Case Of Bilateral Optic Neuropathy Research Articles

A Case of Bilateral Optic Neuropathy Following COVID-19 Infection

Purpose: To report a case of bilateral optic neuropathy after COVID-19 infection.Case summary: Thirty-four-year-old woman presented with bilateral ocular pain, visual disturbance, and decreased visual acuity after contracting COVID-19 infection 16 days ago. At the initial visit, best-corrected visual acuity was 0.8 in the right eye, and 0.7 in the left eye. Left eye had relative afferent papillary defect and visual field tests revealed enlarged blind spot in both eyes. Fundus exam showed bilateral optic disc swelling and peripapillary retinal hemorrhage along with vitreous hemorrhage in the left eye. Fluorescein angiography revealed bilateral leakage of dye from the optic disc with area of hypofluorescence corresponding to retinal hemorrhage around the optic disc in both eyes. Brain magnetic resonance imaging (MRI) showed ill-defined left optic nerve enhancement. A diagnosis of bilateral optic neuropathy was made, and the patient was treated with high dose IV steroid 1 g per day for 3 days and oral steroid tapering for 2 weeks. Disc swelling and retinal hemorrhage were improved 1 month after treatment along with enhanced visual acuity to 1.0.Conclusions: Bilateral optic neuropathy following COVID-19 infection showed improvement after steroid treatment.

Optic Neuropathy and Macular Ischemia Associated with Neurosarcoidosis: A Case Report.

In this study, we present a case of bilateral optic neuropathy and macular ischemia in the right eye associated with neurosarcoidosis. A 26-year-old woman presented to our clinic with complaints of bilateral blurred vision. Bilateral granulomatous anterior uveitis, vitritis, optic neuropathy, and macular ischemia were detected in the right eye in slit-lamp examination. She also reported complaints of fever, weakness, sweating, arthralgia, and headache for 2 months. She was referred to the pulmonary diseases unit of our hospital due to hilar lymphadenopathy seen in her chest x-ray, and biopsies were taken for diagnostic purposes. Histological analysis of the mediastinal lymph node biopsies revealed chronic, non-caseating, granulomatous inflammation. Furthermore, the patient was referred to a neurologist due to concomitant complaint of intense headaches. She was diagnosed with neurosarcoidosis supported by findings on cranial magnetic resonance imaging and lumbar puncture. She received a 3-day course of high-dose (1 g/day) intravenous steroid treatment (methylprednisolone) followed by a tapering dose of oral prednisone. The patient began receiving oral methotrexate 15 mg/week as a steroid-sparing agent. Significant improvement in neurological and ophthalmological symptoms occurred in the first week of treatment. In this case report, we emphasized that neurosarcoidosis should be included in the differential diagnosis of patients with both bilateral optic neuropathy and macular ischemia. Furthermore, early diagnosis and timely treatment of neurosarcoidosis are important for favorable visual outcomes.

Neuropathie optique réversible liée au disulfirame

To report a case of bilateral optic neuropathy, possibly caused by disulfiram. Clinical case report. A 46-year-old patient, treated with disulfiram for the past 4 years for chronic alcoholism, presented with progressive bilateral, painless, severe visual loss, related to optic neuropathy. An extensive work-up did not disclose any other possible cause than a toxic optic neuropathy caused by disulfiram. Discontinuation of disulfiram resulted in rapid, complete visual recovery. Disulfiram can cause toxic optic neuropathy, which can recover after discontinuing the medication, even after a long period of intoxication.

A case of bilateral optic neuropathy in a patient on tacrolimus (FK506) therapy after liver transplantation

PURPOSE: To report a case of bilateral optic neuropathy in a patient receiving tacrolimus (FK 506, Prograf; Fujisawa USA, Inc, Deerfield, Illinois) for immunosuppression after orthotropic liver transplantation. METHOD: Case report. In a 58-year-old man receiving tacrolimus after orthotropic liver transplantation, serial neuro-ophthalmologic examinations and laboratory studies were performed. RESULTS: The patient had episodic deterioration of vision in both eyes, with clinical features resembling ischemic optic neuropathies. Deterioration of vision occurred despite discontinuation of the tacrolimus. CONCLUSION: Tacrolimus and other immunosuppressive agents may be associated with optic nerve toxicity.

Bilateral optic neuropathy with mitochondrial DNA 9804 mutation detected by non-isotopic single-strand conformational polymorphism

The patient in this study was a 46-year-old man with bilateral optic neuropathy following head trauma. Psychological visual loss was initially suspected and nutritional optic neuropathy was subsequently considered. Mitochondrial DNA analysis was conducted on all primary mutations of Leber’s hereditary optic neuropathy using non-isotopic single-strand conformational polymorphism (SSCP). Abnormal homozygous band shifts were detected in SSCP of the cytochrome c oxidase subunit III region. Direct sequencing indicated a G-to-A substitution at position 9804. The point mutation is a missense mutation that causes alanine to be replaced by threonine at codon 200 in cytochrome c oxidase subunit III (CO3). This is the first Japanese case and the fourth published case of bilateral optic neuropathy possessing the nt 9804 mutation.

A Case of Bilateral Optic Neuropathy and Recurrent Transverse Myelopathy Associated With Perinuclear Anti-Neutrophil Cytoplasmic Antibodies (p-ANCA)

A case involving a 52-year-old man having bilateral optic neuropathy and recurrent transverse myelopathy is reported. His clinical features resembled multiple sclerosis, but neuroimaging failed to show evidence of demyelination or inflammation in the brain or the optic nerves. The patient experienced sudden visual loss despite massive steroid therapy. Positive perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) is suggestive that optic neuropathy and recurrent transverse myelopathy may have been caused by some common inflammatory processes associated with p-ANCA, however, having a different etiology from multiple sclerosis.

Optic neuropathy due to lead poisoning. Report of a case.

A case of bilateral optic neuropathy in a 49-year-old paint shop worker is presented. The patient had definite laboratory evidence of systemic lead poisoning without other clinical manifestations. His favorable response to penicillamine therapy supports the diagnosis of lead-induced optic neuropathy and establishes this chelating agent as a useful form of treatment for the optic nerve involvement in lead poisoning.