Form Of Optic Neuritis Research Articles

Retrobulbar Optic Neuritis after COVID-19 Infection

Purpose: To report a case of retrobulbar optic neuritis after COVID-19 infection.Case summary: A 20-year-old Korean man, without any previous relevant medical history, presented with sudden blurred vision in the left eye that began 6 days after a COVID-19 infection. At his initial visit, the best-corrected visual acuity in the left eye was counting fingers at 30 cm. The pupil showed a grade 2 relative afferent pupillary defect. The fundus exam was normal in both eyes. In the visual evoked potential (VEP) exam, the P100 amplitude of the left eye was decreased and delayed. Orbit magnetic resonance imaging showed asymmetric enlargement and mild enhancement in the left optic nerve. No other lesions were observed around the optic nerve. Steroid pulse therapy was started after a diagnosis of retrobulbar optic neuritis. After 1 month, the patient’s visual acuity had improved to 1.0 in the left eye. The relative afferent pupillary defect and visual field defect disappeared. On VEP, the P100 amplitude recovered, and the delay disappeared.Conclusions: Retrobulbar optic neuritis is a possible neuro-ophthalmological complication of COVID-19 infection. In such cases, high-dose steroid pulse therapy may be helpful, as in the treatment of other forms of optic neuritis.

Neutrophil-Lymphocyte Ratio as an Inflammatory Marker for Retrobulbar Optic Neuritis

Abstract
 Introduction & Objectives : Retrobulbar optic neuritis is a form of optic neuritis which part at the back of the eye become inflamed and demyelinated. The inflammatory response might be important for diagnosis and prognosis because in retrobulbar optic neuritis, everything seems normal anteriorly. This study aims to analyze the parameter changes of CBC in retrobulbar optic neuritis.
 Methods : Patients with retrobulbar optic neuritis who were admitted to the Yogyakarta Tertiary Hospital from January 2020 to March 2022 were included in this study. Age-matched healthy patients were recruited for comparison (controls). A venous blood sample was obtained as part of the examination at the first visit. The primary measure was white blood cells (WBC), while the secondary measures were neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), haemoglobin, platelets, neutrophils, and lymphocytes counts.
 Results : 20 Patients were enrolled in case group, with mean age 27.75(±10.9)Y.O. and 13(65%) of them were female. overall, 4(20%) patients had bilateral involvement. Erythrocytes(p=0.45), Haemoglobin(p=0.17), Haematocrit(p=0.126), Thrombocyte(p=0.86), Monocyte(p=0.68), LMR(p=0.26), PLR(p=0.074) were insignificantly different between both group. Meanwhile Neutrophil(p=0.006) and NLR(p=0.021) were significantly higher in case group also Lymphocyte(p=0.05), Eosinophil(p=0.004)and Basophil(p=0.016) were significantly lower in case group.
 Conclusion : The inflammatory Parameters such as Neutrophil and NLR were found to be significantly higher in retrobulbar optic neuritis patients although other parameters like WBC were insignificantly different, even some parameters like Lymphocyte were significantly lower in retrobulbar optic neuritis. thus, these parameters especially NLR might be attributable to the pathogenesis of retrobulbar optic neuritis even when the WBC seems in normal limit.

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.

Pregnancy and visual pathology associated with an examination of multiple sclerosis

Introduction. The problem of pregnancy management in women with extragenital pathology is multidisciplinary and requires the participation of various specialists. It is known that pregnancy does not adversely affect the course of multiple sclerosis, and the incidence of pregnancy and delivery complications in multiple sclerosis does not exceed the general population. Nevertheless, multiple sclerosis exacerbations with different clinical presentation are possible during pregnancy, which may require correction of tactical and therapeutic measures. The purpose of the work was to demonstrate the role of a multidisciplinary team for favorable maternal and perinatal outcomes in visual pathology associated with worsening multiple sclerosis in pregnancy through a clinical example. Materials and methods. We retrospectively reviewed the patient's medical records: individual pregnancy and maternity records, labor and delivery history, and medical records of patients receiving care in outpatient settings. Results. A patient with multiple sclerosis had an exacerbation of the disease in the form of optic neuritis on the right side with temporary loss of vision in the first trimester of pregnancy. This required multiple consultations with an ophthalmologist and surgical treatment in the ophthalmology department of the hospital, followed by delivery by cesarean section. Discussion. Multiple sclerosis and its exacerbation in the form of optic neuritis did not affect the development of pregnancy, its favorable outcome was registered, which corresponds to the data of other researchers. Conclusions. A favorable outcome of pregnancy and delivery in a patient with multiple sclerosis and ophthalmopathology associated with its exacerbation during pregnancy was possible due to coordinated teamwork of specialists in various fields and timely correction of complications using a comprehensive approach and modern surgical techniques.

Optical coherence tomography in central nervous system demyelinating diseases related optic neuritis.

To compare the thickness of the peripapillary retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) among patients with various forms of optic neuritis (ON) and to identify whether any particular parameters or their thinning pattern can be used to distinguish the type of ON. This prospective study was conducted at the Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Thailand, between January, 2015 and December, 2016. We enlisted patients over 18 years of age with history of ON and categorized patients into 4 groups: 1) aquaporin 4 antibodies (AQP4-IgG) positive; 2) multiple sclerosis (MS); 3) myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) positive; 4) idiopathic-ON patients. Healthy controls were also included during the same study period. All patients underwent complete ophthalmological examination and spectral domain optical coherence tomography (OCT) imaging to analyze RNFL and GCIPL thickness after at least 3mo since the last episode of acute ON. The generalized estimating equation (GEE) models were used to compare the data amongst ON groups. Among 87 previous ON eyes from 57 patients (43 AQP4-IgG+ON, 17 MS-ON, 8 MOG-IgG+ON, and 19 idiopathic-ON), mean logMAR visual acuity of AQP4-IgG+ON, MS-ON, MOG-IgG+ON, and idiopathic-ON groups was 0.76±0.88, 0.12±0.25, 0.39±0.31, and 0.75±1.08, respectively. Average, superior, and inferior RNFL were significantly reduced in AQP4-IgG+ON, MOG-IgG+ON and idiopathic-ON eyes, relative to those of MS-ON. Differences were not statistically significant for RNFL or GCIPL between the AQP4-IgG+ON and MOG-IgG+ON groups, whereas visual acuity in MOG-IgG+ON was slightly, but not significantly, better (0.39 vs 0.76). Although RNFL thickness in MOG-IgG+ON was significantly reduced as compared to MS-ON, mean visual acuity and GCIPL were not different. Thinning of superior and inferior quadrants of RNFL are more commonly seen in MOG-IgG+ON and AQP4-IgG+ON. Long term visual acuity in MOG-IgG+ON is often better than AQP4-IgG+ON, whereas the structural change from OCT is comparable.

The abnormal bifid W-waveform visual evoked potential early indicated of demyelination optic neuritis is a primary sign of multiple sclerosis disease

Objective: Multiple sclerosis (MS) is the inflammatory demyelinating process resulting in the episodic neurological dysfunction, involvement of the retinal pathway in the form of optic neuritis. These are clinical causes of ophthalmic symptoms, such as the blurring of vision, impaired of vision, and some cases are silent and the visual evoked potential (VEP) may be beneficial if there is abnormality along the optic tract.Methods: A total of 20 elected patients with MS compared with 15 healthy control groups. All groups in the present study conducted by the reversal pattern of VEP test for both eyes identify the N75-P100-N145 parameters and the percentage of the bifid W-waveform recorded in VEP.Results: The VEPs study recorded the highly significant difference in comparing between the patients and the control group; we found the significant difference (<0.005) in latency of N75, P100, N145 and N75/P100 amplitude in both eyes. The bifid W-waveform of abnormal VEP recorded in 65% of patients, 45% of the patients had bifid changes in both eyes and 20% of patients had changes in the left eye. These changes of waveform ship had a significant relationship to loss of amplitude but not related to prolong of P100 latency.Conclusion: The bifid W-shape waveform in abnormal VEP indication in early diagnosis the demyelination lesions of the optic pathway in patients with clinical and subclinical ophthalmic manifestation, a primary sign of MS diseases.

Bilateral and Simultaneous Retrobulbar Optic Neuritis Revealing Multiple Sclerosis

Optic neuritis is a common manifestation of multiple sclerosis. It occurs in two thirds of patients at some point in the course of this disease and is usually unilateral, acute and often recurrent. However, optic neuritis can be the first manifestation of this demyelinating disease in 15 to 20% of cases. Bilateral, simultaneous and retrobulbar forms of optic neuritis inaugurating multiple sclerosis remain exceptional and unusual. They represent a real diagnostic challenge and require special attention from the clinician Herein we report the case of bilateral simultaneous and isolated retrobulbar optic neuritis inaugurating multiple sclerosis in a 24 year old woman.

Clinical spectrum of neuromyelitis optica 2013

The spectrum of presentation of neuromyelitis optica (NMO) is now recognized as being more diverse than defined by current diagnostic criteria, and includes limited forms of optic neuritis and transverse myelitis, as well as other brain syndromes. Discovery of a specific biomarker, autoantibodies targeting aquaporin-4, facilitated the recognition of this broader spectrum of disease. Brain magnetic resonance imaging lesions in NMO might be relatively specific or entirely non-specific. The most specific lesions are lesions of the area postrema or hypothalamus, longitudinally extensive corpus callosum lesions, and long corticospinal tract lesions in the corona radiata and brainstem. Although the full spectrum of aquaporin-4-associated disease based on population-based serological studies remains undefined, studies from service testing laboratories show that the vast majority of patients have had optic neuritis and myelitis or one of the now well-accepted signature syndromes of NMO, such as intractable vomiting or hiccough, although ascertainment bias undoubtedly influences this conclusion. New diagnostic criteria based on deliberations of an international panel of experts are anticipated shortly. Almost certainly, new criteria will allow for diagnosis of NMO based on a single episode of a “signature” syndrome of NMO. Nevertheless, in the face of a syndrome that is less characteristic and less well associated with NMO, especially if associated with other disease entities, caution is necessary.

Systemic Lupus Erythematosus with Neuromyelitis Optica

Systemic lupus erythematosus (SLE) is an autoimmune disease that can have detrimental effects on many different systems in the body, including the central nervous system. Neuropsychiatric SLE (NPSLE) refers to several different neurological and/or behavioral clinical syndromes, and has been reported as having a prevalence rate of approximately 30−40%, while manifestation of myelitis or optic neuritis of NPSLE is rare (~1%). Myelitis and optic neuritis are easily identifiable since myelitis is frequently transverse, and manifests as severe disturbances in both motor and sensory pathways, while optic neuritis is often both bilateral and severe. At least 85% of patients experience relapses in the form of optic neuritis, transverse myelitis, or both. Furthermore, some cases of NPSLE with optic neuritis are often complicated by myelitis. Interestingly, the characteristics of myelitis or optic neuritis in NPSLE are quite similar to neuromyelitis optica (NMO), a disease characterized by bilateral optic neuropathy and transverse myelopathy. In fact, magnetic resonance imaging (MRI) of patients with NPSLE has demonstrated longitudinal spinal involvement showing cord swelling and hyperintense lesions in central regions. These findings are also typically observed in MRIs of patients with NMO. Additionally, anti-aquaporin 4 (AQP4) antibodies have been discovered in patients with NMO and with NPSLE with myelitis and/or optic neuritis. Therefore, complications that are often encountered with NMO should be considered when treating cases of NPSLE with myelitis and/or optic neuritis. Moreover, since the treatment of NMO closely resembles the therapeutic approaches taken for NPSLE, corticosteroids alone or in combination with immunosuppressants could prove effective in reducing incidents of relapse. Some patients, however, may be refractory to steroid therapy; in such cases, plasma exchange may have priority over other second-line therapeutic strategies, such as intravenous immunoglobulin and rituximab, because of treatment approaches typically employed in NMO. In this review, I will discuss pathological similarities between NPSLE with myelitis and/or optic neuritis and NMO with the aim of demonstrating that our knowledge of NMO should be considered when treating NPSLE with myelitis and/or optic neuritis.

Neuroretinitis: Update on a visual emergency and role of technology in its diagnosis

Neuroretinitis is one of the forms of optic neuritis characterized by swelling of optic nerve head and adjoining retinal nerve fiber layer resulting in a macular star configuration. The underlying pathophysiology involves increased permeability of disc vasculature, but the etiology is not fully defined. Neuroretinitis may occur due to an infectious process involving the disc, a postviral or autoimmune mechanism or sometimes idiopathic. Technological advances like ophthalmoscopy, slit-lamp examination, fluorescein angiography, magnetic resonance imaging and immunodiagnostic tests all come handily and are often imperative in making an accurate diagnosis. Conditions mimicking neuroretinitis include papilledema, anterior ischemic optic neuropathy, and infiltration of the optic disc by tumor and systemic hypertension. Neuroretinitis is usually a self-limited disorder with a good visual prognosis. Treatment of neuroretinitis is required only when there is an underlying infectious or inflammatory condition.

Does neuroretinitis rule out multiple sclerosis?

Neuroretinitis, a form of optic neuritis, is characterized by papillitis and a stellate macular exudate, or "macular star." The star implies the presence of a disc vasculopathy and secondary leakage of lipoproteinaceous material into the macula. Demyelinating optic neuritis would not be expected to produce a secondary macular exudate. We reviewed the literature on the risk of multiple sclerosis developing in a patient after an attack of optic neuritis, and rarely found a comment on the presence of a macular star. We then reviewed two series of 40 patients who had neuroretinitis and added ten patients of our own. Signs of multiple sclerosis had not developed in the 13 patients contacted retrospectively, nor in the patients followed up prospectively. We also noted that in our patients, neuroretinitis may be accompanied by other neurologic manifestations; neuroretinitis may be bilateral and may be staggered; papillitis may present without a macular star, only to have typical exudates develop up to two weeks later; and the macular exudate may take up to 12 months to resolve. We suggest that patients who demonstrate acute papillitis with a normal macula be reevaluated within two weeks for the development of a macular star. Its presence militates strongly against the subsequent development of multiple sclerosis.

RELATION OF BLOOD DYSCRASIA TO RETINOPATHY

According to the present concept, retinopathy implies manifestations in the fundus of hypertension ; renal disease ; diabetes ; retinal edema and exudates secondary to various forms of optic neuritis and papilledema; localized disease of blood vessels, such as Coats's disease (retinitis exudative) and von Hippel's disease (angiomatosis of the retina) ; senile degenerative disease of Bruch's membrane and choriocapillaris, and, finally, diseases of the blood. Actually, all types of retinopathy are based on localized structural changes in the blood vessels and capillaries, irrespective of the cause. With the exception of tuberculosis of the vessels and angiomatosis, these changes in the blood vessels are produced by some type of blood dyscrasia, primary or secondary. Since nutrition of the walls of small vessels and capillaries depends on the quality as well as the quantity of the blood within, qualitative or quantitative reduction results in degenerative changes. In cases of early hypertension with localized quantitative reduction,