Unilateral Optic Neuritis Research Articles

Retinal thickness measured with optical coherence tomography and risk of disability worsening in multiple sclerosis: a cohort study

Most patients with multiple sclerosis without previous optic neuritis have thinner retinal layers than healthy controls. We assessed the role of peripapillary retinal nerve fibre layer (pRNFL) thickness and macular volume in eyes with no history of optic neuritis as a biomarker of disability worsening in a cohort of patients with multiple sclerosis who had at least one eye without optic neuritis available. In this multicentre, cohort study, we collected data about patients (age ≥16 years old) with clinically isolated syndrome, relapsing-remitting multiple sclerosis, and progressive multiple sclerosis. Patients were recruited from centres in Spain, Italy, France, Germany, Czech Republic, Netherlands, Canada, and the USA, with the first cohort starting in 2008 and the latest cohort starting in 2013. We assessed disability worsening using the Expanded Disability Status Scale (EDSS). The pRNFL thickness and macular volume were assessed once at study entry (baseline) by optical coherence tomography (OCT) and was calculated as the mean value of both eyes without optic neuritis for patients without a history of optic neuritis or the value of the non-optic neuritis eye for patients with previous unilateral optic neuritis. Researchers who did the OCT at baseline were masked to EDSS results and the researchers assessing disability with EDSS were masked to OCT results. We estimated the association of pRNFL thickness or macular volume at baseline in eyes without optic neuritis with the risk of subsequent disability worsening by use of proportional hazards models that included OCT metrics and age, disease duration, disability, presence of previous unilateral optic neuritis, and use of disease-modifying therapies as covariates. 879 patients with clinically isolated syndrome (n=74), relapsing-remitting multiple sclerosis (n=664), or progressive multiple sclerosis (n=141) were included in the primary analyses. Disability worsening occurred in 252 (29%) of 879 patients with multiple sclerosis after a median follow-up of 2·0 years (range 0·5-5 years). Patients with a pRNFL of less than or equal to 87 μm or less than or equal to 88 μm (measured with Spectralis or Cirrus OCT devices) had double the risk of disability worsening at any time after the first and up to the third years of follow-up (hazard ratio 2·06, 95% CI 1·36-3·11; p=0·001), and the risk was increased by nearly four times after the third and up to the fifth years of follow-up (3·81, 1·63-8·91; p=0·002). We did not identify meaningful associations for macular volume. Our results provide evidence of the usefulness of monitoring pRNFL thickness by OCT for prediction of the risk of disability worsening with time in patients with multiple sclerosis. Instituto de Salud Carlos III.

Bilateral optic neuritis as the presenting symptom of multiple sclerosis

Background: Optic neuritis (ON) is one of the earliest manifestations of multiple sclerosis (MS). The prevalence of bilateral ON (BON) as the presenting symptom is not clear. The aim of this study was to evaluate the prevalence of BON as the presenting symptom in MS and compare it with unilateral ON (UON). Subjects and Methods: In this study, two groups of definite MS patients according to the McDonald's criteria were enrolled: Thirty patients with BON and fifty persons with UON (selected randomly from all of the UON patients) as the presenting manifestation. The patients' data were collected from the Isfahan MS Society Registry. The SPSS 22 software was used for analysis of the data. P Results: Thirty of 3972 MS patients presented with BON. The mean of their ages was 26.00 ± 6.29 in BON and 30.10 ± 8.25 in UON group ( P = 0.015). Twenty-five of BON patients were females, and five were males and in the UON group, 42 were females, and eight were males. Expanded disability status scale was 1.83 ± 1.17 in BON and 1.84 ± 1.25 in UON group ( P = 0.975). The severities of relative afferent pupillary defect (RAPD) (in pluses) were 2.00 ± 0.52 and 1.43 ± 0.72 in two groups, respectively. Conclusions: The prevalence of BON as the presenting symptom was about 0.7%. The patients who presented with BON were younger at the time of diagnosis when they were compared with those who diagnosed with UON and also had a more severe RAPD. BON could be considered as one of the important presenting manifestations of MS.

Assessment of Retinal Nerve Fiber Layer Thickness in Fellow Eye in Patients with Unilateral Optic Neuritis

Background: One of the main progressive consequences of optic neuritis is inflammatory axonal loss manifested by Retinal Nerve Fiber layer (RNFL) thinning on Optical Coherence Tomography. We assessed RNFL thickness in the fellow eye in patients with unilateral optic neuritis. Methods: Twenty nine patients with unilateral optic neuritis after three months of attack, were enrolled in the study and the RNFL thickness were measured by Optical Coherence Tomography in the quadrants of superior, nasal, inferior, and temporal at both involved and fellow eyes. Results: The mean RNFL thickness was significantly lower in the involved than in fellow eye in all quadrants except for temporal. Significant differences were only in women. Compared to fellow eyes, lower mean RNFL thickness in superior, inferior, and nasal quadrants in involved eyes was found mostly in the ages below 40. RNFL was less thickened in involved than in fellow eyes only in those patients with final diagnosis of isolated optic neuritis not in those with multiple sclerosis. Mean RNFL thickness was significantly lower in involved eyes in all quadrants (except for temporal) only in those who underwent Optical Coherence Tomography 13 to 24 months after optic neuritis. Conclusion: RNFL thinning occurs in involved eye compared to fellow eye in patients with unilateral optic neuritis. It is observed in women more than men and in those patients younger than 40. The abnormal change in RNFL thickness was also found in those patients underwent Optical Coherence Tomography 13 to 24 months after optic neuritis. The difference in mean RNFL thickness may be specified to inferior quadrant in MS patients.

Unilateral Optic Neuritis: A Rare Complication after Measles-Mumps-Rubella Vaccination in a 30-Year-Old Woman.

Purpose. To report a case of unilateral optic neuritis following Measles-Mumps-Rubella (MMR) vaccination. Methods. A 30-year-old female developed unilateral optic neuritis five days after a Measles-Mumps-Rubella (MMR) booster vaccination. The patient displayed unilateral involvement, with severe visual loss. However, visual acuity improved significantly after four days of intravenous steroid therapy with 500 mg/day of methylprednisolone. Conclusions. Optic neuritis is one of the rare complications associated with the mumps, measles, and rubella vaccine. It may be a toxic reaction to the nonviral component of the vaccine, but the exact etiology is unknown. Postvaccination neuritis is generally bilateral and usually affects children. In adults, unilateral optic neuritis is usually correlated with multiple sclerosis (MS).

Effectiveness of Time Domain and Spectral Domain Optical Coherence Tomograph to Evaluate Eyes with And Without Optic Neuritis in Multiple Sclerosi Patients

Abstract Purpose: To compare the macular assessment and retinal nerve fiber layer (RNFL) thickness by using two different optical coherence tomographies (OCTs): a time domain (TD) and a spectral domain (SD) OCT, in multiple sclerosis (MS) patients with and without unilateral optic neuritis (ON). Methods: We enrolled 34 patients (13 males and 21 females): 18 without previous episodes of ON and16 with a previous monolateral episode of ON occurred at least 3 months prior to examination. Patients underwent ophthalmological examination, TD OCT and SD OCT scans. We compared the outcomes of eyes with and without ON by using Student’s t test. Results: In the affected eye group a reduction of the average RNFL was found using TD OCT (reduction of 22.8%) with the difference between the two groups being statistically significant (p<0.05) in almost all the investigated retina areas. Similar results were found when eyes were analysed with SD OCT, also when the ganglion cell layer (GCC) was considered: a reduction of 18.1% of GCC average thickness was found. No significant difference was found when the outer retina was considered. Conclusions: In MS patients both OCT systems were able to detect a difference between eyes with an outcome of optic neuritis and those without optic neuritis.

Unusual Presentation of Unilateral Isolated Probable Lyme Optic Neuritis.

Optic neuritis (ON) is one of the most common manifestations of central nervous system involvement caused by various etiologies. Lyme ON is an exceedingly rare ocular manifestation of Lyme disease (LD) and only a few cases have been published in the literature. Lyme ON is very rare but should be included in the differential diagnosis in unexplained cases, particularly in Lyme endemic areas. Careful and detailed examination and investigation are warranted to make the diagnosis. We report this case to increase awareness of clinicians to include Lyme disease in differential diagnosis of ON for unexplained cases of ON. Herein we present a unique case with a unilateral ON caused by LD along with pre- and posttreatment findings and literature review.

Anti-myelin Oligodendrocyte Glycoprotein Autoantibodies in Optic Neuritis and Venous Sinus Thrombosis in a Girl

The anti-myelin oligodendrocyte glycoprotein autoantibody (anti-MOG) is recognized as a new diagnostic and prognostic markers in paediatric acquired demyelinating diseases of the central nervous system. We report a 6 years gril who developed a venous sinus thrombosis and signs of intracranial hypertension after acute otitis media. One month after this infection the patient had an episode of unilateral optic neuritis associated with anti-MOG in serum. Our patient received intravenous steroid treatment and showed a highly favourable response. This is the first case report of demyelinating disease with anti-MOG antibodies associated with thrombophilia.

Neuromyelitis optica: Evaluation of 871 attacks and 1,153 treatment courses.

Neuromyelitis optica (NMO) attacks often are severe, are difficult to treat, and leave residual deficits. Here, we analyzed the frequency, sequence, and efficacy of therapies used for NMO attacks. A retrospective review was made of patient records to assess demographic/diagnostic data, attack characteristics, therapies, and the short-term remission status (complete remission [CR], partial remission [PR], no remission [NR]). Inclusion criteria were NMO according to Wingerchuk's 2006 criteria or aquaporin-4 antibody-positive NMO spectrum disorder (NMOSD). Remission status was analyzed with generalized estimating equations (GEEs), a patient-based statistical approach. A total of 871 attacks in 185 patients (142 NMO/43 NMOSD, 82% female) were analyzed. The 1,153 treatment courses comprised high-dose intravenous steroids (HD-S; n = 810), plasma exchange (PE; n = 192), immunoadsorption (IA; n = 38), other (n = 80), and unknown (n = 33) therapies. The first treatment course led to CR in 19.1%, PR in 64.5%, and NR in 16.4% of attacks. Second, third, fourth, and fifth treatment courses were given in 28.2%, 7.1%, 1.4%, and 0.5% of attacks, respectively. This escalation of attack therapy significantly improved outcome (p < 0.001, Bowker test). Remission rates were higher for isolated optic neuritis versus isolated myelitis (p < 0.001), and for unilateral versus bilateral optic neuritis (p = 0.020). Isolated myelitis responded better to PE/IA than to HD-S as first treatment course (p = 0.037). Predictors of CR in multivariate GEE analysis were age (odds ratio [OR] = 0.97, p = 0.011), presence of myelitis (OR = 0.38, p = 0.002), CR from previous attack (OR = 6.85, p < 0.001), and first-line PE/IA versus HD-S (OR = 4.38, p = 0.006). Particularly myelitis and bilateral optic neuritis have poor remission rates. Escalation of attack therapy improves outcome. PE/IA may increase recovery in isolated myelitis.

Lesion Activity on Brain MRI in a Chinese Population with Unilateral Optic Neuritis.

Longitudinal studies have shown that brain white matter lesions are strong predictors of the conversion of unilateral optic neuritis to multiple sclerosis (MS) in Caucasian populations. Consequently brain MRI criteria have been developed to improve the prediction of the development of clinically definite multiple sclerosis (CDMS). In Asian populations, optic neuritis may be the first sign of classical or optic-spinal MS. These signs add to the uncertainty regarding brain MRI changes with respect to the course of unilateral optic neuritis. The aim of this study was to examine the association between brain lesion activity and conversion to CDMS in Chinese patients with unilateral optic neuritis. A small prospective cohort study of 40 consecutive Chinese patients who presented with unilateral optic neuritis was conducted. Brain lesion activity was recorded as the incidence of Gd-enhanced lesions and new T2 lesions. Brain lesions on MRI that were characteristic of MS were defined according to the 2010 revisions of the McDonald criteria. The primary endpoint was the development of CDMS. We found that nineteen patients (48%) had brain lesions that were characteristic of MS on the initial scan. One of these patients (3%) had Gd-enhanced brain lesions. A significantly lower percentage of the patients (10%, p<0.001) presented with new T2 brain lesions on the second scan. During a median of 5 years of follow-up, seven patients (18%) developed CDMS. There was no significant difference in the conversion rate to CDMS between patients with and without brain lesions that were characteristic of MS (4/19 and 3/21, respectively; Fisher exact test, one-sided, p = 0.44). We conclude that brain lesions characteristic of MS are common in Chinese patients with unilateral optic neuritis; however, these patients exhibit low lesion activity. The predictive value of brain lesion activity for CDMS requires investigation in additional patients.

The Diagnosis and Treatment of Optic Neuritis

Typical optic neuritis is often the presenting manifestation of multiple sclerosis (MS). Its incidence in central Europe is 5 cases per 100 000 persons per year. This review is based on articles retrieved by a selective search of the PubMed database, on the pertinent guidelines, and on the authors' clinical experience. The diagnosis of optic neuritis is based on a constellation of symptoms and signs. The onset is usually with pain on eye movement in one eye and subacute visual loss. In unilateral optic neuritis, the direct pupillary light reflex is weaker in the affected eye. One-third of patients with optic neuritis have a mildly edematous optic disc. The visual disturbance resolves in 95% of cases. A less favorable course may be evidence of neuromyelitis optica, and macular involvement may be evidence of neuroretinitis. High-dosed intravenous methylprednisolone therapy speeds recovery but does not improve the final outcome. The risk that a patient with optic neuritis will later develop multiple sclerosis can be assessed with an MRI scan of the brain. Optic neuritis is easy to distinguish from otherv diseases affecting the optic nerve. Atypical forms of this disease and other optic nerve diseases require special treatment. For patients judged to be at high risk of developing multiple sclerosis, immune prophylaxis with beta- interferon or glatiramer acetate is recommended.

Description and clinical application of the Pulfrich effect.

In 1922, German physicist Carl Pulfrich described an illusory binocular perceptual disturbance in which an object moving across an observer's field of vision is perceived as traveling along a curved trajectory. To review the discovery of the Pulfrich effect, and subsequent clinical applications. We translated Pulfrich's description and searched for subsequent publications using electronic databases and review of reference lists in identified publications. In 1901, Pulfrich developed an optical device to accurately compare stereoscopic photographs, but brightness difference between plates caused distance misperceptions that interfered with precise measurements. Pulfrich proposed that this Stereo-Effekt resulted from interocular differences in perceptual latency. He induced the effect by placing a smoked glass in front of one eye. The resulting perceptual disparity creates an apparently curved trajectory of an object moving sideways across the field of vision. Pulfrich also recognized that visual pathway disorders can produce a pathologic Stereo-Effekt. In 1925, Grimsdale demonstrated this in a man with unilateral retrobulbar optic neuritis and suggested treatment with a neutral density filter (NDF) over the good eye. Not until the 1970s, however, was the Pulfrich effect evaluated as a diagnostic test for retrobulbar optic neuritis and the therapeutic efficacy of an NDF confirmed. Although the clinical importance of the Pulfrich effect was suggested by Pulfrich and quickly confirmed, it took decades before its diagnostic utility and the efficacy of an NDF were assessed. Recognition remains clinically important to minimize safety risks and mislabeling, and because resulting misperceptions can be easily treated.

Update on clinically isolated syndrome

Optic neuritis, myelitis and brainstem syndrome accompanied by a symptomatic MRI T2 or FLAIR hyperintensity and T1 hypointensity are highly suggestive of multiple sclerosis (MS) in young adults. They are called "clinically isolated syndrome" (CIS) and correspond to the typical first multiple sclerosis (MS) episode, especially when associated with other asymptomatic demyelinating lesions, without clinical, radiological and immunological sign of differential diagnosis. After a CIS, the delay of apparition of a relapse, which corresponds to the conversion to clinically definite MS (CDMS), varies from several months to more than 10 years (10-15% of cases, generally called benign RRMS). This delay is generally associated with the number and location of demyelinating lesions of the brain and spinal cord and the results of CSF analysis. Several studies comparing different MRI criteria for dissemination in space and dissemination in time of demyelinating lesions, two hallmarks of MS, provided enough substantial data to update diagnostic criteria for MS after a CIS. In the last revision of the McDonald's criteria in 2010, diagnostic criteria were simplified and now the diagnosis can be made by a single initial scan that proves the presence of active asymptomatic lesions (with gadolinium enhancement) and of unenhanced lesions. However, time to conversion remains highly unpredictable for a given patient and CIS can remain isolated, especially for idiopathic unilateral optic neuritis or myelitis. Univariate analyses of clinical, radiological, biological or electrophysiological characteristics of CIS patients in small series identified numerous risk factors of rapid conversion to MS. However, large series of CIS patients analyzing several characteristics of CIS patients and the influence of disease modifying therapies brought important information about the risk of CDMS or RRMS over up to 20 years of follow-up. They confirmed the importance of the initial MRI pattern of demyelinating lesions and of CSF oligoclonal bands. Available treatments of MS (immunomodulators or immunosuppressants) have also shown unequivocal efficacy to slow the conversion to RRMS after a CIS, but they could be unnecessary for patients with benign RRMS. Beyond diagnostic criteria, knowledge of established and potential risk factors of conversion to MS and of disability progression is essential for CIS patients' follow-up and initiation of disease modifying therapies.

ATON: Results from a Phase II randomized trial of the B-cell-targeting agent atacicept in patients with optic neuritis

The 36-week ATON study compared the efficacy and safety of atacicept with matching placebo in 34 patients with unilateral optic neuritis as a clinically isolated syndrome. Atacicept (150mg) was administered twice weekly for 4weeks (loading period), then once weekly for 32weeks. The ATON study was terminated prematurely by the sponsor when an independent Data and Safety Monitoring Board review observed increased multiple sclerosis (MS)-related disease activity in the atacicept arms of the concurrent ATAcicept in MS (ATAMS) study. Analysis of the prematurely terminated ATON study showed that the mean (standard deviation) change from baseline in retinal nerve fiber layer thickness at last observed value in the affected eye was −8.6 (10.1) μm in patients treated with atacicept (n=15) compared with −17.3 (15.2) μm in patients treated with placebo (n=16). In the atacicept treatment group, a higher proportion of patients converted to clinically definite MS during the double-blind period compared with placebo (35.3% [6/17] vs 17.6% [3/17]). Treatment-emergent adverse events were similar across both treatment groups in the double-blind period. A dichotomy emerged with more atacicept-treated patients converting to relapsing–remitting MS compared with placebo-treated patients, despite the same patients experiencing less axonal loss after an optic neuritis event.

Longitudinal Changes in Retinal Nerve Fibre Layer Thickness after an Isolated Unilateral Retrobulbar Optic Neuritis: 1-Year Results

The objective of this study was to investigate the longitudinal changes in retinal nerve fibre layer (RNFL) thickness 1 year after an episode of unilateral acute optic neuritis. This prospective cohort study recruited consecutive patients with a first episode of isolated, unilateral acute optic neuritis from October 2010 to June 2013. RNFL thickness of the attack and normal fellow eyes was measured by optical coherence tomography on presentation and 3, 6, and 12 months post attack in both the treatment and non-treatment groups. The treatment group consisted of subjects that opted for systemic steroids to hasten recovery time. In 20 subjects, 11 received systemic steroids and 9 were treated conservatively. The baseline RNFL thickness was similar in the attack and fellow eyes (p ≥ 0.4). Progressive RNFL thinning was seen in the attack eye over the 12-month period, with significant differences for baseline versus 3 months; baseline versus 12 months; and 3 versus 12 months (all p < 0.0001). At 12 months, the attack eye had a thinner average RNFL than the fellow eye (100.9 ± 6.1 versus 107.3 ± 5.5 µm; p = 0.002). The 12-month RNFL was similar between the treatment and non-treatment groups (p ≥ 0.6). A single episode of optic neuritis triggered an accelerated, progressive RNFL thinning up to 6 months post attack. Initial treatment with systemic steroids did not seem to alter the degree of RNFL loss at 12 months.

O espectro expandido de neuromielite óptica - evidências para uma nova definição

The article 1 commented on herein offers a brief historical review of neuromyelitis optica (NMO) and shows the changes that have occurred in the diagnostic criteria in recent decades, including the discovery of the anti-aquaporin 4 antibody (AQP-4) and the introduction of the concept of an NMO spectrum disorders (NMOSD). It is fundamental for ophthalmologists to learn regarding these changes, considering the fact that one aspect of the NMOSD is atypical optic neuritis, for which patients typically seek an ophthalmologist first. The classic concept of NMO (or Devic's disease) was that it was a variant of multiple sclerosis (MS) characterized by myelitis and concomitant bilateral optic neuritis or, in a short period, associated with serious vision loss and a lower chance of visual recovery than in the case of typical optic neuritis associated with MS. 2 However, other patients with NMO have differently presented with unilateral optic neuritis and without serious vision loss or recurring crises. 2 Therefore, a definitive diagnosis of NMO was difficult, considering the clinical variability and lack of specific laboratory examinations. The 2004 discovery of AQP-4 in patients with NMO 3 filled this laboratory gap in the diagnostic criteria and provided valuable information regarding the pathophysiology of the disease. The concept of a clinical spectrum of NMO has been introduced, with the existence of limited forms of the disease, one of which is isolated optic neuritis without myelitis. 4 In the article commented on herein 1 , the authors propose the term expanded spectrum of neuromyelitis optica to include other limited forms of NMO even in patients who test negative for AQP-4. These forms include optic neuritis (without myelitis) presenting with atypical characteristics such as vision loss worse than 20/400 and a lack of visual recovery, in addition to concomitant bilateral impairment or recurrent events. The authors suggests that the presence of typical NMO lesions in a brain MRI may be used as an alternative criterion to the antibody in patients who test negative for AQP-4. However, critical judgment is necessary before MS and other related conditions being excluded in patients with suspected NMO. The final message of the authors is to call attention about the importance of recognizing the limited forms of NMO (such as atypical optical neuritis) in order to promote early diagnosis and, therefore, an appropriate immunosuppressive treatment to reduce the risk of recurrences and permanent visual or neurological damage.

Acute optic neuritis: a clinical paradigm for evaluation of neuroprotective and restorative strategies?

What makes the acute optic neuritis model unique in an era of trials for neuroprotective and myelin repair agents? Acute optic neuritis (AON) is a common, and often the earliest manifestation of central nervous system (CNS) inflammatory demyelinating disorders like multiple sclerosis (MS) and neuromyelitis optica (NMO). It affects at least half the patients with MS and is the presenting feature in 15–20% of patients. Vision loss in AON secondary to NMO tends to be more severe with less potential for recovery and greater axonal degeneration, as measured by optical coherence tomography (OCT) (Bennett et al., 2014). Several unique features of the afferent visual pathway (AVP) make the AON model an ideal system to study disease pathogenesis and evaluate potential neuroprotective and myelin repair strategies.

Unilateral Optic Neuropathy and Acute Angle-Closure Glaucoma following Snake Envenomation.

Purpose. We aimed to describe a unique case in which a patient developed unilateral optic neuritis and angle-closure glaucoma as a result of snake envenomation. Case Report. Approximately 18 hours after envenomation, a 67-year-old female patient described visual impairment and severe pain in her left eye (LE). The patient's best corrected visual acuity was 10/10 in the RE and hand motion in the LE. Cranial magnetic resonance imaging showed signs of neuropathy in the left optic nerve. In the LE, corneal haziness, closure of the iridocorneal angle, and mild mydriasis were observed and pupillary light reflex was absent. Intraocular pressure was 25 mmHg and 57 mmHg in the RE and LE, respectively. The patient was diagnosed with acute angle-closure glaucoma in the LE. Optic neuropathy was treated with intravenous pulse methylprednisolone. Left intraocular pressure was within normal range starting on the fourth day. One month after the incident, there was no sign of optic neuropathy; relative afferent pupillary defect and optic nerve swelling disappeared. Conclusions. Patients with severe headache and visual loss after snake envenomation must be carefully examined for possible optic neuropathy and angle-closure glaucoma. Early diagnosis and treatment of these cases are necessary to prevent permanent damage to optic nerves.

Mycobacterium W administration for steroid resistant optic neuritis with long-term follow-up.

We report the long-term safety and outcomes of off-label Mycobacterium W (Mw) administration in steroid resistant optic neuritis. In a case series, six patients with documented idiopathic corticosteroid refractory unilateral optic neuritis were treated with immuvac (Mycobacterium W extract). The dose was repeated at three months. Outcomes measures included the best corrected visual acuity (BCVA), pupillary reaction, colour vision, visual field(VF) examination (when possible), fundus examination and photography, and visually evoked potential (VEP) testing. BCVA, pupillary reaction, and color vision were monitored immediately prior to steroid therapy on days 1 and 7 post-steroid therapy, pre-Mw administration (i.e., 30 days after the last dose of steroids had been completed) and post-Mw administration on days 1, 7, 30, 90, 120, and 180. VF, VEP, and fundus photography were performed immediately prior to steroid administration, 30 days after the last dose of steroids (i.e., immediately prior to Mw), and at days 30, 90,120 and, 180. The patients were assessed six-month intervals thereafter for visual acuity, colour vision, and visual fields. There were five females and three males in the age range of 30-54 years. Minimum follow-up was five years. All patients showed improvement in visual acuity, colour vision, and pupillary reaction. The patients showed stable improvement. There was no recurrence of the disease and no adverse events till the end of the follow-up period. Mw appears to be safe in the long term and to improve steroid resistant optic neuritis; future randomized clinical trials would help affirm this observation.

Комплексная (неврологическая, морфологическая, нейрофизиологическая) оценка состояния зрительного анализатора у пациентов с рассеянным склерозом

Comprehensive examination (neurophysiological, morphological) of the patients with multiple sclerosis with unilateral and bilateral optic neuritis phenomenon was carried out. The study included two non-invasive research methods: the optical coherent tomography and the induced visual potentials turned on a checkerboard pattern. The study found thinning nerve fiber layer of the retina (73,8±3.4 microns on the affected side and 93,7±7,1 micron on the contralateral side unilaterally to defeat and 70.4±of 5.6 microns in bilateral defeat) and significant increase in the latency of potential P100 (124±10,8 ms) and the decrease in amplitude inter-peak interval N75-P100 (3,1±1,7 mV) when assessing induced visual potentials. The study results indicate simultaneous presence of inflammatory-demyelinating and degenerative processes in the visual pathways, as on the affected side, and on the contralateral side, which indicates the active during the pathological process, even in the absence of clinical manifestations of the disease in the form of eye disorders. It is proposed to use these methods for the early diagnosis of multiple sclerosis, detection of subclinical of the centers of demyelination and degeneration, determine the effectiveness of therapy.

Optic neuritis following Varicella zoster vaccination: Report of two cases

Two women presented at our clinic with vision blurring following Varicella zoster virus (VZV) vaccination, 3 weeks and 1 week ago. Ophthalmologic examination and magnetic resonance imaging revealed bilateral and unilateral optic neuritis, respectively. One patient had a history of optic neuritis in the fellow eye 33 years ago without recurrence since then. Both patients completely recovered after treatment with high dose intravenous methylprednisolone followed by a tapered dose of oral prednisolone. This is the first report of optic neuritis occurring in relation to VZV vaccination.