a case with new signs that could be caused by polycythemia vera itself or just a coincidence and managing it with systemic steroids. Methods: This was interventional case report, of a 59-year-old patient with polycythemia vera, presented with acute unilateral vision loss. Ophthalmological investigation revealed multiple serous retinal detachments with mild anterior chamber reaction these signs look similar to ocular signs of Vogt-Koyanagi-Harada disease, but in one eye and without systematic involvement of VKH. Polycythemia vera is a haematological disease that causes an increase number of red blood cells. The patient red blood cells were normal and he was compliance with Polycythemia vera treatment. All infectious tests were negative as well as autoimmune disease markers. Unilateral probable VKH disease was our diagnosis, patient was managed. Results: Polycythemia vera is a haematological disease that have a few ocular symptoms. These signs include multiple serous retinal detachments with uveitis that respond well to corticosteroids. Conclusion: Systematic corticosteroids which show a remarkable improvement in ocular signs and symptoms of Polycythemia vera that mimic VKH.

Compressive Optic Neuropathy due to a Large Onodi Air Cell: A Case Report and Literature Review

Background:To report an unusual case of compressive optic neuropathy secondary to a large onodi air cell.Method:Case report.Results:A 50 year-old gentlemen presented to the eye clinic with left eye painless loss of vision for one day. Visual acuity was counting finger in the left eye with a positive relative afferent pupillary defect (RAPD). Dilated left fundus examination revealed a pale optic disc. A computed tomography of orbit and brain showed a large left sphenoid sinus with onodi-cell-like projection on the left superior margin of left optic canal impinging on the left optic nerve. He was referred to the otorhinolaryngology team and subsequently underwent left optic nerve decompression. Post-operatively, his left visual acuity improved to 6/60 with reversal of RAPD.Conclusion:There are many causes of optic neuropathy and compressive optic neuropathy due to large onodi air cell is uncommon. Acute unilateral loss of vision heralds from a multitude of sinister causes and junior residents should be vigilant that onodi air cell pneumotisation could be one of them.

Die nicht arteriitische anteriore ischämische Optikusneuropathie (NAION)

Non-arteritic ischemic optic neuropathy (NAION) is virtually unknown outside ophthalmology. It is characterised by acute unilateral visual loss, no pain on eye movements and virtually always optic disc swelling. Optic disc oedema resolves within 1 to 2 months, leaving behind optic atrophy. Vision hardly improves. NAION is the product of local abnormalities of the vascular supply to the optic nerve and general vascular risk factors. Of these, diabetes, hypertension and especially sleep apnoea syndrome are the most important. Recurrences in the involved eye are rare; contralateral recurrence occurs in approximately 15 % of patients. There is no clear scientific evidence for any specific therapy. However, there is general agreement that it is reasonable to control risk factors.

Acute optic neuritis: Unmet clinical needs and model for new therapies.

Idiopathic demyelinating optic neuritis (ON) most commonly presents as acute unilateral vision loss and eye pain and is frequently associated with multiple sclerosis. Although emphasis is often placed on the good recovery of high-contrast visual acuity, persistent deficits are frequently observed in other aspects of vision, including contrast sensitivity, visual field testing, color vision, motion perception, and vision-related quality of life. Persistent and profound structural and functional changes are often revealed by imaging and electrophysiologic techniques, including optical coherence tomography, visual-evoked potentials, and nonconventional MRI. These abnormalities can impair patients' abilities to perform daily activities (e.g., driving, working) so they have important implications for patients' quality of life. In this article, we review the sequelae from ON, including clinical, structural, and functional changes and their interrelationships. The unmet needs in each of these areas are considered and the progress made toward meeting those needs is examined. Finally, we provide an overview of past and present investigational approaches for disease modification in ON.