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PubMed2004

The first rapid onset optic neuritis after measles-rubella vaccination: case report.

During the largest mass campaign for measles-rubella (MR) vaccination 33,000,000 people with an age range of 5-25 years were vaccinated in Iran. Some complications were encountered, including a rare case of optic neuritis. In the past 30 years of medical literature, five cases of optic neuritis have been reported but all of them were developed at least 8 days after vaccination. We are supposed to report the first case of rapid onset optic neuritis in which the complication came out just in few hours in a 16 years old boy.

Adolescent↗
PubMed1999

Cyclophosphamide pulse therapy in optic neuritis due to systemic lupus erythematosus: an open trial.

OBJECTIVE: To evaluate the efficacy of intravenous cyclophosphamide pulse therapy in patients with optic neuritis associated with systemic lupus erythematosus (SLE). PATIENTS AND METHODS: Ten consecutive patients with optic neuritis due to SLE whose condition was refractory to corticosteroids and oral immunosuppressants were treated with intravenous cyclophosphamide (0.5 to 1.0 g/m2) monthly for 6 months. RESULTS: All patients had bilateral eye involvement. One eye was legally blind, and 13 eyes could see only hand movements or count fingers. Six patients had evidence of the secondary antiphospholipid antibody syndrome. Complete recovery in visual acuity occurred in 10 eyes (50%), and a partial response occurred in six eyes (30%); four eyes (20%) had no response. Complete response in the field tests occurred in eight eyes (40%), with a partial response in nine eyes (45%); no improvement occurred in three eyes (15%). CONCLUSIONS: Intravenous cyclophosphamide pulse therapy seems to be an effective treatment for optic neuritis refractory to corticosteroids, oral immunosuppressants, or both. A randomized controlled trial will be necessary to confirm our results.

Adolescent↗
PubMed2001

Interferon beta-1a for optic neuritis patients at high risk for multiple sclerosis.

PURPOSE: To evaluate the effect of treatment with interferon beta-1a (Avonex) initiated at the time of a first episode of optic neuritis in patients at high risk for multiple sclerosis (MS). DESIGN: Randomized clinical trial. METHODS: Prospective. SETTING: Fifty clinical centers throughout the US and Canada. STUDY POPULATION: After the onset of a first episode of optic neuritis treated with intravenous and oral corticosteroids, 192 patients with brain magnetic resonance imaging (MRI) evidence of subclinical demyelination were randomly assigned to receive weekly intramuscular injections of 30 microg interferon beta-1a or placebo. MAIN OUTCOME MEASURE: The study outcomes were the development of clinically definite MS within 3 years of follow-up and brain MRI changes at 6, 12, and 18 months. RESULTS: The rates of clinically definite MS and of a combined MS/MRI outcome were lower in the interferon beta-1a group than in the placebo group (adjusted rate ratios 0.58, 95% confidence interval 0.34 to 1.00; and 0.50, 95% confidence interval 0.34 to 0.73, respectively). Compared with the placebo group, on the 18-month brain MRI the interferon beta-1a group had a smaller change from baseline in T2 lesion volume (P =.02), fewer new or enlarging T2 lesions (P <.001), and a lower frequency of Gd-enhancing lesions (P <.001). CONCLUSION: The clinical and brain MRI results of this trial support initiating interferon beta-1a treatment at the time of a first episode of optic neuritis occurring in patients at high risk for MS based on the presence of subclinical brain MRI lesions.

Adolescent↗
PubMed1996

Unilateral optic neuritis caused by Histoplasma capsulatum in a patient with the acquired immunodeficiency syndrome.

PURPOSE: To evaluate the potential of Histoplasma capsulatum to cause optic neuritis in the setting of the acquired immunodeficiency syndrome (AIDS). METHODS: We examined a 35-year-old man with a history of AIDS and disseminated histoplasmosis who developed a unilateral progressive optic neuritis of enigmatic origin. An optic nerve sheath biopsy was performed to provide a tissue diagnosis. RESULTS: Histoplasma capsulatum was identified in both the optic nerve sheath and fungal culture. CONCLUSION: Histoplasma capsulatum should be considered in the differential diagnosis of optic neuritis in patients with AIDS, even in the absence of chorioretinal findings.

AIDS-Related Opportunistic Infections↗
PubMed1981

Relative afferent pupillary defects in optic neuritis.

We measured relative afferent pupillary defects in 105 patients with various stages of optic neuritis. We detected pupillary defects in 96% of acute unilateral cases, 92% of recovered unilateral cases 91.7% of acute cases with evidence of optic neuropathy in the other eye, and 65.8% of recovered bilateral cases. With careful testing, one can find relative afferent pupillary defects in nearly all patients with unilateral optic neuritis and in most patients with bilateral disease. A patient without a pupillary defect after apparent unilateral optic neuritis frequently has evidence of disease in the other eye when visual-evoked potentials are tested.

Evoked Potentials, Visual↗
PubMed1999

Recovery of visual field function in the optic neuritis treatment trial.

PURPOSE: To assess the pattern of recovery of the visual field of patients with optic neuritis and to determine whether all affected portions of the visual field recover similarly or certain portions of the visual field have greater recovery. METHODS: We reviewed the Humphrey Visual Field (Allergan-Humphrey Inc, San Leandro, California) data from the initial and 6-month examination for the involved and fellow eyes of patients enrolled in the Optic Neuritis Treatment Trial (ONTT). The average threshold for each patient was calculated for the entire tested field and for locations within concentric rings having a radius 3, 9, 15, 21, and 27 degrees from fixation. The absolute amount of improvement and percentage improvement in average threshold between entry and the 6-month follow-up examination were determined for each patient. These measurements were compared within the concentric rings to assess patterns of recovery. RESULTS: Patients with localized defects recovered 86%+/-20% of their initial defect in average threshold, whereas those having diffuse defects recovered an average of 85%+/-23%. The area about fixation had the greatest relative recovery of threshold (87%+/-21% at 3 degrees); the relative recovery decreased with increasing eccentricity from fixation (P<.01). CONCLUSIONS: Patients with optic neuritis have a marked return of visual field function that does not appear to differ between patients with diffuse or localized field defects. The reduced redundancy of axons in the periphery of the field compared with near fixation may be responsible for the greater relative recovery of threshold near fixation.

Fixation, Ocular↗
PubMed1999

Global visual field involvement in acute unilateral optic neuritis.

PURPOSE: To quantify automated visual field defects seen at entry in the Optic Neuritis Treatment Trial (ONTT) to determine whether particular areas of the field are preferentially affected and to determine the extent of visual field involvement in patients having "localized" field defects. METHODS: Review of Humphrey 30-2 Visual Field (Allergan-Humphrey, Inc, San Leandro, CA) data from the involved and fellow eyes of 440 patients who were enrolled in the ONTT. Field defects were evaluated by comparing the involved eye to the fellow eye. RESULTS: Patients with diffuse visual field defects had a relatively equal diminution of visual threshold throughout the tested 30-2 field. Patients with localized central and cecocentral scotomas had their greatest depression of threshold centrally; however, even those patients with mild defects (mean defect, <6 dB) had diminution of visual threshold throughout the entire tested 30-degree field. Patients with moderate (mean defect, 6 to 20 dB) and severe (mean defect, >20 dB) central and cecocentral defects had even greater peripheral depression. Patients with altitudinal or quadrant defects had involvement of the "unaffected" field that also varied with the mean defect. The overall average depression of visual threshold for all patients averaged 36%+/-4% and was relatively uniform throughout the tested field. CONCLUSIONS: Optic neuritis affects the entire central 30-2 field, even in patients who appear to have localized depression of visual threshold. Optic neuritis does not appear to have a predilection for any particular area of the visual field.

Acute Disease↗
PubMed2003

Changes in phosphorylation of ERK and Fos expression in dorsal horn neurons following noxious stimulation in a rat model of neuritis of the nerve root.

Mechanical compression and chemical inflammation of the spinal nerve root are considered major sensory pathologies secondary to a lumbar disc herniation. In order to elucidate the dorsal horn responsiveness to noxious stimulation to the peripheral tissue in the neuritis model of the nerve root, we examined extracellular signal-regulated kinase (ERK) phosphorylation and Fos expression in spinal cord dorsal horn neurons. Male Sprague-Dawley rats received hemilaminectomies and the implantation of disc tissue that was obtained from coccygeal intervertebral discs. Three or 7 days after surgery, rats were perfused after receiving noxious mechanical stimulation of the plantar surface of the hind paw using a hemoclip, and the L4/5 spinal cord was processed for immunohistochemistry with antibodies for phospho-ERK and Fos. The number of Fos-immunoreactive (Fos-LI) neurons and phospho-ERK-immunoreactive (phospho-ERK-LI) neurons in the neuritis group after the noxious stimulation significantly increased compared to the sham-treated group at 3 and 7 days after surgery. The change in number of phospho-ERK-LI and Fos-LI neurons occurred mainly in the superficial dorsal horn. The number of Fos-LI neurons observed when the MEK inhibitor, U0126, was administered was significantly suppressed compared to the DMSO- (vehicle control) administered group. The increase in ERK phosphorylation and Fos expression in the spinal cord dorsal horn neurons indicates that responses/activation by the noxious stimulation applied to the periphery were elevated in spinal cord neurons in this neuritis model of the lumbar nerve root. Moreover, the increase in the Fos expression in the spinal cord dorsal horn may have been the result of the activation of the MAP kinase cascade.

Animals↗
PubMed1998

Increased calpain expression in experimental demyelinating optic neuritis: an immunocytochemical study.

Since calcium activated neutral proteinase (calpain) is present in the central nervous system (CNS) and degrades myelin proteins, this endopeptidase has been suggested to play a role in myelin destruction in demyelinating diseases such as multiple sclerosis (MS). In the present study, calpain immunocytochemical expression was examined in Lewis rats with acute experimental allergic encephalomyelitis (EAE), an animal model for MS and optic neuritis. To identify cells expressing calpain, we labeled rat optic nerve sections for calpain with a polyclonal myelin calpain antibody and with monoclonal antibodies for glial (GFAP, OX42) and inflammatory (CD2, ED2, ED1, IFN-gamma) cell-specific markers. The results showed increased calpain expression in microglia (OX42) and infiltrating macrophages (ED1,2) in EAE compared to normal controls. Astrocytes constitutively expressed calpain in controls and acute EAE. Reactive astrocytes in EAE located in or near inflammatory foci, exhibited markedly increased calpain expression. Most T cells in acute EAE showed low level calpain expression while activated IFN-gamma-producing lymphocytes in inflammatory foci exhibited elevated levels of calpain expression. Thus, our results demonstrate increased calpain expression (at transcriptional and/or translational levels) in a rat model of optic neuritis. A role for calpain in myelin destruction during optic neuritis may be relevant to the pathogenesis of this disorder.

Animals↗
PubMed2002

Management of acute optic neuritis.

Optic neuritis is a common condition that causes reversible loss of vision. It can be clinically isolated or can arise as one of the manifestations of multiple sclerosis. Occasional cases are due to other causes, and in these instances management can differ radically. The treatment of optic neuritis has been investigated in several trials, the results of which have shown that corticosteroids speed up the recovery of vision without affecting the final visual outcome. Other aspects of management, however, are controversial, and there is uncertainty about when to investigate and when to treat the condition. Here we review the diagnostic features of optic neuritis, its differential diagnosis, and give practical guidance about management of patients. The condition's association with multiple sclerosis will be considered in the light of studies that define the risk for development of multiple sclerosis and with respect to results of trials of disease-modifying drugs in these individuals.

Adrenal Cortex Hormones↗
PubMed2003

Optic neuritis: correlation of pain and magnetic resonance imaging.

PURPOSE: To demonstrate whether the magnetic resonance imaging (MRI) localization of the abnormal enhancement of the optic nerve can be related to the pain or pattern of visual field loss associated with acute optic neuritis. DESIGN: Retrospective observational series and MRI review from a referral neuro-ophthalmology service. PARTICIPANTS: Seventy-three women and 23 men with acute optic neuritis who had high resolution gadolinium-enhanced fat-suppressed MRI within twenty days of the onset of visual loss. METHODS: The presence of eye or other fifth cranial nerve (V(1)) pain, and pain with eye movement ipsilateral to the affected optic nerve or no eye pain was recorded. The neuroradiologist reviewed the MRI, masked to the affected eye, and recorded the length and segment (orbital, canalicular, intracranial, or combination of segments) of abnormal optic nerve enhancement. The presenting visual field defects were characterized as diffuse, central, arcuate, nasal or temporal. MAIN OUTCOME MEASURES: The types of pain and patterns of field loss were correlated with the segments of optic nerve enhancement in the affected eye. RESULTS: Five patients had nerves that did not enhance and were excluded from the outcome analysis. In the 91 patients with abnormal enhancement, 70 experienced eye/V(1) pain, 67 had pain with eye movement and 17 patients had no pain. Enhancement of the orbital optic nerve occurred in 66 patients, 93.9% who had eye/V(1) pain and 92.4% who had pain with eye movement. In the 25 patients with enhancement of the canalicular, intracranial or both segments, without orbital involvement, 32% had eye/V(1) pain and 24% had pain with eye movement. No pain occurred in 3% with enhancement of the orbital segment and in 60% with enhancement of the other optic nerve segments. The length of enhancement moderately correlated with eye/V(1) pain (r = 0.49, P = 0.01) and pain with eye movement (r = 0.37, P = 0.01). Patients with enhancement longer than 10 mm had pain five times (P = 0.004) more frequent than did those with enhancement <or=10 mm. There was no significant specific pattern of field loss associated with a particular location of enhancement, except temporal field loss occurred in 25% of intracranial lesions (P = 0.04). CONCLUSION: When optic neuritis involved the orbital segment of the optic nerve, eye or other V(1) distribution pain (94.3% vs. 32%) and pain with eye movement (91.4% vs. 24%) were significantly more frequent. In contrast, pain was absent 20 times more often when the orbital segment was not involved (60% vs. 3%). Except for temporal field loss in eyes with intracranial nerve lesions, no pattern of visual field loss appeared to correlate with the location or length of abnormal optic nerve enhancement.

Acute Disease↗
PubMed1987

Deficits in visual function after resolution of optic neuritis.

A study was done to systematically characterize visual function in eyes with recovered optic neuritis. Thirty-five eyes from 27 patients, all of whom had recovered at least 20/30 Snellen acuity after resolution of the neuritis, were included. Minimum recovery period was 6 months. Abnormalities were found in color vision (57%), contrast sensitivity (72%), perimetry (26%), stereoacuity (80%), light brightness (89%), pupillary reaction (89%), and optic disc appearance (77%). Eighty-five percent of patients complained of at least some subjective disturbance in vision. Subjective visual complaints correlated better with deficits in contrast sensitivity than they did with the other measures. The results of the study indicate that deficits in visual function are common after resolution of optic neuritis.

Adolescent↗
PubMed1989

Optic neuritis with secondary retinal venous stasis.

The authors report five cases of optic neuritis accompanied by secondary impairment of retinal venous outflow producing the clinical appearance of impending or actual central retinal vein occlusion. In four of five cases, intravenous fluorescein angiography showed delayed venous filling with venous dilation and tortuosity. Decreased visual function was entirely attributable to optic nerve involvement because the clinical and angiographic examinations revealed no evidence of capillary nonperfusion, macular edema, or macular hemorrhage. The visual outcome of the patients paralleled that expected with optic neuritis. The authors believe that optic nerve inflammation associated with secondary impairment of retinal venous outflow is a distinct but uncommon entity. Because of its ophthalmoscopic appearance, this variety of optic neuritis may be confused with either papillophlebitis or central retinal venous occlusion in young patients.

Adolescent↗
PubMed1990

Toxoplasma gondii retinochoroiditis and optic neuritis in acquired immune deficiency syndrome. Report of a case.

A 29-year-old man with acquired immune deficiency syndrome (AIDS) was found to have a retinochoroiditis and optic neuritis of his left eye. Results of fundus examination showed inflammatory and hemorrhagic retinal lesions consistent with retinitis due to cytomegalovirus infection. A computed tomographic (CT) scan demonstrated enlargement of the optic nerve. The eye was enucleated and results of histopathologic examination showed retinal necrosis with underlying choroiditis and an optic neuritis. Numerous encysted Toxoplasma gondii organisms were present in the retina and tachyzoites were present in the optic nerve. To the authors' knowledge this is the second histologically documented case of Toxoplasma optic neuritis in a patient with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Prognostic value of magnetic resonance imaging in monosymptomatic optic neuritis.

PURPOSE: Magnetic resonance imaging is able to depict lesions in the optic nerve in the acute stage of monosymptomatic optic neuritis. Most patients have lesions located intraorbitally, intracanalicularly, and/or intracranially. The goal of this study is to determine whether these lesions resolve after visual recovery, change in length or localization, or could be correlated to the visual function. METHODS: Between 1987 and 1992, the authors examined 22 patients with acute optic neuritis using magnetic resonance imaging short-time inversion recovery sequences. Additionally, the authors determined visual acuity, visual field, color vision, contrast sensitivity, and visual-evoked responses. All patients were re-examined between 1993 and 1994 in the same manner. Visual recovery in the re-examination was divided into three groups: group 1 with complete visual recovery (visual acuity better than 20/25); group 2 with incomplete recovery (visual acuity better than 20/25 but defect in at least one of the other tests: visual field, color vision, and contrast sensitivity); and group 3 with partial recovery (visual acuity remained less than 20/25, defect in all the other tests). RESULTS: All group 1 patients initially had lesions less than 17.5 mm, group 2 patients had lesions greater than 17.5 mm (44%) and/or lesions located intracanalicularly (66%), and most of group 3 patients initially had lesions greater than 17.5 mm (79%). CONCLUSION: Eyes with lesions less than 17.5 mm in the optic nerve in acute optic neuritis have a good prognosis for visual recovery. Lesions greater than 17.5 mm or lesions involving the intracanalicular portion of the optic nerve lead to incomplete or partial visual recovery.

Acute Disease↗
PubMed1998

Varicella zoster virus retrobulbar optic neuritis preceding retinitis in patients with acquired immune deficiency syndrome.

OBJECTIVE: This study aimed to describe a recently recognized and rare presentation of varicella zoster virus (VZV) retrobulbar optic neuritis preceding retinitis in patients with acquired immune deficiency syndrome and to identify factors that may relate to improved visual outcome. METHODS: Diagnosis, treatment, and clinical course are described for three eyes of two patients with this viral infection. RESULTS: Patients had decreased vision, headache, and recent zoster dermatitis. Varicella zoster virus retrobulbar optic neuritis was diagnosed on the bases of clinical, laboratory, and electrophysiologic examination results. Profound vision loss and peripheral retinitis ensued despite intravenous antiviral treatment. Combination intravenous and intravitreous antiviral injections were administered with dramatic visual recovery. CONCLUSIONS: Varicella zoster virus retrobulbar optic neuritis should be considered in immunocompromised patients with visual loss. Early diagnosis and aggressive combination therapy via systemic and intravitreous routes may enable return of useful vision.

AIDS-Related Opportunistic Infections↗
PubMed1999

The impact of the optic neuritis treatment trial on the practices of ophthalmologists and neurologists.

OBJECTIVE: To determine whether the Optic Neuritis Treatment Trial (ONTT) results have altered the practice patterns of ophthalmologists and neurologists. DESIGN: Mail survey. PARTICIPANTS: A random sample of 987 ophthalmologists and 900 neurologists practicing in the United States were mailed a questionnaire that inquired into decision-making with regard to management of optic neuritis before and after the publication of the ONTT results. MAIN OUTCOME MEASURES: Responses received from 202 ophthalmologists and 244 neurologists, a response rate of 47%. RESULTS: Following the ONTT reports, nearly all ophthalmologists and neurologists have reduced their use of oral prednisone alone, substituting a regimen that includes intravenous methylprednisolone. A large proportion of practitioners in both specialties mistakenly believe that intravenous methylprednisolone treatment improves final visual outcome. Only 7% of neurologists and 36% of ophthalmologists (P = 0.0001) are adhering to the ONTT suggestion to use magnetic resonance imaging as a basis for initiating treatment. CONCLUSIONS: The ONTT has led to a dramatic reduction in the use of oral prednisone without a preceding course of intravenous methylprednisolone in the treatment of acute optic neuritis. Ophthalmologists and neurologists have changed some of their practices without fully understanding the results of the ONTT.

Administration, Oral↗
PubMed1998

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 neuritis is a common significant role in the pathophysiology and progression of neurological disease in CREAE which may be relevant to studies of optic neuritis in multiple sclerosis.

Animals↗