Optic Nerve Affection Research Articles

ADC Value of Optic Nerve in Multiple Sclerosis

Abstract Background Multiple sclerosis (MS) is the commonest non-traumatic disabling disease to affect young adults. The incidence of MS is increasing worldwide, together with the socioeconomic impact of the disease. The underlying cause of MS and mechanisms behind this increase remain opaque, although complex gene–environment interactions almost certainly play a significant role. Aim of the Work To investigate diffusion alteration by measuring ADC values in optic nerve in multiple sclerosis in comparison to the healthy controls. The ADC values of optic nerve may have potential for MS patients as it predict the patients at risk of optic nerve disease and assess the long term effect of MS on optic nerve. Patients and Methods This study is a retrospective study. The study was conducted at Ain Shams University Hospitals over a course of 8 months from December 2022 to July 2023 and the main source of data for this study was the archived MRI imaging of the patients referred to the department of Radiology, Ain Shams University Hospitals. Results Our study included a heterogeneous group of adult patients older than 18 years old. Male patients= 50 (33.8%) and female patients= 98 (66.2%). Multiple sclerosis was found to be associated with risk of optic nerve disease and atrophy due to axonal loss as presented by facilitated diffusion of optic nerve indicated by increase of mean ADC value in MS patients as compared to optic nerve of normal controls. It was found that there is positive correlation between disease duration and optic nerve affection, The mean value of disease duration was found to be 6.18 +/- 5.29 years ranged from 1 to 26 years, Although it was statistically significant weak positive correlation yet it was a good indication to put eye upon the optic nerve affection in MS patients regardless of their clinical presentation, suggesting subclinical optic neuritis in MS. Conclusion Changes detected in ADC value of optic nerve could be helpful in early detection of subclinical optic neuritis even before it presented clinically, this necessitate some modifications in the treatment strategies to prevent or even delay the possibility of optic nerve axonal damage.

An analytical longitudinal observational study on the association of Vitamin D insufficiency in subjects with primary (idiopathic) demyelinating optic neuritis using visual evoked potential and optical coherence tomography

Background: Optic neuritis (ON) is an acute and often immune-mediated inflammatory condition of the optic nerve. Vitamin D acts as an anti-inflammatory agent and may confer neuroprotection. Visual evoked potential (VEP) and optical coherence tomography (OCT) are emerging tools for demyelinating diseases. Aims and Objectives: We tried to correlate between Vitamin D insufficiency and acute demyelinating ON using different parameters such as VEP, ganglion cell layer (GCL) thickness, and retinal nerve fiber layer (RNFL) thickness. Materials and Methods: This observational longitudinal analytical study included thirty non-consecutive patients with primary ON and 30 healthy controls. All patients with ON underwent detailed clinical and ophthalmological examination, and detailed blood workup, including serum 25 (OH) Vitamin D. VEP P100 latency, amplitude, OCT, RNFL thickness, and GCL thickness at presentation and after 3 months from May 2019 to November 2020. Results: Vitamin D insufficiency (below 30 ng/mL) was present in 60% of cases of ON. The baseline VEP showed significantly prolonged P100 latency in affected eyes in the Vitamin D insufficient group (mean 129.78±7.97 ms vs. 121.0±4.99 ms) whereas the P100 amplitude was not significantly altered between the two groups (5.5±3.13 μV vs. 7.08±3.01 μV). The baseline RNFL thickness (132.21±10.69 μm vs. 118.01±10.4 μm) and GCL thickness (76.82±2.04 μm vs. 73.06±3.2 μm) were greater in affected eyes of vitamin D insufficiency ON. There was greater RNFL thinning (79.93±3.42 μm vs. 74.80±3.5 μm) and GCL thinning (64.78±1.9μm vs. 69.02±2.22 μm) in affected eyes of ON with Vitamin D insufficiency at 3 months. Conclusion: Vitamin D insufficiency was found in most cases of ON. Insufficient Vitamin D positively correlated with optic nerve affection severity as evidenced by significantly increased baseline thickness of RNFL and GCL and more thinning of RNFL and GCL at the end of 3 months of follow-up.

THU162 Impact On Visual Function And Optic Nerve Morphology In Early Stages Of Growth Hormone Treatment

Abstract Disclosure: D.G. Braslavsky: None. A.C. Keselman: None. M.G. Ballerini: None. S. Rosenbrock: None. N. Cappa: None. G. Negrete: None. G. Dech: None. M.G. Ropelato: None. S. Gamio: None. I. Bergada: None. Background Current safety of recombinant human growth hormone (rhGH) treatment arises mainly from postmarketing surveillance. Headache is a relatively frequent symptom in children under rhGH. Secondary intracranial hypertension (SIH), is an adverse effect (AE), usually occurring within the first 12 weeks of treatment associated to headaches. Permanent visual defects are the most feared complication. Scarce information exists regarding incidence and natural history of visual impairment under rhGH. Aim To evaluate visual impairment and/or optic nerve affection in children throughout early rhGH treatment. Materials and Methods Prospective interventional study conducted from February 2018 to January 2020. Children ≥4 yr who received rhGH treatment for growth hormone deficiency (GHD), 0.16-0.25 mg/kg/w; Turner syndrome (TS), small for gestational age (SGA), 0.33 mg/kg/w and Prader Willy Syndrome (PWS) 1 mg/m2/d. Patients were assessed at basal, 1, 3, and 6 months of treatment. Each visit included clinical variables (adherence, auxology, AE, presence of headache), serum IGF1, IGFBP3, glucose, insulin, aldosterone, plasma renin activity, electrolytes and ophthalmologic evaluation [fundoscopy, optical coherence tomography (OCT), retinal nerve fiber layer (RNFL), ganglionic eye complex, ocular ultrasound, intraocular pressure (IOP), autorefractometry, biomicroscopy]. Results Sixty patients were enrolled, 12 GHD, 11 ST, 31 SGA, 3 PWS, 3 TBI (23 females), with a median age of 8.08 yrs (ranged 4.24-15). Median height was -2.25 ± 1.05 SDS. Baseline ophthalmologic evaluation was normal. Abnormal ophthalmological findings were observed in 15/60 (25%). Twelve patients showed changes in OCT, spontaneous recovery occurred in 8, whereas persistence or worsening of RNFL thickening lead to an MRI assessment and lumbar puncture (LP) in 4 patients (1 GHD, 2 SGA, 1 ST); only one referred headache. LP revealed opening pressure of 19, 21, 22 and 30 mmHg, respectively, the latter assumed as SIH at the 1st month of treatment. In these four patients, during the findings of ocular abnormalities, they presented a mean IGF1 1.12 ± 1.04 SDS and IGFBP3 -0.02 ± 2.34 SDS. ΔBMI -0.45 ± 0.71 SDS. Prevalence of SIH was 1.6%. All four patients received acetazolamide; median time for RNFL improvement took 4 months (range 4-8). One patient developed post-dural puncture headache. Three had elevated IOP. Along the protocol 19/60 referred headache (26 events). Three of these patients with headaches had abnormal ophthalmological findings (2 mild changes in OCT; 1 elevated IOP). Conclusion We have demonstrated a marked prevalence of abnormal ophthalmological findings upon early rhGH treatment. These observations occurred in the absence of suggestive clinical symptoms, and conversely, headache did not predict SIH. The prevalence of SIH due to rhGH is higher than previously reported. Presentation: Thursday, June 15, 2023

Central retinal artery occlusion in a young child affected by COVID-19: a first case report

BackgroundCentral retinal artery occlusion (CRAO) is an ophthalmic emergency, and its etiology is generally ascribed to vessel occlusion by a thrombus or embolus, eventually due to a hypercoagulable state. CRAO occurrence is described even in the pediatric population, but its incidence is very rare. SARS-CoV-2 infection has a multitude of presentations, and almost any organ may be involved including the ocular district. Cases of CRAO in patients affected by COVID-19 are reported in the literature in the adult population, but not in the pediatric one.Case presentationWe describe the case of a six-year-old otherwise healthy girl, who presented a sudden and complete bilateral vision loss after a one-day fever. All the clinical, ophthalmological, laboratory and instrumental investigations led to the diagnosis of a right CRAO and the suspicion of a contralateral posterior optic nerve affection. These manifestations could not be ascribed to any etiological condition apart from the documented ongoing mild SARS-CoV-2 infection. Treatment with anticoagulants and steroids was tried but the visual outcome was poor during the one-month hospitalization and at the last follow-up.ConclusionsTo the best of our knowledge, this is the first report of CRAO in the course of SARS-CoV-2 infection in the pediatric age. In our review of the literature, we found few cases of CRAO in adults with COVID-19; we highlighted differences in anamnestic, clinical, and interventional aspects and therefore we tried to summarize the state of the art on this topic to facilitate further studies. Even if rare, the prognosis of CRAO is poor and the thrombolytic treatment could be effective only if rapidly administered, so the disease suspicion should be high in a patient with sudden vision loss, also in pediatric age.

Structural and Functional Optic Nerve Changes in Patients on Amiodarone Therapy

Purpose To investigate the structural and functional optic nerve changes in patients on amiodarone therapy. Methods A total of 30 eyes were examined were divided into two groups, study group of patients included (15 eyes) of cardiac patients on amiodarone therapy for more than four consecutive months, and control group included (15 eyes) of age- and sex-matched healthy participants. Both groups have underwent full ophthalmological examination, optical coherence tomography examination for optic nerve head scan, electrophysiological studies included (pattern visual evoked potential). Results Electrophysiological studies were the tool for the assessment of the functionality of the ocular structure in our study, the pattern visual evoked potential results have shown to be of no statistically significant difference between the N75 latency (ms) (P-value=0.972), P100 latency (ms) (P-value 0.547) and N75-P100 amplitude (µV) (P-value =0.18), in the numeric values between the control and cases groups. And for qualitative structural assessment we have performed optical coherence tomography scan imaging for the optic nerve head for all the participants in this study, and the results revealed no statistically significant differences in the obtained values regarding NFL thickness map. This agrees with the obtained electrophysiological tests results to be both within normal limits Conclusion The current study revealed normal electrophysiological as well as optical coherence tomography measurements in the included sample of patients on chronic amiodarone therapy. All the included patients had good, best corrected visual acuity (BCVA) and none complained of any visual symptoms. None had clinically suspected optic nerve affection and this was confirmed by the detailed imaging and electrophysiological assessment for both macula and optic nerve.

The effect of postmenopausal hormonal drop on optic nerve head and peripapillary perfusion using optical coherence tomography angiography (OCTA)

We studied the effect of menopause with subsequent estrogen drop on optic nerve head structure and peripapillary vasculature. This cross-sectional analytic study was carried out on 100 eyes of 100 patients; patients were divided into a premenopausal group (50 eyes) and a postmenopausal group (50 eyes). Optical coherence tomography was done to evaluate retinal nerve fiber layer thickness (RNFLT) and optical coherence tomography angiography (OCTA) to assess the peripapillary capillary vessel density. RNFLT as well as the peripapillary vessel density (VD) were significantly lower in the postmenopausal group (P value < 0.001) with increasing age, hormonal drop, and higher intraocular pressure (IOP), specifically in the inferior quadrant. However, the negative correlation between IOP and VD (r = − 0.541) was stronger than its negative correlation with RNFLT (r = − 0.318). Postmenopausal hormonal changes lead to a significant rise in IOP-although still not glaucomatous- and a decrease in the RNFLT and perfusion of the optic nerve. This confirms the relation between hormonal drop and glaucoma in postmenopausal women. Changes in peripapillary vascular density were more evident than RNFL in correlation with IOP and age changes. So, OCTA can be used to detect early optic nerve affection.

Full-field electroretinogram in evaluation of the outer retina in patients with multiple sclerosis

Background: Background: Optic nerve inflammation may contribute to the pathology of multiple sclerosis (MS) (retrograde trans-synaptic degeneration) However, within the past ten years, some investigations have indicated that primary retinopathy may be brought on by MS. This study used a full-field electroretinogram to test the function of the outer retinal layers in people with relapsing remitting multiple sclerosis (RRMS) (ff-ERG). Methods: This is a case- control study, conducted on 30 RRMS patients and 30 healthy controls. RRMS patients were subjected to neurological, ophthalmological, and radiological assessment. Both RRMS patients and controls were subjected to full field ERG. Results: The ff-ERG showed a significant delay of latencies of a and b-waves of both light and dark-adapted condition with reduction of their amplitudes compared to control. ERG responses were significantly affected in MS patients with or without optic neuritis compared to control. Most of ff-ERG parameters showed non statistically significant difference between optic neuritis and non-optic neuritis eyes. Conclusion: There is functional affection of the bipolar and the photoreceptors layers in the outer retina in optic neuritis and non-optic neuritis eyes of MS. Therefore, the outer retina could be a site for primary pathology in MS, unrelated to the optic nerve affection.

Optic nerve injury in preoperative imaging is associated with visual improvement outcome in endoscopic optic nerve decompression.

ObjectiveTo evaluate potential clinical parameters having an impact on visual outcome after endoscopic optic nerve decompression in acute optic neuropathy patients.MethodsA retrospective chart review of patients with acute optic neuropathy, who underwent endoscopic optic nerve decompression between June 2001 and November 2018 at an academic center was performed. Patients were divided into groups according to visual improvement after surgical treatment (yes/no). Following clinical parameters were compared between groups: perioperative steroid use, evidence of optic nerve affection in preoperative neuroimaging, additional optic nerve sheath incision, surgery delay and preoperative C-reactive protein (CRP) levels. Further subgroups analyses were conducted based on etiology (trauma/tumor).ResultsAmong 32 included cases, 16 patients (50%) reported visual improvement after endoscopic optic nerve decompression. There was no significant difference in visual improvement between etiology subgroups (trauma: n = 9/20 (45%) vs. tumor: n = 7/12 (58.3%), p = 0.465). Tumor subgroup patients with visual improvement had a significantly higher prevalence of optic nerve affection in preoperative neuroimaging than those without visual improvement (p = 0.018, φ = 0.683). Perioperative steroid administration was negatively associated with visual outcome (p = 0.034, φ = 0.375). Nerve sheath incision, surgery delay and preoperative CRP levels did not have a significant impact on visual outcome (p > 0.05).ConclusionRadiological findings can help as an indicator for surgical treatment since an affected optic nerve in preoperative neuroimaging resulted in better visual outcome after surgery. The use of steroids should be considered more carefully since it did not show any beneficial effect.

Lateralization bias for autoimmune optic neuritis

The asymmetrical structure of the human brain is reflected not only by innate interhemispheric differences but also by lateralization in neurological disease. We tested if unilateral autoimmune optic neuritis (aON) manifests more frequently on the left than the right eye in clinical and neuroimaging terms and whether Google searches for aON symptoms reflect this bias, too.We employed a retrospective analysis of a patient cohort from 2009 to 2019 with 552 unilateral aONs and 374 corresponding MRI imaging data sets. Searchmetrics Suite keywords tool was applied for the analysis of Google searches on aON-symptoms in Germany, the US and the UK for the last 12 months.Left eye aON manifestations were more frequent than right aON manifestations (55.3% vs. 44.7%, p = 0.015) and 1.9 times more likely to be associated with a pathological MRI finding in the affected optic nerve (p = 0.013). Keywords describing aON-typical but not other ocular symptoms were more frequently associated with Google searches for the left in comparison to the right eye (p < 0.001).Autoimmune optic neuritis more frequently affects the left than the right eye and people search on the Internet more often for left-sided aON symptoms. Although a reporting bias due to an increased perception of left eye symptoms is one possible explanation, MRI evidence of more frequent optic nerve affection for the left in comparison to the right side suggests a leftward lateralization bias similar to the one previously shown for cerebral neuroinflammatory lesions.

Ophthalmic Screening in Patients with Coronavirus Disease 2019: A Prospective Cohort Study

Postmortem pathological examinations, animal studies, and anecdotal reports suggest that coronavirus disease 2019 (COVID-19) could potentially affect intraocular tissue. However, published evidence is scarce and conflicting. In our study, we screened 100 eyes of 50 patients hospitalized for COVID-19. Relevant medical and ophthalmological history was assessed as well as symptoms, laboratory results, specific treatments, clinical course, and outcome. Ophthalmic exams including assessment of best corrected visual acuity (BCVA), intraocular pressure (IOP), color perception, ocular motility, ophthalmoscopy as well as optical coherence tomography (OCT) of the macula and the optic disc was performed at hospital admission and 29 to 192 days later. Of the 50 patients included, 14 (28%) were female. Median age was 64.5 (range 29–90) years. COVID-19 severity was mild in 15 (30%), severe in 30 (60%), and critical in five cases (10%). At baseline, median BCVA was 0.1 (0–1.8) Logarithm of the Minimum Angle of Resolution (LogMAR) and median IOP was 16 (8–22) mmHg. At follow-up, no relevant changes in BCVA and IOP were documented. No signs of active intraocular inflammation or optic nerve affection were found and OCT findings were widely stable during the observation period. Our findings suggest that COVID-19 does not regularly affect intraocular tissue.

Ocular radiological findings in Children with Acute Lymphoblastic Leukemia: a cross sectional study

Background:Ophthalmic complications in pediatric acute lymphoblastic leukemia (ALL) have become serious and recognition of ocular manifestations of leukemia is fundamental. In this study, we aimed to detect radiological findings among ALL patients.Patients and methods:This cross sectional study was conducted in Pediatric Oncology Unit and Ophthalmology Department; Faculty of Medicine; Zagazig University with a total of 45 patients diagnosed with ALL (18 patients were denovo ALL, 14 patients were receiving treatment of leukemia and 13 patients finished their treatment protocol and were on follow up schedule). Detailed radiological work up was done including MRI of brain and both orbits, fundus photography, fluorescein angiography (FA), optical coherence tomography (OCT) and orbital CT.Results:Ocular manifestations were detected in 35.6% of ALL patients by ophthalmic examinations. 44.4% of ALL patients had abnormal brain MRI and most commonly, ischemic changes, post-radiation leukomalacia and CNS infiltration were detected. Twenty-two percent of the studied cases reported abnormal orbital MRI and most common abnormalities were sutural metastasis and optic nerve affection. Fundus photographs were done for selected patients. Optic nerve head leukemic infiltration, choroidal, retinal and vitreal infiltration were detected (4.44%). Moreover, CMV retinitis was detected in one patient.Conclusions:Several ocular abnormalities are present in pediatric ALL and the most common are retinal lesions. Knowledge about ocular problems in children with ALL could be beneficial to reduce morbidity and mortality.

Genetic Diagnosis of Glaucoma

Purpose: Glaucoma, the most prevalent cause of irreversible blindness across the world, is progressive optic nerve degeneration and affection (neuropathy) caused by a mixture of both genetic and environmental factors [1]. The extracellular matrix (ECM) structure of the trabecular Meshwork TM has a major role in intraocular pressure IOP control. Transforming growth factor beta (TGF-β) is a growth factor that plays major roles in cellular functions, including encouraging extracellular matrix synthesis and vascular angiogenesis. TGFβ2 treatment of TM cells alters ECM components [8] and induces ECM bonds.&#x0D; Aim of the Study: To study the relationship between family history and glaucoma according to genotype and genetic polymorphism.&#x0D; Methods: Blood collection and DNA extraction Genotyping: TGFB2 Rs99196 genotyping was done using TaqMan SNP genotyping Assay (ID C___8853564_10). StepOne real time PCR system (Applied Biosystem, Ca, USA) was used for amplifiction.&#x0D; Statistical Analysis: The sample size of the study group was calculated using a program at (www.openepi.com/SampleSize/ SSCC.htm).&#x0D; Results: Important genotype differences frequencies were detected between the positive family history and negative family history groups for the codominant, dominant, recessive and overdominant inheritance models.&#x0D; Conclusion: This study recommends that other polymorphisms of genes associated with glaucoma and the analysis of these gene products and their relationship with disease risk factors should be more studied.

Functionally Relevant Maculopathy and Optic Atrophy in Spinocerebellar Ataxia Type 1.

BackgroundSpinocerebellar ataxia type 1 (SCA‐ATXN1) is an inherited progressive ataxia disorder characterized by an adult‐onset cerebellar syndrome combined with nonataxia signs. Retinal or optic nerve affection are not systematically described.ObjectivesTo describe a retinal phenotype and its functional relevance in SCA‐ATXN1.MethodsWe applied optical coherence tomography (OCT) in 20 index cases with SCA‐ATXN1 and 22 healthy controls (HCs), investigating qualitative changes and quantifying the peripapillary retinal nerve fiber layer (pRNFL) thickness and combined ganglion cell and inner plexiform layer (GCIP) volume as markers of optic atrophy and outer retinal layers as markers of maculopathy. Visual function was assessed by high‐ (HC‐VA) and low‐contrast visual acuity (LC‐VA) and the Hardy‐Rand‐Rittler pseudoisochromatic test for color vision.ResultsFive patients (25%) showed distinct maculopathies in the ellipsoid zone (EZ). Furthermore, pRNFL (P < 0.001) and GCIP (P = 0.002) were reduced in patients (pRNFL, 80.86 ± 9.49 μm; GCIP, 1.84 ± 0.16 mm3) compared with HCs (pRNFL, 97.02 ± 8.34 μm; GCIP, 1.98 ± 0.12 mm3). Outer macular layers were similar between groups, but reduced in patients with maculopathies. HC‐VA (P = 0.002) and LC‐VA (P < 0.001) were reduced in patients (HC‐VA [logMAR]: 0.01 ± 010; LC‐VA [logMAR]: 0.44 ± 0.16) compared with HCs (HC‐VA [logMAR]: –0.12 ± 0.08; LC‐VA [logMAR]: 0.25 ± 0.05). Color vision was abnormal in 2 patients with maculopathies.ConclusionsA distinct maculopathy, termed EZ disruption, as well as optic atrophy add to the known nonataxia features in SCA‐ATXN1. Whereas optic atrophy may be understood as part of a widespread neurodegeneration, EZ disruption may be explained by effects of ataxin‐1 gene or protein on photoreceptors. Our findings extend the spectrum of nonataxia signs in SCA‐ATXN1 with potential relevance for diagnosis and monitoring.

Evaluation of retinal vasculitis among cases of Behçet disease

Abstract Background Behçet disease is an obliterative and necrotizing systemic vasculitis that involves different organ systems. It affects both arteries and veins, mainly the veins. Ocular affection is one of the major criteria of Behçet disease; the most common ocular presentation is bilateral non-granulomatous panuveitis with retinal vasculitis. Purpose To identify early, evaluate and follow-up properly the posterior segment involvement in Behçet disease cases with the help of Fundus fluorescein angiography and Optical coherence tomography. Patients and Methods This is a descriptive cross sectional study involved 40 eyes. All patients had a complete ophthalmological examination, a comprehensive history taking as well as review of systems and the laboratory tests. This is followed by pupillary dilatation and retinal imaging by fundus fluorescein angiography and optical coherence tomography. Results On ophthalmological examination, 35 eyes had retinal affection due to Behçet disease and 5 eyes are retina-free. The most common retinal affection was vasculitis in 29 eyes, followed by optic nerve affection in 10 eyes then less common was retinitis in 6 eyes. Regarding visual acuity (VA) 14 eyes had low visual acuity of less than (6/60), 21 eyes had VA between (6/60 – 6/12) and 5 eyes had good visual acuity of more than (6/12). Fluorescein angiograms showed that, 36 eyes representing 90% of the total eyes had abnormal angiogram; vascular leakage was the commonest abnormality in 29 eyes, less common was optic disc edema in 12 eyes, then retinitis in 6 eyes. Macular edema was present in the angiogram of 6 eyes. About OCT, there were abnormalities in 33 eyes; macular edema was the most common in 21 eyes, epiretinal membrane (ERM) in 9 eyes, then neurosensory detachment (NSD) and macular hole each was seen in 4 eyes. Conclusion This study demonstrated that posterior pole involvement, retinal vascular leakage, optic disc hyperfluorescence, and macular leakage are significantly associated with worse VA in Behçet retinal vasculitis. This suggests that, use of Fundus Fluorescein Angiography and Optical Coherence Tomography in evaluation of Behçet retinal vasculitis is clinically significant in predicting visual prognosis and determining of treatment efficacy.

Anti-myelin oligodendrocyte glycoprotein antibodies in an Egyptian boy with recurrent paraplegia

Abstract We report a case of NMOSD anti-MOG demyelinating disorder in a 5-year-old male. Case presentation A previously healthy 5-year-old male presented due to secondary inability to walk and incontinence. Initial neuroimaging identified demyelinating lesions of both corona radiata and centrum semiovale with intramedullary abnormal signal intensity opposite C5 and a long segment at upper dorsal spinal cord extending from D2 to D4. The patient received oral steroid with complete resolution of his symptoms. 2 years later, the patient presented with quadriparesis and incontinence. MRI brain and cervical spine revealed multiple cerebral demyelinating lesions and intramedullary high signal intensity opposite most of cervical spinal cord. After a course of oral steroid, the patient showed complete resolution of his symptoms except for mild right-hand weakness. CBC, ESR, ANA were normal. Aquaporin- 4 was negative. VEP showed mild bilateral optic nerve affection. CSF revealed no cells with no abnormal oligoclonal bands, but high IgG index was detected. As a result, IV methyl-prednisolone was initiated. Four months later, the patient presented with sudden diminution of vision. MRI brain showed bilateral symmetrical occipital T2 hyperintense signal. Anti-MOG antibody evaluation was positive. The patient received IV methyl-prednisolone and was commenced on mycophenolate mofetil. He showed complete clinical remission with no relapses. Conclusions This case outlines the management of anti-MOG demyelinating disorder. Understanding the presentation of this clinical entity may allow for earlier intervention and diagnosis with concomitant reduction of morbidity.

Anatomical and Functional Retinal Complications of Combined Sofosbuvir and Ribavirin Therapy in Patients With Chronic Hepatitis C Virus.

To evaluate the anatomical and functional retinal complications of combined sofosbuvir and ribavirin therapy in patients with chronic hepatitis C virus (HCV). Three hundred patients with chronic HCV were recruited for this prospective, observational study from the National Liver Institute of Menoufia University from November 2015 to September 2017. Ophthalmic examination and follow-up were performed in the outpatient clinic of the Ophthalmology Department at Menoufia University. All patients received the same regimen (sofosbuvir and ribavirin) for 6 months. Patients were followed up during the period of treatment (6 months) and for 6 months after treatment completion. Complete ophthalmic examination, fundus fluorescein angiography (FFA) (to detect retinal ischemia), optical coherence tomography (OCT) (to detect retinal nerve fiber layer [RNFL] thickness and central macular thickening), and electroretinogram (ERG) (to detect rod and cone functions) tests were performed before and after treatment completion. The mean age of the patients was 46.17 years ± 11.38 years (range: 20 years to 60 years). The study included 138 men (46%) and 162 women (54%). During follow-up, there were no signs of retinopathy or optic nerve affection. There were also no signs of retinal ischemia (by FFA), RNFL affection, macular edema (by OCT), or rod or cone affection (by ERG). Combined treatment (sofosbuvir and ribavirin) may be safe without causing anatomical or functional retinal complications. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:39-42.].

The role of optical coherence tomography in therapeutics and conditions, which primarily have systemic manifestations: a narrative review.

Optical coherence tomography is designed to evaluate in vivo qualitative and quantitative changes of the anterior segment, optic nerve and the retina. Initial applications of this technology were confined mainly to ophthalmic diseases. However recently, numerous studies have evaluated its use in systemic conditions and in therapeutics where, optic nerve and retinal architecture can be assessed to monitor progression of systemic conditions and its response to treatment. This is a narrative review aimed at evaluating the debate surrounding the role of spectral domain optical coherence tomography, in systemic conditions where optic nerve affection can be measured and be used in the diagnosis, monitoring and assessment of treatment effect as a non-invasive, quick, novel technique.

Intracranial hypertension, nephritis and serositis complicating unexpected pregnancy in a lupus patient

Background: Systemic lupus erythematosus (SLE) flare in pregnancy is challenging. The simultaneous occurrence of intracranial hypertension (IH) is unusual and raises the possibility of being a presentation of neuropsychiatric SLE. Aim of the work: We here discuss the presentation and management of a complicated case of lupus associated with IH, lupus nephritis (LN) and serositis in unplanned pregnancy. Case presentation: A 26-year old SLE patient presented 10 weeks pregnant with marked pleural effusion, hypertension, grade V papilledema, impaired renal functions, proteinuria (2.2 g/24 h), high anti-double stranded deoxyribonucleic acid and consumed complement (C3). Renal biopsy revealed LN (class IV and V). MRI brain demonstrated features consistent with IH and perimetry revealed early optic nerve affection. Ultrasound-guided pleurocentesis and relieving lumbar puncture were performed. Pulse methylprednisolone and cyclosporine A (CsA) (2 mg/kg/day) were provided. Acetazolamide was added to manage the IH and meticulous control of BP was achieved. In 2 weeks renal functions, proteinuria and papilloedema improved. The patient gave birth via vaginal delivery at full term to a normal healthy boy. On follow-up after delivery, proteinuria ranged from 100 to 300 mg/24 h with normal renal functions and fundus. The patient was maintained on CsA, hydroxychloroquine and tapering doses of steroids with no relapses. Conclusion: Pregnant SLE cases presenting with IH, LN and serositis are challenging concerning the management of SLE activity. IH may be a sign of lupus activity and its resolution coincides with the control of the flare. Lower dose CsA is potentially effective in treating LN in pregnancy with no reported side effects.

ELECTRORETINOGRAPHIC AND VISUAL-EVOKED POTENTIAL CHANGES IN RELATION TO CHELATION MODALITY IN CHILDREN WITH THALASSEMIA.

To evaluate possible benefits of using electrophysiological investigations for detecting retinal and visual pathway changes and correlating them with chelation modality in children with thalassemia. This study included 60 patients on single oral iron chelator (deferasirox) (Group 1), 60 on deferoxamine chelator (Group 2), and 60 controls (Group 3). Participants underwent full ophthalmologic examination, pattern visual-evoked potential, pattern electroretinogram, and multifocal electroretinogram. Fundus showed no abnormalities. Multifocal electroretinogram mean P1 amplitude showed statistically significant differences in all 5 rings, amplitudes being significantly lower in Groups 1 and 2 than Group 3; moreover, significantly lower in Group 2 than Group 1. There was a statistically significant difference between groups regarding P50 wave latency and N35-P50 of pattern electroretinogram amplitude (P < 0.001 and P < 0.001, respectively). However, there were no statistically significant differences between groups regarding N95 wave of pattern electroretinogram and pattern visual-evoked potential waves' amplitude and latency. Multiple regression analyses illustrated that chelator was the most important determinant for multifocal electroretinogram and P50 parameters. Preclinical electrophysiologic changes existed in thalassemics, more obvious in those on deferoxamine. Electrophysiologic studies analysis denotes an early toxic macular insult rather than optic nerve affection. Thus, regular follow-up using multifocal electroretinogram and pattern electroretinogram is recommended.

Токсичне ураження зорових нервів внаслідок тривалого прийому левоміцетину на тлі наркотичної залежності від кодтерпіну

Токсичне ураження зорових нервів внаслідок тривалого прийому левоміцетину на тлі наркотичної залежності від кодтерпіну