Neuritis In Multiple Sclerosis Research Articles

Evaluation of contrast sensitivity measurements after retrobulbar optic neuritis in Multiple Sclerosis

BackgroundThe evaluation of contrast sensitivity is an important additional examination that allows the physician to achieve the full picture of a patient's quality of vision. In low-contrast conditions, more discrete visual dysfunctions may be revealed, which could be overlooked in high-contrast tests.MethodsThe examined group consisted of 33 eyes of 27 patients with multiple sclerosis. The study included patients with full or almost full visual acuity, without visual field defects or any other ophthalmic condition, and who had never undergone any ocular surgery or trauma. The reference group consisted of 49 eyes of 37 patients. This group included healthy subjects with full visual acuity. Contrast sensitivity was examined with a Functional Vision Analyzer™ device in photopic conditions (with and without glare) and in mesopic conditions (with and without glare).ResultsIn patients with multiple sclerosis who had experienced optic neuritis, contrast sensitivity was found to be significantly reduced in all spatial frequencies in both mesopic and photopic conditions (with and without glare).ConclusionsContrast sensitivity in patients with multiple sclerosis who have also had optic neuritis is significantly reduced. This may explain patients' complaints regarding their quality of vision, despite good visual acuity. Contrastometry is a useful basis for further examination, providing additional information regarding a patient's quality of vision.

Diseases of the Eye with Systemic Involvement and /or Acute Presentation

Opticneuritis is defined as an inflammation of the optic nerve, which is mostlyidiopathic. However, it can be associated with variable causes: demyelinatinglesions, autoimmune disorders, infectious conditions, compressive, toxic,metabolic and hereditary conditions. It is divided intoarteritic, which is commonly seen in temporal arteritis/polymyalgia rheumaticaand non arteritic, which is associated with advanced age, atherosclerosis,hypertension and hyperlipidemia. Among demyelinating disorders, multiplesclerosis is the most common cause. The term optic neuritis is indicated bysub-acute unilateral painful visual loss mostly in a young healthy female andby excluding glaucoma. The clinical diagnosis of optic neuritis consists of theclassic triad of visual loss, periocular pain and dyschromatopsia whichrequires careful ophthalmic, neurologic and systemic examinations todistinguish between typical and atypical optic neuritis. In neuromyelitis optica,optic neuritis is initially misdiagnosed as optic neuritis in multiplesclerosis or other conditions such as ischemic optic neuritis and Leber’sdisease. Therefore, differential diagnosis is necessary to make a propertreatment plan. According to Optic Neuritis Treatment Trial, the first line oftreatment is intravenous methylprednisolone with faster recovery and lesschance of recurrence of optic neuritis and conversion to multiple sclerosis.Apart from optic neuritis of various causes, loss of vision could be due toglaucoma or uveitis. Glaucoma is optic nerve damage due to an interruption ofthe production and/or abduction of vitreous gel of the eye. Uveitis refers to a group of heterogeneous diseasesthat share the features of intraocular inflammation, but whose etiologies includeidiopathic autoimmune disease, infections and masquerade syndromes. Acute retinal necrosis and detachment may have a debilitatingeffect on vision and must be rapidly diagnosed and confronted, too. Theabove-mentioned clinical entities, their etiologies and current therapies arebriefly discussed in this review.Key-words: optic neuritis; multiple sclerosis; age-relatedmacular degeneration; diabetic retinopathy; glaucoma; uveitisAbbreviations: AMD (age-related macular degeneration); DR (diabeticretinopathy); DME (diabetic macular edema); AGEs (advanced end glycationproducts)

Age Related Recovery from Acute Optic Neuritis in Multiple Sclerosis (P04.120)

Age Related Recovery from Acute Optic Neuritis in Multiple Sclerosis (P04.120)

Treatment of retrobulbar neuritis in multiple sclerosis with corticosteroids and interferon β1b

Objective. Retrobulbar neuritis is the inflammation of optical nerve which is localized behind the eye. Patients with multiple sclerosis are adequate for our examination, because of well-known association between these two diseases. Methods. The study included 64 patients, divided in 4 groups, during last five years, during hospitalizations and outpatient controls. We analyzed demographic characteristics, neuro-ophthalmological clinical symptoms, diagnostic tests and the effectiveness of therapy. Results. The greatest number of patients was young women, from urban regions, treated primarily during the winter time of the year. Temporal pallor of optic head was always present in clinical status. The loss of visual acuity appeared in 64%, MRI findings were positive at 56%, positive cerebrospinal fluid findings were at 43% subjects. VEP examination was positive at 84%, ocular sequels at 67% and neurological disturbances occurred in 48% subjects. Incidence of relapse of retrobulbar neuritis was found in 16% of patients with normal MRI in the period of five years. After the treatment with corticosteroids, the appearance of plaques was delayed for 2 years at almost all patients. A good recovery of patients appeared after 2-3 weeks of corticosteroid treatment. The good results with interferon beta-1b therapy were achieved in 76% of patients. In our patients, prolongation of relapse-remitting status of retrobulbar neuritis during multiple sclerosis evolution was about 2 years. Conclusion. Retrobulbar neuritis is an important health problem in many patients suffering from multiple sclerosis.

Ipsilateral Uveitis and Optic Neuritis in Multiple Sclerosis

Background. Uveitis is 20 times more frequent in multiple sclerosis (MS) patients than in the general population. Methods. A retrospective study of local multiple sclerosis (n = 700) and uveitis cohorts (n = 450) described the ophthalmological and neurological characteristics of patients with multiple sclerosis and uveitis. Results. Uveitis and multiple sclerosis were associated in seven patients. The time intervals between diagnoses of MS and uveitis ranged from 6 months to 15 years. Analysis of the patients' characteristics revealed that multiple sclerosis was associated with an older age of onset than usually expected, that is, 39 years. Uveitis was bilateral in three cases and mainly posterior (5/10). Five patients presented with acute optic neuritis (two in one eye and three in both eyes). All eyes presenting with acute optic neuritis were also affected by uveitis (P = 0.02), though not simultaneously. Conclusion. The ipsilateral association between optic neuritis and uveitis in this series of patients with multiple sclerosis may suggest a reciprocal potentiation between optic neuritis and uveitis in multiple sclerosis.

Bilateral and recurrent optic neuritis in multiple sclerosis

To assess the frequency of bilateral and recurrent optic neuritis (ON) in multiple sclerosis (MS) and to compare these results with epidemiological data of ON in neuromyelitis optica (NMO) and recurrent ON without other signs of disease. We identified 472 patients with diagnosis of MS from the Swedish Multiple Sclerosis Register. These patients were evaluated for the presence of ON and whether the ON was the presenting symptom of MS; unilateral or bilateral; monophasic or recurrent. Twenty-one percent presented with ON as their first manifestation of MS. The proportion of patients developing a second attack of ON before demonstration of other manifestations of MS was 5.5% and the frequency of recurrent bilateral ON as the presenting symptom was 3.8%. Only two patients presented with simultaneously appearing bilateral ON corresponding to 0.42%. Recurrent ON, whether unilateral or bilateral, is a common presentation of MS. As MS is a much more common disease than NMO, care must be taken when evaluating the work-up of patients with recurrent ON. In some cases repeated MRI and lumbar punctures are warranted to improve diagnostic accuracy, even in the presence of the serological marker NMO-IgG.

This issue of Acta

The cover illustrations are contributed by Gysbert van Setten and show the bimanual insertion of a capsular tension ring as reported in this issue of Acta. Anders Behndig discusses the pros and cons of operating both eyes for cataract at the same time and discusses the article by Lundström et al. in this issue. Resch and associates in Vienna review the evidence for endothelial dysfunction in glaucoma and its relevance in the ischemic nature of glaucoma. Kawasaki and Purvin in Switzerland and USA present a comprehensive review of giant cell arteritis including epidemiology, pathophysiology and treatment. Lundström et al. in Sweden point out that it is less expensive to operate both eyes of a cataract patient in the same setting. The pros and cons of this approach are discussed further in the editorial by Behndig. Karalezli et al. in Turkey find changes in conjunctival impression cytology and the tear film in patients with Mediterranean fever. Kimura et al. en Japan did not find adenovirus before the onset of symptoms in adenoviral conjunctivitis. Wollensak and Iomdina in Germany and Russia found that photodynamic collagen cross-linking increases the rigidity of the rabbit cornea. Berker et al. in Turkey examined the genetic pattern of Peters' anomaly. Bordaberry et al. in Brazil found peribulbar injection of trimacinolone to reduce inflammation in Graves' ophthalmopathy and optic neuropathy. Hradilek et al. in the Check Republic describe transient changes in orbital hemodynamics in optic neuritis in multiple sclerosis. Konstas et al. in Greece and United States found that a fixed combination of travoprost and timolol reduces intraocular pressure over a 24-hour period. Rensch et al. in Germany found that intravitreal bevacizumab improves vision and reduces macular edema in non-ischemic central retinal vein occlusion. Sharma et al. in United States suggest that preconditioning may protect retinal pigment epithelial cells from oxidative stress in an in vitro experiment. Schmid-Kubista in Vienna found that patients with age-related macular degeneration produce less melatonin than control patients without macular degeneration. Saricaoglu et al. in Turkey describe decompression retinopathy following glaucoma filtering surgery. Abouzeid et al. in Switzerland and Germany used optical coherence tomography to show that subretinal fluid may persist for months after scleral buckling surgery inferior detachments. Song et al. in Korea used intravitreal bevacizumab to treat choroidal neovascularization with a choroidal osteoma. Ikewaki et al. in Japan describe a fungal abscess following triamcinolone injection. I hope that the readers of Acta find sources of enjoyment and education in this issue of Acta. I wish you all a Happy New Year.

Colour Doppler imaging evaluation of blood flow parameters in the ophthalmic artery in acute and chronic phases of optic neuritis in multiple sclerosis

Optic neuritis (ON) is a common manifestation of multiple sclerosis (MS). It is caused by the immune-mediated inflammation of the optic nerve. Some vascular factors that may influence blood flow in the ophthalmic artery (OA) have also been suggested as factors in the pathogenesis of ON. The purpose of our study was to evaluate blood flow velocities and resistance (RI) and pulsatile (PI) indices in the OA in both orbits in patients in the acute and chronic phases of unilateral ON and to compare these with equivalent findings in healthy control subjects. Orbital colour Doppler imaging (CDI) was performed in 40 consecutive MS patients during acute unilateral ON prior to corticosteroid treatment. Optic neuritis was diagnosed on the basis of clinical presentation and facultative assessment of visual evoked potentials (VEPs). The peak systolic (PSV) and end-diastolic (EDV) velocities and RI and PI were measured in the OA in both eyes. We compared results from affected and unaffected orbits using the paired t-test. The same measurements were performed in 114 MS patients with a history of acute unilateral ON that occurred > 1 year prior to ultrasound examination. We also measured the same parameters in the middle cerebral arteries (MCAs) on both sides in all subjects in both groups. The same measurements were obtained in healthy controls. The PSV (p < 0.0001), RI (p < 0.0001) and PI (p < 0.0001) in the OA in the eye affected with acute ON were significantly higher than in the unaffected eye. There was no difference in EDV in the OA between affected and unaffected eyes (p > 0.05) in the group with acute ON. We did not observe any significant differences between eyes in either blood flow velocities or the RI or PI (p > 0.05) in the group in the chronic phase of ON or in the control group. All the parameters in the MCAs on both sides were normal in both the acute and chronic groups, as well as in the control group. Pathophysiological changes during acute unilateral ON influence orbital haemodynamics, as is indicated by increased PSV, RI and PI in the OA in eyes affected with ON. However, these changes do not persist over longer periods.

Acute Optic Neuritis in Multiple Sclerosis: Evaluation of Hemodynamics in the Ophthalmic Artery with Colour Doppler Imaging

Background: Optic neuritis (ON) is a common manifestation of multiple sclerosis. It occurs because of the immune-mediated inflammation of the optic nerve. Some vascular factors that could influence the blood flow in the ophthalmic artery (OA) have been suggested in the pathogenesis of ON as well. The purpose of our study was to evaluate blood flow velocities and resistance (RI) and pulsatile (PI) indexes in the OA in patients with acute unilateral ON. Materials and methods: Orbital color Doppler imaging was performed in 27 consecutive patients during acute unilateral ON prior to corticosteroid treatment. ON was diagnosed on the basis of clinical presentation, acute unilateral loss of vision, and assessment of visual evoked potentials (VEP). The peak-systolic velocity (PSV) and the end-diastolic velocity (EDV) and RI and PI were measured in the OA on both sides. We compared results from affected and unaffected orbits, using the paired t-test. We also measured the same parameters in the middle cerebral arteries (MCA) on both sides. Results: The PSV (p < 0.0001), RI (p < 0.0001), and PI (p < 0.0001) in the OA on the side affected by acute ON were significantly higher compared to the unaffected side. There was no difference in EDV in the OA between affected and unaffected sides (p > 0.05). All the parameters in the MCA on both sides were normal. Conclusion: Pathophysiological changes during acute unilateral ON influence the orbital hemodynamics as documented by increased PSV, RI, and PI in the OA on the side affected by ON.

Optic neuritis in multiple sclerosis

Purpose: To review the clinical features, natural history, potential pathogenic mechanisms, differential diagnosis, and management of optic neuritis in multiple sclerosis. Methods: Relevant literature regarding optic neuritis in multiple sclerosis from 1970 to the present was reviewed. Results: Optic neuritis is an acute inflammatory optic neuropathy. It is the most common type of optic neuropathy causing acute visual loss in young adults (peak age at 30-40 years), especially among women. Patients usually present with an acute reduction of visual acuity, orbital pain exacerbated by eye movements, dyschromatopsia, and an afferent papillary defect, with or without swelling of the optic nerve head. Visual field testing most often reveals central defects, but others, such as centrocecal, can also occur. Magnetic resonance image (MRI) scanning of the brain should be undertaken in all cases of acute optic neuritis for diagnostic and prognostic purposes. The brain lesions of multiple sclerosis are commonly seen as T2 ovoid high-signal white matter lesions on MRI scans of the brain located in perivenular regions perpendicular to ventricles with variable enhancement. For atypical presentations of optic neuritis, additional laboratory tests, such as cerebrospinal fluid analysis, serologic tests, and visual evoked potentials, prove to be useful in the diagnosis and subsequent management of the patient. The recommended treatment for optic neuritis is intravenous steroids, as shown in the Optic Neuritis Treatment Trial (ONTT). Conclusion: Optic neuritis is often the initial presentation of multiple sclerosis. Recent advances in the understanding of the immune basis for multiple sclerosis has led to earlier and more effective treatment of this disease.

Optic neuritis in chronic relapsing experimental allergic encephalomyelitis in Biozzi ABH mice: Demyelination and fast axonal transport changes in disease

The encephalitogenicity of optic nerve tissue was demonstrated in Biozzi ABH (H-2 dq1) mice. Acute experimental allergic encephalomyelitis (EAE) occurred in 11/14 animals and 4/5 exhibited relapse. The involvement of the optic nerve in spinal cord homogenate induced chronic relapsing EAE (CREAE) was demonstrated by mononuclear cell infiltration and myelin degradation in the optic nerve prior to and during clinical disease. During the relapse phase gross pathological assessment revealed swollen and translucent plaques on the optic nerves. Advanced lesions showed widespread demyelination, astrocytic gliosis and fibrotic changes of the blood vessels. Physiologically, the fast axonal transport of proteins from the retina to the optic nerve and superior colliculus was significantly decreased during relapse. The association of inflammation and demyelination with physiological deficit in the optic nerve highlights the usefulness of this model in the study of multiple sclerosis in which acute monosymptomatic unilateral optic neuritis is a common manifestation. Furthermore, the novel induction of CREAE with optic nerve homogenate suggests that optic nerve antigens play a significant role in the pathophysiology and progression of neurological disease in CREAE which may be relevant to studies of optic neuritis in multiple sclerosis.

Reflections on the pathogenesis of optic (retrobulbar) neuritis in multiple sclerosis

The conditions which lead to a plaque of demyelination in the retrobulbar optic nerve are discussed. Growth of the plaque occurs along venules as small fingerlike sleeves which develop outwards from the contour of the plaque. This occurs slowly and at intervals; the very gradually expanding lesion remain for a long time clinically silent. It is here postulated that the change to clinical disease is induced if cells digesting myelin debris settle in a more distal part of the perivascular space of a vein, than during the subclinical phase. In sufficient numbers these cells will impede the movement of molecules from extra-cellular fluid surrounding nodes of Ranvier into cerebrospinal fluid. A restriction in this vital drainage pathway results in oedema causing distrubed signal transmission in neurons passing through the veins drainage territory. Depending on intensity this can induce the characteristics symptom of blurred vision. These concepts have been used to speculate on sequential changes in neurons and to relate them to various phases of the disease. This seems to be justified as the pattern evolved corresponds well with the clinical symptomatology.

Diagnosing Acute Retrobulbar Neuritis by Vitreous Fluorophotometry

We studied six patients with acute retrobulbar neuritis (including two with definite multiple sclerosis) during acute episodes and in convalescence, clinically and with fluorescein angiography and vitreous fluorophotometry. We compared vitreous fluorophotometric readings with visual-evoked responses. In seven of ten eyes with abnormal visual-evoked responses, there was an acute increase in posterior vitreous fluorophotometric readings. Vitreous fluorophotometry may be useful as objective evidence of (1) acute retrobulbar neuritis, (2) involvement of the asymptomatic eye in acute retrobulbar neuritis, (3) the duration of neuritic inflammation in acute retrobulbar neuritis, (4) a recurrence of acute retrobulbar neuritis, (5) alterations in the blood-ocular barrier in patients with acute retrobulbar neuritis in multiple sclerosis, and (6) the effects of corticosteroids and other therapeutic agents in the treatment of acute retrobulbar neuritis.