Bilateral Disc Swelling Research Articles

NeuroBehcet’s-related intracranial hypertension without cerebral venous thrombosis: case report and review of literature

BackgroundWe present a rare case of NeuroBehcet’s-related intracranial hypertension without cerebral venous thrombosis (NBrIHwCVT), occurring as the first presentation of NeuroBehcet’s. In addition, we describe the novel use of subcutaneous tocilizumab for this indication. This is followed by a review of the literature on this topic.CaseThe patient was a 28-year-old lady of Southern Chinese origin with a known history of Behcet’s disease with oral ulcers and ocular findings for which she was on mycophenolate mofetil and adalimumab. She presented with a headache and bilateral disc swelling associated with an intracranial pressure (ICP) of > 40cmH20. There were no structural lesions or cerebral venous thrombosis (CVT) on imaging. Initial lumbar puncture had raised leucocytes and protein. We discuss diagnostic challenges given persistently elevated ICP despite subsequent non-inflammatory cerebrospinal fluid (CSF) profiles and non-response to acetazolamide. She eventually showed a response to immunosuppressant therapy in the form of pulsed methylprednisolone, cyclophosphamide and subsequently subcutaneous tocilizumab, supporting the diagnosis of NBrIHwCVT. Complete normalization of ICP remains challenging. Her disease course was severe, unusual for her ethnicity.Literature reviewWe identified 34 patients (including ours) from 14 publications. We found that the majority of NBrIHwCVT patients were young (average age of 34 years), with a slight female preponderance. Of the 17 cases in the literature with available data on CSF profile, none had raised leucocytes whilst one patient had elevated protein. Patients were generally treated with steroids and occasionally azathioprine, in line with the suspected autoimmune pathophysiology. Of 22 patients with data on outcome, six (27%) were noted to have recurrence of symptoms generally occurring a few months later.ConclusionAs demonstrated by this case, NBrIHwCVT can present with BD with raised ICP even if there is no prior history of NB, central Asian ethnicity, cerebral venous thrombosis or features of inflammation on the CSF. We demonstrated how novel use of Tocilizumab may have a role in the management of NBrIHwCVT. Based on our literature review, patients were more likely to be young, female, display a non-inflammatory CSF picture, be treated with steroids and harbour a possibility of recurrence.

Clinical Profile of Patients with Bilateral Optic Disc Swelling Attending in an Apex Eye Hospital in Bangladesh

Background: Patient with optic disc swelling demands thorough ophthalmic as well as systemic evaluation as it may reflect intraocular as well as systemic diseases. Early diagnosis and proper management of bilateral disc swelling is important, as it can save vision as well as life. This study is aimed to determine the socio-demographic and clinical profile of patients with bilateral optic disc swelling in a tertiary eye hospital of Bangladesh.
 Methods: This cross sectional study had been conducted over 102 patients with bilateral disc swelling at the Neuroophthalmology clinic of National institute of ophthalmology and Hospital, Dhaka between April 2019 and March 2020. Patients were selected purposively based on specific selection criteria. Detail history was taken, ocular examinations like visual acuity, color vision, field of vision, pupillary light reaction, fundus examination were done and relevant investigations included color fundus photograph, visual field analysis, Computed tomography scans and Magnetic Resonance Imaging were performed. All the information’s were recorded in a pre-designed data collection sheet.
 Results: The mean age of the patients was 30.2±10.8 years where 37.3% patients were from 18-27 year age group. Females (67.7%) were commonly presented with bilateral disc swelling than male (33.3%). Most of the patients commonly presented with the symptoms like headache (71.6%), dimness of vision (62.8%), nausea & vomiting (42.2%), ocular pain (21.6%) etc. Best corrected visual acuity of the study population was within 0-0.3 log MAR unit in the right eye in 55.9% cases and in the left eye in 59.8% cases. Majority of the patients (Right eye: 60.8%, Left eye: 63.7%) could read all plates while color vision assessment. About 20% patient had RAPD. About 17% patients had field defect in their right eyes whereas about 15% had visual filed defect in left eyes. Other than disc swelling, 14 patients had diplopia (13.7%), 12 patients had uveitis (11.8%). Out of 102 patients, 36 patients were clinically diagnosed as IIH (35.3%). Others were diagnosed as ICSOL (24.5%), bilateral optic neuritis (12.7%), VKH (12.7%), grade-IV hypertensive retinopathy (8.8%). The analysis of neuro imaging findings among the patients showed 72 patients (70.6%) had no space occupying lesions, 9 patients (8.8%) had meningioma, 6 patients had CP angle tumor (5.9%), 5 patients had empty sella (4.9%).
 Conclusions: Most of the Bangladeshi patients with bilateral disc swelling report to neuro-ophthalmology clinic in NIO&H are female and belong to 18-37 years age group. Among them headache is the most common presenting complaint and IIH is the most common clinical diagnosis.
 J. Natl. Inst. Ophthalmol. 2022;5(1):39-45

Severe Ocular Hypertension in a Child with Pediatric Optic Neuritis

Purpose: To report a rare case of severe ocular hypertension following intravenous methylprednisolone treatment in a child with bilateral optic neuritis.Case summary: A 6-year-old girl presented with bilateral severe visual loss and disc swelling. Magnetic resonance imaging revealed optic nerve enhancement, and she received high-dose intravenous methylprednisolone for 3 days and oral prednisolone 30 mg/day for 2 weeks. Two weeks after initiating treatment, ophthalmologic examination revealed an intraocular pressure (IOP) of 46 mmHg in the right eye and 42 mmHg in the left eye. The best-corrected visual acuity was 1.0 in the right eye and 0.6 in the left eye. Relative afferent pupillary defect was noted in the left eye. Fundus examination showed normal cup-to-disc ratio (0.4) in both eyes. The iridocorneal angle was open in all directions. The treatment plan included the cessation of oral prednisolone and initiation of latanoprost and dorzolamide-timolol fixed combination agent. After 12 hours, the IOP decreased to 18 mmHg in the right eye and 14 mmHg in the left eye. Six months later, her visual acuity was 1.0 in both eyes, and IOP was maintained at 11 and 13 mmHg in the right and left eye, respectively. Optic disc examination showed no sign of glaucomatous change with normal cup-to disc ratio in both eyes.Conclusions: Since steroid medication may cause asymptomatic IOP elevation, regular intraocular pressure measurements are required during steroid treatment for pediatric optic neuritis. The administration of IOP-lowering eyedrops returned IOP to the normal range without damaging the optic nerve.

Occam versus Hickam

A 23-year-old man presented with new onset horizontal diplopia 5 months after a left orbital floor fracture. Examination revealed bilateral abduction deficits and disc swelling. Urgent MRI and MRI showed no significant abnormalities in the CNS. Lumbar puncture revealed a minimally elevated opening pressure and significant leukocytosis. Additional CSF testing revealed probable Lyme meningitis. The patient responded to a course of oral doxycycline, with rapid resolution of his diplopia, abduction deficits, and disc edema.

Binocular Optic Neuritis in an Eight-Year-Old Boy Due to COVID-19 Infection

Introduction: Optic neuritis or inflammation of the optic nerve is a frequent cause of acute optic nerve damage in children and adults. Optic neuritis can occur in association with some viruses, such as influenza and mumps viruses. At the end of 2019, a novel coronavirus, known as COVID-19, spread throughout the world. Coronavirus is known to cause optic neuritis in animal models, and several adult cases have been reported up to now, as well. However, to date, no case of optic neuritis has been reported in children with COVID-19. Case Presentation: The patient was an eight-year-old boy referred to our center, complaining of sudden bilateral and progressive blurring of vision with right-eye preference. He had a history of severe headache for three days in the previous two weeks and slight mood disturbance. On physical examination, bilateral disk swelling and significant loss of vision were detected in his both eyes. Magnetic resonance imaging (MRI) of the brain showed bilateral maxillary sinus thickening with mild optic nerves enlargement with slightly hyperintense T2 and mild post-contrast enhancement. No pathologic finding was seen in the brain, and cerebrospinal fluid and other immunologic tests were normal. Due to the patient’s history of headache and outbreak of COVID-19, a nasopharyngeal reverse transcription-polymerase chain reaction (RT-PCR) test for COVID-19 was requested, and a positive result was obtained, confirming the diagnosis of COVID-19 infection. The optic neuritis was treated with pulsed methylprednisolone and the patients’ vision improved. Conclusions: In this article, we reported an eight-year-old child with optic neuritis and headache in the context of COVID-19. No case of optic neuritis has been reported in children with COVID-19.

Proning related bilateral anterior ischaemic optic neuropathy in a patient with COVID-19 related acute respiratory distress syndrome

BackgroundNon-arteritic ischaemic optic neuropathy (NAION) is a rare but harmful complication of prone positioning. Prone mechanical ventilation is a therapeutic strategy which has been used extensively during the COVID-19 pandemic to treat acutely hypoxemic patients with COVID-19 related acute respiratory distress syndrome (ARDS). Though a small number of cases of unilateral NAION have been reported in patients testing positive for the SARS-CoV-2 virus, we describe what is to our knowledge, the first reported case of bilateral NAION occurring in a patient proned extensively for the treatment of COVID-19 related ARDS. We consider the potential aetiological factors leading to NAION after prone mechanical ventilation in patients with COVID-19 and suggest strategies to protect against its development.Case presentation: We report a case of severe, irreversible, visual impairment secondary to bilateral anterior ION in a fifty-five-year-old male who underwent eight episodes of prone mechanical ventilation to treat COVID-19 related ARDS. Once weaned from his sedation he reported bilateral painless vision loss, and bedside ophthalmological assessment identified a reduced visual acuity of 3/30 unaided in the left eye and counting fingers in the right. Dilated indirect ophthalmoscopy revealed inferotemporal optic disc oedema with splinter haemorrhages in the right eye and mild disc oedema, temporal pallor, and nerve fibre layer haemorrhages inferiorly in the left eye. Humphrey visual field 24 − 2 testing confirmed a severely constricted visual field with macular sparing on the right and depressed inferonasal vision with preserved peripheral vision on the left eye. OCT disc imaging shortly after diagnosis revealed bilateral disc swelling and flame haemorrhages in the right eye.ConclusionsNAION is a devastating, but preventable complication of prone positioning, which may pose significant risk of vision loss in patients with COVID-19 related ARDS.

Etiology of Optic Disc Swelling in a Tertiary Care Center in Nigeria.

Optic disc swelling in clinical practice is worrisome. It may be associated with benign, sight- or life-threatening conditions. The common etiologies of optic disc swelling are variable in different communities. To determine the etiology of optic disc swelling at the Eye Clinic of the University of Benin Teaching Hospital, Nigeria. The case files of all patients with optic disc swelling seen over a 7-year period were retrieved. Demographics and clinical information were obtained from their case files. The data was analyzed with the IBM SPSS Statistics Version 21 software. Descriptive analyses such as frequency, mean, and standard deviation were utilized. There were 66 patients with bilateral or unilateral disc swelling. These included 23 males with a male: female ratio of 1:1.87. The age range was from 3 years to73 years; mean age 36.9 years (SD15.3). A total of 109 eyes were affected with bilateral involvement in 43 patients. Papillitis 15 (22.7%), brain tumor 8 (12.1%), and tilted disc 6 (9.1%) were the most frequent diagnosis. Papilledema in 20 (30.3%) patients, optic neuritis 19 (28.8%), and pseudopapilledema 11 (16.7%) were the most frequent etiologic processes of optic disc swelling. Papillitis, brain tumors, and tilted disc were the most frequent etiologies of optic disc swelling in this study. These etiologies should be excluded in patients with optic disc swelling in our clinics.

Myelin oligodendrocyte glycoprotein-positive optic neuritis masquerading as pseudotumor cerebri at presentation

Optic neuritis (ON) is a common clinical manifestation in myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease. Other clinical manifestations include acute demyelinating encephalomyelitis, transverse myelitis and neuromyelitis optica spectrum disorders. Uncommon presentations of MOG-positive disease have recently been reported. ON in MOG-positive disease commonly involves the anterior portion of both optic nerves, leading to bilateral disc swelling. During the early stages of ON, in the setting of bilateral disc swelling and pain, patients may initially be suspected as pseudotumor cerebri (PTC). In this study, we report five cases presenting early in the course of MOG-IgG-related ON, which were misdiagnosed as PTC in the emergency department. MOG-IgG-positive ON requires timely treatment to prevent RNFL and vision loss secondary to the high relapse rate associated with these antibodies. Our aim is to increase the awareness of the unique findings of MOG-IgG-positive ON, which may initially mimic PTC, thereby delaying treatment.

Idiopathic intracranial hypertension: Clinical profile and outcome

Background: It has been a long standing challenge to clinicians and investigators to explain the pathophysiology of Idiopathic Intracranial Hypertension (IIH).Therefore, the goal of this study is to delineate the clinical course of this disorder. Aim: To delineate the clinical course of Idiopathic Intracranial Hypertension with an emphasis on visual prognosis. Settings and Design: Prospective, observational study of 18 patients. Materials and Methods: Patients with unilateral or bilateral disc oedema; CSF pressure >25 cm H2O non- focal neurological examination, and normal CT/MRI/MRV scans were included in the study, while those with concurrent ocular disease were excluded .Ocular examination, visual acuity, fundus photography and visual fields evaluation was done at presentation and during follow up visits for a period of two years. Statistical analysis: Descriptive study. Results: Of the 18 patients, 16 were females. The average age of onset was 31.5 years. Hypertension was the most common systemic comorbidity, seen in 5 patients. Headache was the most common presenting symptom, seen in all 18 patients. Diminution of vision was seen in 16 eyes, out of which 14 improved while 2 showed progressive impairment of vision. Abnormal visual field tests included an enlarged blind spot in 11 out of 36 eyes and peripheral constriction in 14 out of 36 eyes .17 patients had a bilateral and symmetric disc swelling. A CSF opening pressure of more than 40 cm of H2O was noted in 6 patients. All the patients were managed medically with diuretics therapy (acetazolamide) and weight reduction. Conclusion: A strong suspicion of Idiopathic Intracranial Hypertension in chronic severe headaches and immediate investigations followed by proper treatment can salvage vision of patients even in cases with established papilledema.

A study of the causes of bilateral optic disc swelling in Japanese patients.

PurposeTo investigate the etiology of bilateral disc swelling in Japanese.MethodsUsing Kitasato University’s Department of Neuro-Ophthalmology medical records and fundus photographs of the period December 1977 through November 2010, we retrospectively identified 121 outpatients who had been initially confirmed with bilateral disc swelling.ResultsThe most common cause of the bilateral disc swelling was increased intracranial pressure (ICP) (59%); followed by pseudopapillitis (16%); uveitis (8%); hypertensive retinopathy (5%); bilateral optic neuritis, acute disseminated encephalomyelitis (ADEM) and optic disc drusen (all at 2% each); and leukemia (1%). Unknown etiology accounted for 6% of the cases.ConclusionAlthough increased ICP is the most common etiology for bilateral disc swelling, it can also be triggered by a variety of other causes. Pseudopapillitis is the most important progenitor of bilateral disc swelling in Japanese.

Falx Meningeoma Induced Optic Neuropathy—Clinical Manifestation and Differential Diagnosis: A Case Report

Purpose: Meningiomas are the most frequently diagnosed neoplasms. Ocular symptoms vary depending on size and localisation of the tumor, which is capable of compressing critical anatomic structures. Patients and Methods: A 44-year-old immunocompetent male was admitted to our hospital for further investigation of his bilateral optic disc swelling. A complete ophthalmological examination was performed including visual field assessment (VF), visual evoked potentials (VEP), fluorescein angiography (FLA) and magnetic resonance imaging (MRI). The patient had experienced only minor visual disturbances. Serological testing was performed. Results: Serological testing showed positive IgM and IgGtiters for cytomegalovirus (CMV) and subsequent imaging (MRI) revealed a frontal falxcerebri meningioma. Conclusions: We present a case of falx meningioma with overlapping serologically active CMV in an otherwise healthy and immunocompetent individual. Detailed differential diagnostic workup in immunocompetent individuals presenting with clinically unremarkable bilateral disc swelling is recommended.

Bilateral ocular perineuritis as the presenting feature of acute syphilis infection

We describe the case of a 48-year-old man who presented with a 2-month history of recurrent, transient visual obscurations that were not exacerbated by straining or coughing. During this period, he felt unwell with headaches, malaise, and flu-like symptoms. Visual symptoms improved but failed to resolve to two courses of oral amoxicillin prescribed for a presumed upper respiratory tract infection. On examination, he had a normal body mass index. Bilateral disc edema (Fig. 1a) and absent ocular spontaneous venous pulsations were identified. Visual acuity (corrected), color vision, and visual fields were all normal. Slit-lamp examination confirmed disc swelling but was otherwise normal. No other neurological deficits were detected and general medical examination was normal. MRI brain, MR venogram, and MR angiogram were all normal. A lumbar puncture examination revealed an opening pressure of 19 cm of CSF (normal range 12–22 cm of CSF). The CSF white cell was 1, protein 0.32 g/dl (normal range 0.15–0.45) with normal glucose. Positive unmatched oligoclonal bands were detected but there was a normal IgG index. Blood tests, including a full blood count, urea and electrolytes, thyroid function tests, serum protein electrophoresis and anti-nuclear, extractable nuclear antigens, and anti-neutophil cytoplasmic antibodies were normal or negative. An HIV test was negative, however, an initial screen for syphilis demonstrated a positive VDRL and RPR IgM, with a titer of 1:32. Further studies including Treponema pallidum IgM enzyme immunoassay and Treponema pallidum particle agglutination were positive with a titer of [1/80, indicating acute infection. CSF treponemal studies were negative. On further questioning, the patient recalled painless ulceration of his glans penis 12 weeks prior to presentation. He had not sought medical attention and it had resolved spontaneously. He had a long-term female partner but reported unprotected intercourse with another female 16 weeks prior to presentation. We diagnosed ocular perineuritis appearing as bilateral disc swelling as a presenting sign of active syphilis. The patient made a full clinical recovery with resolution of the visual symptoms and signs following appropriate antibiotic therapy. Syphilis has reemerged within Europe and North America since the late 1990s. In Ireland in 2008, 221 cases (4.9/100,000) were reported [1], the majority of which being diagnosed in men who have sex with men. HIV coinfection is associated with higher rates of transmission and increased severity of symptoms [2]. Increases are considered to be a consequence of unprotected sexual encounters rather than antibiotic resistance [3]. Ocular manifestations of syphilis as the presenting feature are limited to case reports and small case series [4–9]. Symptoms can be unilateral or bilateral. The most common ocular presentation is uveitis [8], but chorioretinitis, retinitis, keratitis, retinal vasculitis, and optic neuropathy are reported, occurring at any stage of the disease [10]. Previous reports of syphilis presenting as optic disc swelling as a result of papillitis or perioptic neuritis have been associated with other evidence of central nervous system involvement as demonstrated by a CSF pleocytosis, raised protein, or positive CSF syphilis studies [4–9]. K. O’Connell (&) M. Marnane C. McGuigan Department of Neurology, St. Vincent’s University Hospital, Elm Park, Dublin, Ireland e-mail: kazzoc@hotmail.com

Pseudotumor cerebri and ciprofloxacin: a case report

IntroductionWe present a case of ciprofloxacin-associated pseudotumor cerebri in a 22-year-old African American woman. Withdrawal of ciprofloxacin in our patient resulted in complete resolution of ciprofloxacin-associated pseudotumor, as evidenced by a normal neuro-ophthalmic examination and a cerebrospinal fluid opening pressure of 140 mmH20.Case presentationA 22-year-old African American woman presented with a headache of two weeks duration, visual blurring and horizontal diplopia after starting ciprofloxacin for pyelonephritis. An ophthalmic examination revealed that she had left eye esotropia, and a picture of the fundus demonstrated bilateral disc swelling without spontaneous venous pulsations. Magnetic resonance imaging of the brain and a magnetic resonance venogram were normal. A diagnostic lumbar puncture demonstrated an elevated opening pressure of 380mmH2O in a supine position. Laboratory examinations, including a cerebrospinal fluid exam, were unremarkable.Conclusionciprofloxacin-associated pseudotumor can cause chronic disabling headache and visual complications. Therapy is sub-optimal, often symptomatic, insufficient and complicated by side effects. When ciprofloxacin-associated pseudotumor presents in an atypical population, an inciting agent must be suspected because prompt withdrawal of the agent may lead to complete resolution of symptoms and prevent recurrence of similar episodes.

Bilateral disc swelling associated with posterior scleritis

Bilateral disc swelling associated with posterior scleritis

Bilateral optic disk swelling in the 4q34 deletion syndrome

Terminal deletion of chromosome 4q is a genetic abnormality associated predominantly with cardiac abnormalities, abnormal facial features, and developmental delay. A specific clinical clue to this infrequently diagnosed disorder is hypoplasia of the terminal phalanx of the fifth finger with an abnormal nail, occasionally extending onto the volar surface. Ocular manifestations of the disorder are uncommon, but anterior segment dysgenesis and glaucoma have been described with proximal deletions of chromosome 4 with phenotypes resembling Rieger's anomaly. We present a case of 4q deletion syndrome, presenting with asymptomatic bilateral disk swelling.

Un point d’appel ophtalmologique à l’origine du diagnostic de deux cas de mucopolysaccharidose

The mucopolysaccharidoses (MPS) form a group of heterogeneous hereditary lysosomal storage diseases, distinguished by facial dysmorphy in gargoyle-like facies. The enzymatic deficiency involves the degradation of glycosaminoglycans, whose accumulation manifests in severe general and ophthalmologic problems. We report the cases of two 18-month-old girls consulting for corneal clouding and photophobia. The diagnosis was made based on the facial dysmorphy, then biologically corroborated: Scheie's syndrome (MPS type I-S) and Hurler's syndrome (MPS type I-H). The corneal clouding was isolated or associated with bilateral disc swelling. Enzyme replacement therapy was instituted in both cases while waiting for bone marrow transplantation, with a better prognosis in the first case because of the type of MPS and the less severe neurological involvement. The accumulation of glycosaminoglycans in ocular tissues can involve stromal opacities, glaucoma, retinopathy, and optic nerve swelling. Whereas the ophthalmological involvement is often secondary, it can lead the ophthalmologist to the diagnosis of MPS. The early diagnosis of MPS, before the onset of neurological signs, is vital, since treatment can stop disease progression. Better knowledge of the clinical signs of MPS on the part of the ophthalmologists could improve the prognosis of these patients.

Images in neuroscience

A 22-year-old woman of 14 weeks gestation, presented with a four-week history of severe vomiting and a week of decreased visual acuity. Past medical history was not significant. Medications included folate supplements commenced after pregnancy. Examination revealed a drowsy patient with stable vital signs, bilateral disc swelling on fundoscopy with decreased visual acuity, a horizontal gaze paresis with horizontal nystagmus. She was ataxic without other focal neurological deficits.

Optic neuropathy: puls/minus

A 26-year-old Asian woman presented with bilateral disk swelling, retinal exudates and infarcts. Evaluation found the underlying cause of the hypertensive optic neuropathy to be renal artery stenosis due to Takayasu's arteritis.

Diabetic papillopathy in type II diabetic patients.

To evaluate the patient characteristics and fundus findings of patients with type II diabetes presenting with diabetic papillopathy. The authors retrospectively reviewed the medical records of 3,235 patients with diabetes followed in their institution since 1986 and identified the patients with unilateral or bilateral transient disk swelling and without significant deterioration of best-corrected visual acuity. The authors investigated patient demographics, symptoms, fundus findings, ancillary test results, and clinical course of those patients. Twenty-four eyes of 16 patients with type II diabetes mellitus met the criteria. Patients had a mean age of 57.1 (+/-8.8) years and had diabetes mellitus of long duration (mean 10.0 +/- 8.6 years). Approximately half of the patients had poor metabolic control. Disk swelling was bilateral in 8 (50%) patients and resolved in an average of 7.8 +/- 3.7 months. A total of 13 (54%) eyes had nonproliferative and 2 (8%) eyes had proliferative diabetic retinopathy at presentation. In 4 (17%) eyes retinopathy progression into the proliferative stage occurred and panretinal photocoagulation was performed. Diabetic papillopathy may be found in older patients with type II diabetes. Nonproliferative or proliferative diabetic retinopathy as well as macular edema may also be associated with this disorder.

Hypertensive retinopathy mimicking neuroretinitis in a twelve-year-old girl

Bilateral disk swelling and marked peripapillary and macular exudates were found on routine ophthalmologic examination in a 12 1 2 - year-old girl. Eleven months later, with persistent findings, her blood pressure was found to be extremely elevated. She had an Ask-Upmark kidney, a rare form of segmental renal hypoplasia. The Ask-Upmark kidney abnormality occurs primarily in young women and is associated with hypertension. The disk edema and retinopathy resolved after the hypertension was controlled. Hypertensive retinopathy can sometimes resemble neuroretinitis.