Clinical characteristics of radiation-induced optic neuropathy:A single-center retrospective study

Purpose:To observe the clinical and imaging characteristics of radiation-induced optic neuropathy(RION).Methods:We retrospectively reviewed the clinical data of 43 patients(69 eyes)who were diagnosed with RION at the Chinese PLA General Hospital from 2010 to 2021.Results:The latency from radiotherapy to onset of visual loss ranged from 1 to 132(36.33±30.48)months.Optic disc pallor and optic disc edema were found in 27.0%(10/37)and 8.1%(3/37)of the eyes,respectively,within 2 months.After treatment,the best corrected visual acuity(BCVA)was restored in 24.6%(17/69)of the eyes and the final BCVA improved in 13.0%(9/69)of the eyes.An 82.5%(33/40)of the eyes with magnetic resonance imaging(MRI)showed enhancement of the affected optic nerve,mostly(69.7%)in the intracranial segment,and 36.4%(12/33)of the eyes with expansion and T2-high signals also showed enhancement of the affected optic nerve.The superior retinal nerve fiber layer(RNFL)and the outer circle superior quadrant(OS)of the inner limiting membrane to retinal pigment epithelium(ILM-RPE)layer thinned significantly during the first month.The center of the ILM-RPE layer thickened significantly during the first two months and the inner circle temporal quadrant(IT)of the ILM-RPE layer thickened significantly from the third to sixth month.The RNFL thinned significantly after 6 months except for the temporal quadrant,and the average inner circle superior quadrant(IS)and outer circle of the ILM-RPE layer thinned significantly after 6 months.There was no significant difference between hyperbaric oxygen therapy(HBOT)and high-dose intravenous methylprednisolone(IVMP)therapy in improving BCVA recovery or final BCVA(P>0.05).Conclusions:The structural damage of the RNFL and ILM-RPE layer occurred during the first month,the RNFL showed progressive thinning during the follow-up period,while the ILM-RPE layer showed thinning during the first month,thickening from the third to sixth month,and thinning after 6 months.There was a discrete region of enhancement of the optic nerve,often with expansion and high-T2 signals on MRI.HBOT and high-dose IVMP therapy were hardly effective for treating RION in the non-acute stage.

Efficacy and safety of monoclonal antibodies in neuromyelitis optica spectrum disorders:A survival meta-analysis of randomized controlled trials

Background Monoclonal antibodies such as rituximab(RTX),eculizumab,inebilizumab,satralizumab,and tocilizumab have been found to be effective therapies for neuromyelitis optica spectrum disease(NMOSD)in several clinical randomized controlled trials.Objective The purpose of this meta-analysis of randomized controlled trials was to assess the efficacy and safety of monoclonal antibodies in the treatment of NMOSD.Methods We searched the following databases for relevant English language literature from the establishment of the database to June 2021:PubMed,Embase,Cohorane Library,the Central Register of Controlled Trials(CENTRAL),and Web of Science.Randomized controlled trials of monoclonal antibodies were the targets of the review.Results We included seven trials containing 775 patients(485 in the monoclonal antibody group and 290 in the control group).Patients in the monoclonal group(HR 0.24,95%CI:0.14 to 0.40,P<0.00001),as well as patients with seropositive AQP4-IgG(HR 0.18,95%CI:0.11 to 0.29,P<0.00001),both had a higher free recurrence rate than that in the control group.In the first year(HR 0.25,95%CI:0.09 to 0.71,P=0.009)and the second year(HR 0.32,95%CI:0.13 to 0.81,P=0.02),no relapses were documented.The average changes of the expanded disability status scale(EDSS)score decreased by 0.29(95%CI:−0.09 to 0.51,P=0.005).Upper respiratory tract infection(OR 1.52,95%CI:0.76 to 3.04,P=0.24),urinary tract infection(OR 0.79,95%CI:0.51 to 1.21,P=0.27),and headache(OR 1.30,95%CI:0.78 to 2.17,P=0.31)were three most frequent adverse reactions.Conclusions Monoclonal antibodies are particularly effective treatments in avoiding recurrence for NMOSD patients,according to this meta-analysis.The associated adverse responses are not significantly different from those seen with traditional immunosuppressants.

Differences in the involved sites among different types of demyelinating optic neuritis in traditional MRI examination:A systematic review and meta-analysis

Background:Magnetic resonance imaging(MRI)plays a significant role in assessing optic neuropathy and providing more detailed information about the lesion of the visual pathway to help differentiate optic neuritis from other visual disorders.This study aims to systematically review the literature and verify if there is a real difference in lesion location among different demyelinating optic neuritis(DON)subtypes.Methods:A systematic search was conducted including 8 electronic databases and related resources from the establishment of the database to August 25th,2020.We classified DON into 5 subtypes and divided the visual pathways into five segments mainly comparing the differences in the involved visual pathway sites of different subtypes.Results:Fifty-five studies were included in the analysis,and the abnormal rate was as high as 92%during the acute phase(within 4 weeks of symptom onset).With respect to lesion location,the orbital segment of the optic nerve was the most frequently involved(87%),whereas optic tract involvement was very rare.Involvement of the orbital segment was more common in myelin oligodendrocyte glycoprotein antibody-related optic neuritis(MOGON)(78%)and chronic relapsing inflammatory optic neuropathy(CRION)(81%),while the lesion was found to be located more posteriorly in neuromyelitis optica spectrum disorder-related optic neuritis(NMOSD-ON).With respect to lesion length,approximately 77%of MOG-ON patients had lesions involving more than half of the optic nerve length.Conclusions:MRI examination is recommended for DON patients in the acute phase.In MOG-ON,anterior involvement is more common and the involved length is mostly more than 1/2 of the optic nerve length,whereas posterior involvement,intracranial segment,optic chiasm,or optic tract,is more common in NMOSD-ON.

The clinical application of critical flicker fusion frequency in demyelinating optic neuritis

Purpose:To investigate the application of critical flicker fusion frequency(CFF)in demyelinating optic neuritis(DON).Methods:A cross-sectional study.A total of 127 eyes in 69 DON patients and 63 eyes in 33 healthy control(HC)groups were included between January 2021 to September 2021 from Department of Ophthalmology,PLA General Hospital.Patients underwent best-corrected visual acuity(BCVA),visual field,optical coherence tomography(OCT),flash visual evoked potential(F-VEP),and CFF examinations.The affected eyes were divided into aquaporins 4(AQP4-),myelin oligodendrocyte glycoprotein(MOG-),and double negative DON according to serum antibody;mild,moderate,severe degree visual impairment according to BCVA
0.5,0.1-0.5,<0.1;and 4 groups:<1,1~<3,3~<6 and>6 months according to time interval from onset to CFF examination.One-way ANOVA was used to perform above subgroup analysis.The correlations between CFF and F-VEP peak time,peak value,BCVA and mean visual filed defect(MD)were analyzed in order via Pearson correlation analysis.Results:he trichromatic values of red,green,and yellow in DON affected eyes were 21.83±9.03,23.66±10.21,24.09±10.77 Hz,respectively,which was significantly reduced compared with the HC group(t=-14.82,-14.22,-14.00;P<0.001).The subgroup analysis showed no significant difference between different antibody subtypes(P=0.914<0.848<0.604),whereas,a significant decrease of CFF trichromatic value was found in severe visual acuity impairment group(P<0.001).There was a significant difference in CFF-trichromatic values at different time points(P<0.001),to be specific,CFF fluctuated under 20Hz within 3 months after onset and tended to be stable around 24-28Hz.Correlation analysis showed that the peak time of F-VEP(r=-0.486,-0.515,-0.526;P<0.001),BVCA(r=-0.640,-0.659,-0.642;P<0.001),were negatively correlated with CFF trichromatic values,MD and CFF were positively correlated(r=0.486,0.453,0.476;P=0.003,0.006,0.004).Conclusions:A significant decrease of CFF value was found in DON-affected eyes,and it has a good correlation with BCVA,MD and latency of F-VEP,and can better reflect the impairment of visual function.