Comparison of macular changes according to the etiology of optic neuritis:a cross-sectional study

AIM:To compare the macular structure including foveal thickness among patients with optic neuritis(ON)according to the etiology and to investigate the possible correlation between structural and visual outcomes METHODS:In this retrospective cross-sectional study,the clinical data of patients with aquaporin-4 immunoglobulin G-related ON(AQP4 group,40 eyes),myelin oligodendrocyte glycoprotein IgG-related ON(MOG group,31 eyes),and multiple sclerosis-related ON(MS group,24 eyes)were obtained.The retinal thickness of the foveal,parafoveal and perifoveal regions were measured.Visual acuity(VA),visual field index and mean deviation were measured as visual outcomes.RESULTS:The AQP4 group showed a significantly thinner fovea(226.4±13.4μm)relative to the MOG(236.8±14.0μm,P=0.015)and MS(238.9±14.3μm,P=0.007)groups.The thickness in the parafoveal area also was thinner in the AQP4 group,though the difference in perifoveal retinal thickness was not significant.Foveal thickness was correlated with VA in the AQP4 group(coefficientρ=-0.418,P=0.014),but not in the MOG and MS groups(P=0.218 and P=0.138,respectively).There was no significant correlation between foveal thickness and visual field test in all three groups.CONCLUSION:The significant thinning in the fovea and parafoveal areas in the AQP4 group compared to the MOG and MS groups are found.Additionally,macular changes in AQP4-ON show a significant correlation with VA.The results provide the possibility that retinal structural damage could reflect functional damage in AQP4-ON,distinct from MOGON and MS-ON.

Fifteen acute retrobulbar optic neuritis associated with COVID-19:A case report and review of literature

BACKGROUND A subtype of the Omicron variant of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is suggested to be responsible for the outbreak in Northern China since the quarantine was lifted in December 2022.The coronavirus disease 2019 virus is primarily responsible for the development of respiratory illnesses,however,it can present a plethora of symptoms affecting a myriad of body organs.This virus has been theorized to be linked to demyelinating lesions of the peripheral and central nervous system including transverse myelitis and acute retrobulbar optic neuritis(ARON).For example,magnetic resonance imaging(MRI)of the orbit and brain showed enlargement of the retrobulbar intraorbital segments of the optic nerve with high T2 signal,and no abnormalities were seen in the brain tissue.In this case series,we analyzed the connection between SARSCoV-2 infection and the onset of ARON.CASE SUMMARY Fifteen patients,and a teenage boy who did not have any pre-existing ocular or demyelinating diseases suddenly experienced a loss of vision after SARS-CoV-2 infection.The patients expressed a central scotoma and a fever as the primary concern.The results of the fundus photography were found to be normal.However,the automated perimetry and MRI scans showed evidence of some typical signs.Out of the 15 patients diagnosed with ARON after SARS-CoV-2 infection,only one individual tested positive for the aquaporin-4 antibody.CONCLUSION Direct viral invasion of the central nervous system and an immune-related process are the two primary causes of SARS-CoV-2-related ARON.

Macular microvascular and structural changes on optical coherence tomography angiography in atypical optic neuritis

BACKGROUND Atypical optic neuritis,consisting of neuromyelitis optica spectrum disorders(NMOSD)or myelin oligodendrocyte glycoprotein antibody disease(MOGAD),has a very similar presentation but different prognostic implications and longterm management strategies.Vascular and metabolic factors are being thought to play a role in such autoimmune neuro-inflammatory disorders,apart from the obvious immune mediated damage.With the advent of optical coherence tomography angiography(OCTA),it is easy to pick up on these subclinical macular microvascular and structural changes.AIM To study the macular microvascular and structural changes on OCTA in atypical optic neuritis.METHODS This observational cross-sectional study involved 8 NMOSD and 17 MOGAD patients,diagnosed serologically,as well as 10 healthy controls.Macular vascular density(MVD)and ganglion cell+inner plexiform layer thickness(GCIPL)were studied using OCTA.RESULTS There was a significant reduction in MVD in NMOSD and MOGAD affected as well as unaffected eyes when compared with healthy controls.NMOSD and MOGAD affected eyes had significant GCIPL thinning compared with healthy controls.NMOSD unaffected eyes did not show significant GCIPL thinning compared to healthy controls in contrast to MOGAD unaffected eyes.On comparing NMOSD with MOGAD,there was no significant difference in terms of MVD or GCIPL in the affected or unaffected eyes.CONCLUSION Although significant microvascular and structural changes are present on OCTA between atypical optic neuritis and normal patients,they could not help in differentiating between NMOSD and MOGAD cases.

Bilateral retinal nerve fiber layer thickness reduction in a 9-year-old myopic boy suffering from unilateral optic neuritis:A case report

BACKGROUND In this paper,we present a 9-year-old boy who demonstrates a complex interplay between myopia progression,axial length(AL)extension,and retinal nerve fiber layer(RNFL)thickness loss in both eyes.Additionally,concurrent optic neuritis has directly impacted RNFL thickness in his right eye,and its potential indirect influence on RNFL and macular ganglion cell layer(mGCL)thickness in his left eye is also noteworthy.CASE SUMMARY A 9-year-old boy with bilateral myopia presented with diminished vision and pain in his right eye due to optic neuritis,while his left eye showed pseudopapilledema.Steroid therapy improved his vision in the right eye,and 16-mo follow-up revealed recovery without recurrence despite myopia progression.Follow-up optical coherence tomography conducted 16 mo later revealed a notable thinning of the RNFL in both eyes,especially along with a reduction in mGCL thickness in the left eye.This intricate interaction between optic neuritis,myopia,and retinal changes underscores the need for comprehensive management,highlighting potential long-term visual implications in young patients.CONCLUSION The progression of myopia and AL extension led to the loss of RNFL thickness in both eyes in a 9-year-old boy.Concurrently,optic neuritis directly affected RNFL thickness in his right eye and may indirectly play a role in the thickness of RNFL and mGCL in his left eye.

Optical coherence tomography in central nervous system demyelinating diseases related optic neuritis

AIM：To compare the thickness of the peripapillary retinal nerve fiber layer（RNFL）and ganglion cell-inner plexiform layer（GCIPL）among patients with various forms of optic neuritis（ON）and to identify whether any particular parameters or their thinning pattern can be used to distinguish the type of ON.METHODS：This prospective study was conducted at the Department of Ophthalmology,Faculty of Medicine,Siriraj Hospital,Thailand,between January,2015 and December,2016.We enlisted patients over 18 years of age with history of ON and categorized patients into 4 groups：1）aquaporin 4 antibodies（AQP4-IgG）positive;2）multiple sclerosis（MS）;3）myelin oligodendrocyte glycoprotein antibodies（MOG-IgG）positive;4）idiopathic-ON patients.Healthy controls were also included during the same study period.All patients underwent complete ophthalmological examination and spectral domain optical coherence tomography（OCT）imaging to analyze RNFL and GCIPL thickness after at least 3mo since the last episode of acute ON.The generalized estimating equation（GEE）models were used to compare the data amongst ON groups. RESULTS： Among 87 previous ON eyes from 57 patients（43 AQP4-IgG＋ON,17 MS-ON,8 MOG-IgG＋ON,and 19idiopathic-ON）,mean logMAR visual acuity of AQP4-IgG＋ON,MS-ON,MOG-IgG＋ON,and idiopathic-ON groups was 0.76±0.88,0.12±0.25,0.39±0.31,and 0.75±1.08,respectively.Average,superior,and inferior RNFL were significantly reduced in AQP4-IgG＋ON,MOG-IgG＋ON and idiopathic-ON eyes,relative to those of MS-ON.Differences were not statistically significant for RNFL or GCIPL between the AQP4-IgG＋ON and MOG-IgG＋ON groups,whereas visual acuity in MOG-IgG＋ON was slightly,but not significantly,better（0.39 vs 0.76）.Although RNFL thickness in MOG-IgG＋ON was significantly reduced as compared to MS-ON,mean visual acuity and GCIPL were not different.CONCLUSION：Thinning of superior and inferior quadrants of RNFL are more commonly seen in MOG-IgG＋ON and AQP4-IgG＋ON.Long term visual acuity in MOG-IgG＋ON is often better than AQP4-IgG＋ON,whereas the structural change from OCT is comparable.

Early Diagnosis of Recurrent Optic Neuritis Using Contrast-Enhanced T2 Fluid-attenuated Inversion Recovery Imaging：a Case Report

The diagnosis of the recurrent optic neuritis is commonly established clinically,and sometimes it could be challenging because the involved optic nerve does not always show significant enhancement on conventional contrast enhanced-T1 weighted imaging（CE-T1W1）.In this paper,we reported a middle-aged female with early diagnosis of recurrent optic neuritis using contrast-enhanced T2 fluid-attenuated inversion recovery imaging（CET2FLAIR）.The involved optic nerve presented evident enhancement on CE-T2FLAIR and no enhancement on CE-T1W1.This case suggested that the CE-T2FLAIR may be a useful diagnostic tool specifically for the recurrent optic neuritis in clinical practice.

Neuroprotective effects of gypenosides in experimental autoimmune optic neuritis

AIM：To determine whether gypenosides have protective effects in experimental autoimmune optic neuritis（EAON）.METHODS：Mice were randomly divided into seven groups：control group,model group,three different density gypenosides monotherapy,methylprednisolone monotherapy,combination of gypenosides and methylprednisolone group.The control group was subcutaneously injected with oil emulsion adjuvant and all other groups were subcutaneously immunized with an emulsified mixture of myelin oligodendrocyte glycoprotein（MOG） 35-55 peptide to induce EAON.Mice in the gypenosides groups were administered injections daily with three concentrations（15 mg/kg,30 mg/kg,45 mg/kg） of gypenosides respectively.Mice in the methylprednisolone group and the combination treatment group were injected daily with methylprednisolone（20 mg/kg） or methylprednisolone（20 mg/kg） ＋ gypenosides（30 mg/kg）,respectively.After MOG immunization,visual evoked potential（VEP）,optical coherence tomography（OCT）,and histopathologic examination were performed at 14,20,30,and 40 d post-inoculation（p.i.）.All results were expressed as mean±SEM.The data were evaluated by oneway ANOVA followed by Tukey or Games-Howell test.RESULTS：Compared with the control group,p2 latency was prolonged in the model group（P=0.041）.Combination treatment can alleviated the change in VEP at 20 d p.i.（P=0.012）.Average peripapillary retinal nerve fiber layer（RNFL） thickness was reduced in the model group（P= 0.000,30d;P=0.000,40d） and gypenosides treatment remarkably diminished the degree of RNFL degenerationat 30 d and 40 d p.i（P=0.000,30d;P=0.000,40d）.The pathomorphological results showed a decrease in demyelination（P=0.020） and inflammatory reactions in the combination group compared with the model group（20d p.i.）.Gypenosides treatment also alleviated the degree of axonal loss（40d p.i.）（P=0.003）.CONCLUSION：Treatment with gypenosides exerts protective effects on retinal nerve fibers and axons in EAON.When combined with gypenosides,methylprednisolone reduces demyelination in the acute stage of EAON.

Primary Sjgren's syndrome related optic neuritis

AIM:To determine the clinical features,diagnosis and treatment of the primary Sjogren syndrome(SS)related optic neuritis.METHODS:The clinical data of 8 patients(12 eyes)with primary SS related optic neuritis were analyzed retrospectively.RESULTS:Eight of 128 consecutive patients with optic neuritis resulted from varied causes fulfilled the diagnostic criteria for the primary SS.They presented initially with the signs and symptoms of non-specific optic neuritis,and 5 patients presenting without dryness showed a chronic inflammation of submandibular gland or parotid gland,and lymphocyte infiltration was demonstrated by labial gland biopsy in 2 patients.There were serum positive titers for anti-Sjogren syndrome A(SSA)in 7 patients and anti-Sjogren syndrome B(SSB)in 8 patients.Anti-aquaporin-4(AQP4)antibody was negative in all the 8 patients.Both glucocorticoids and immunosuppressive agent were administered,and visual acuity elevated in 8 eyes(66.7%),3 patients(37.5%)recurred in the follow-up.CONCLUSION:Primary SS related optic neuritis is less common and easily misdiagnosed.The conventional therapies for optic neuritis could not control the recurrence.

Structural-visual functional relationships detected by optical coherence tomography in varying age-cohorts' patients with optic neuritis

AIM: To assess the relationships of final best-corrected visual acuity(BCVA) and the optic nerve structural loss in varying age-cohorts of optic neuritis(ON) patients.METHODS: This is a retrospective, cross-sectional study.Totally 130 ON subjects(200 eyes) without ON onset within 6mo were included, who underwent BCVA assessment,peripapillary retinal nerve fibre layer(pRNFL) and macular segmented layers evaluation by optical coherence tomography(OCT).RESULTS: For the 0-18y cohort, the final BCVA(logMAR)was significantly better and less frequent recurrences than adult cohorts(P=0.000). The final BCVA(logMAR) in all age-cohorts of the ON patients had negative and linear correlations to the pRNFL thicknesses and macular retinal ganglion cell layer(mRGCL) volumes, when the pRNFL thicknesses were reduced to the thresholds of 57.2-67.5 μm or 0.691-0.737 mm;in mRGCL volumes, respectively, with the strongest interdependence in the 19-40y cohort. The ON patients from varying age cohorts would be threatened by blindness when their pRNFL thicknesses dropped 36.7-48.3 μm or the mRGCL volumes dropped to 0.495-0.613 mm;.CONCLUSION: The paediatric ON has best prognosis and young adult ON exhibits perfectly linear correlations of final vision and structural loss. The pRNFL and the mRGCL could be potential structural markers to predict the vision prognosis for varying-age ON patients.

Acute changes in ganglion cell layer thickness in ischemic optic neuropathy compared to optic neuritis using optical coherence tomography

AIM:To elucidate the changes of different ganglion cell layer(GCL)thinning patterns between the optic neuritis(ON)and non-arteritic anterior ischemic optic neuropathy(NAION).METHODS:A prospective,observational study was conducted to evaluate the timing of GCL changes between acute ON and NAION using optical coherence tomography.RESULTS:Thinning on optical coherence tomography in the NAION group occurs as early as 11 d after symptomatic onset of vision loss and follows an altitudinal pattern.The mean superior-inferior GCL thickness difference in the NAION cohort was clinically significant at 5.7μm in the NAION cohort compared to controls of 0.8μm(P=0.032),but not significant in the ON group compared to controls with both groups measuring 1.1μm.Global thinning was significant for the ON group compared to controls at 7.2μm(P=0.011)but not the NAION group compared to controls at 1.35μm.CONCLUSION:These findings suggest that future treatments for NAION should be given early,and possibly before 11 d in order to prevent GCL and irreversible vision loss.

Effects of minocycline on apoptosis and neuronal changes in retinal ganglion cells from experimental optic neuritis rats

BACKGROUND： Minocycline, a tetracycline derivative, is neuroprotective in models of various neurological diseases. OBJECTIVE： To investigate the effects of minocycline on retinal ganglion cells （RGCs） in rats with optic neuritis, and to compare with the effects of methylprednisolone. DESIGN, TIME AND SETTING： This neuropathology controlled study was performed at the First Affiliated Hospital, Chongqing Medical University, China in May 2007. MATERIALS： A total of 22 female Wistar rats were randomly assigned into a normal control group （n ： 5） and an experimental group （n = 17）. The experimental group was composed of a model subgroup （n = 7）, a minocycline subgroup （n = 5）, and a methylprednisolone subgroup （n = 5）. Minocycline was supplied by Sigma, USA. METHODS： Antigen homogenate made from guinea pig spinal cord and complete Freund adjuvant was used to induce autoimmune encephalomyelitis, which could induce demyelinated optic neuritis models. Rats in the minocycline subgroup were intraperitoneally injected with minocycline （45 mg/kg） daily from day 8 following autoimmunity. Rats in the methylprednisolone subgroup were intraperitoneally injected with methylprednisolone （20 mg/kg） daily from day 8 following autoimmunity. MAIN OUTCOME MEASURES： On day 18 after autoimmunily induction, pathological changes in the optic nerve were observed by hematoxylin-eosin staining. The percentage area of axons in the transverse section of the optic nerve was measured by Bielschowsky staining. Apoptosis of RGCs was detected by TUNEL. RESULTS： Under an optical microscope, the optic nerve in rats with demyelinated optic neuritis showed a vacuole-like structure of fibers, irregular swelling of the axons, and infiltration of a large quantity of inflammatory cells. With an electron microscope, the optic nerve presented with vacuole-like structures in the axons, a small percentage area of axons in the transverse section, loose myelin sheaths, and microtubules and microfilaments disappeared. The pathological changes in the optic nerve met the changes in demyelinated optic neuritis. Moreover, there was significant apoptosis of RGCs. The percentage area of optic nerve axons in the transverse section was significantly increased and the number of apoptotic RGCs was increased after treatment with methylprednisolone and minocycline. Compared with methylprednisolone, minocycline had better effects on reducing RGC apoptosis （P 〈 0.05）. CONCLUSION： Minocycline has better inhibitory effects on RGC apoptosis than methylprednisolone. Minocycline can decrease the damage to axons of demyelinated optic neuritis rats, and has similar protective effects on neurons from demyelinated optic neuritis rats as methylprednisolone.

An unusual cause of optic neuritis:rickettsiosis disease

Optic neuritis(ON) may be associated to a range of autoimmune or infectious diseases.We report herein a case of ON induced by Rickettsia conorii.A 53-year-old woman presented with a recent decrease in visual acuity and headache.ON was diagnosed on the basis of ophthalmologic examination and flash visual evoked potentials.Etiological investigation made in our department eliminated first autoimmune disorders(vasculitis and connective tissue diseases).Rickettsial optic neuritis was confirmed by detection of specific antibodies in serum and the negativity of other serologic tests.An association between corticosteroids and cyclines was prescribed with improvement of visual acuity.

Choroidal changes in eyes treated with high-dose systemic corticosteroids for optic neuritis

AIM:To analyze the effect of systemic high-dose corticosteroid on the choroid in patients with unilateral optic neuritis.METHODS:A retrospective comparative cohort study.Seventy-six eyes of 38 patients with unilateral optic neuritis that received systemic high-dose corticosteroid treatment were enrolled.Choroidal thickness(CT)and choroidal vascularity index(CVI)were measured in both affected and the fellow eyes at baseline,1 wk.1 and 3 mo.Changes in CT and CVI were analyzed in both eyes and compared between eyes.RESULTS:The mean CT and CVI were 349μm and 0.70 in the affected eyes and 340μm and 0.69 in the fellow eyes at baseline(P=0.503 and 0.440,respectively).Decrement of CT and CVI at month 3 were significant in affected eyes(P=0.017 and P<0.001).Decreased CVI began 2 wk after treatment whereas CT decreased from 1 mo.The CVI also decreased significantly in fellow eyes at 3 mo compared to the baseline(P=0.001).CONCLUSION:A significant decrement in CT and CVI can appear after 3 mo in optic neuritis patients treated with high-dose systemic corticosteroid treatment.The decrease in CVI appeared earlier than the decrease in CT,suggesting choroidal vasoconstriction caused by systemic steroid as a possible mechanism.

Clinical characteristics of 72 cases with neuromyelitis optical associated optic neuritis

Objective:To analyze the clinical characteristics of neuromyelitis optical associated optic neuritis(NMO-ON)patients,and to provide reference and basis for the prevention and treatment accordingly.Methods:The medical records of 72 NMO patients with ON as the first clinical manifestation in China-Japan Friendship Hospital from January 2016 to December 2019 were retrospectively analyzed and summarized,including general information,morbidity characteristics,course of disease,comorbid diseases,immunological tests,treatment response and prognosis,etc.Results:Totally 72 NMO-ON patients had a median age of 33 years.The ratio of male to female is about 1:5.54;The median course was 67 months,mainly"relapseremission".Totally 61.11% patients were successively involved in both eyes,the median incidence of ON was 2 times,and the median time of the second onset of ON was 3 months.The 1-year and 3-year recurrence rates were 55.56% and 73.61%,respectively.Around 91.67% of the patients had the onset of ON alone,and 81.94% of the patients had monocular involvement.About 19.44% patients were associated with inducement,the most common was upper respiratory tract infection;15.28% patients were associated with systemic immune diseases,most commonly associated with Sjogren's syndrome and thyroid diseases and 75.64% patients had first visual acuity less than 0.1,aquaporin-4 immunoglobulin G(AQP4-IgG)status(P=0.032,OR=2.55)and onset age(P=0.037,OR=3.93)were independent risk factors for first visual acuity.Up to the last follow-up time,the rate of unilateral blindness was about 48.61%,and the median of unilateral blindness ON was 2 times.Other nervous system involvement occurred in 73.61% of patients,and spinal cord(61.11%)was the most common site of recurrence.Serum AQP4-IgG was positive in 80.00%(48/60)of patients.A total of 18 cases(25.00%)were associated with other systemic immune antibodies,most commonly associated with ANA antibody positivity.Conclusions:The first onset of NMO-ON patients is mostly ON alone,with unilateral involvement and high incidence in young and middle-aged women.Bilateral optic nerve involvement and repeated recurrence are common in the long course of disease.AQP4-IgG status and onset age are independent risk factors affecting the visual function of NMO patients for the first onset,and most patients have positive AQP4-IgG serum.Some patients are associated with systemic immune diseases represented by Sjogren's syndrome and thyroid disease,which are at high clinical risk and require early diagnosis and treatment intervention.

Mechanism of delayed conduction of fellow eyes in patients with optic neuritis

To test the hypothesis that latency delay in the fellow eyes of optic neuritis（ON） patients and to compensate for delayed transmission of visual information, latency change of multi-focal visual evoked potential（mf VEP） traces in fellow eyes of 15 ON patients were analyzed. Patients with low risk（LR） for developing multiple sclerosis（MS） were examined separately from MS patients to isolate effect of cortical plasticity from potential pathological changes in disseminated disease. The small increase in latency in fellow eyes of LR group was statistically not significant. In MS patients, the latency was significantly delayed（P〈0.02）. The magnitude of the latency change in the fellow eyes did not correlate with the severity of latency delay in the affected eyes（R^2〈0.02, P=0.3）. The differences between ON patients with and without MS, reported here, suggest that the presence of disseminated disease plays critical role in latency delay of the fellow eye.

Optic Neuritis in Acute Neuroborreliosis (Lyme Disease) in the U.S.-Mexican Border: Case Report

Objective: We describe a patient diagnosed with acute neuroborreliosis presenting with anterior optic neuritis (papillitis) in a non-endemic region. Case Presentation: A 43-year-old previously healthy right handed man admitted due to an insidious onset of severe headache and spells of ascending paresthesias from his right foot into his right arm and face followed by speech arrest and clumsiness of his right hand. His neurologic exam was significant for somnolence, nuchal rigidity and Kernig and Brudzinski signs were present. MRI of the brain with gadolinium showed diffuse hyperintense signal involving the supra and infratentorial cortical sulci, with associated faint diffuse leptomeningeal enhancement, consistent most likely with diffuse leptomeningoencephalitis. EEG: normal. CSF VDRL was negative. Dilated fundus exam revealed mild optic nerve edema more significant to the left than to the right eye, confirmed and measured by spectral domain OCT (Optical Coherence Tomography). There was an evidence of posterior uveitis with an early vitreous hemorrhage superficial to the left optic nerve. Lyme disease serum antibody (IgM) Immunoblotting was positive in 2 bands confirming the diagnosis of neuroborreliosis. Conclusion: Optic nerve involvement in Lyme disease is an uncommon complication that should be confirmed by specific diagnostic criteria to establish its causal relation.

Clinical features of retinal diseases masquerading as retrobulbar optic neuritis

Background Managements of optic neuritis （ON） included high-dose corticosteroids or combined with systemic immunomodulatory agents. It was important to make a correct diagnosis of ON before initiation of treatment. The purpose of the study was to report and analyze the clinical features of retinal diseases in patients who were misdiagnosed as having retrobulbar ON. Methods Retrospective review of 26 patients （38 eyes） initially diagnosed with retrobulbar ON but were ultimately diagnosed with retinal or macular diseases. Data obtained from fundus examination, fluorescence fundus angiography （FFA）, automated static perimetry, full-field electroretinogram （ffERG）, multifocal electroretinogram （mfERG）, and optical coherence tomography （OCT） were evaluated. Results Thirty-eight eyes of 26 patients were found to have misdiagnosis of retrobulbar ON, based on normal or slight abnormal fundus findings and abnormal visual evoked potentials （VEP）. The mean age of the patients was 34 years and the correct diagnosis of the patients included acute zonal occult outer retinopathy （AZOOR, 15 eyes, 14 patients）, occult macular dystrophy （OMD, 8 eyes, 4 patients）, cone or cone-rod dystrophy （10 eyes, 5 patients）, acute macular neuroretinopathy （AMNR, 3 eyes, 2 patients）, and cancer-associated retinopathy （CAR, 2 eyes, 1 patient）. Conclusion When attempting to diagnose retrobulbar ON in clinical practice, it is crucial to carry out necessary examinations of the retinal function and morphology to decrease misdiagnosis.

Application of immunosuppressant facilitates the therapy of optic neuritis combined with Sj（o）gren＇s syndrome

Background Optic neuritis （ON） is often the first symptom of multiple sclerosis （MS） and neuromyelitis optica （NMO） while there has been very little research reported on ON combined with Sj（o）gren＇s syndrome （SS）.The aim of this study is to provide different treatments and services for and NMO patients combined with SS.Methods Twenty-seven patients with ON combined SS were divided into two groups：corticosteroid group （C group,methylprednisolone sodium succinate,14 patients） and corticosteroid＋ immunosuppressant group （C＋I group,leflunomide,13 patients）.ON relapse times in 1 year after treatment,number of patients who relapsed to NMO/MS in 1 years,visual acuity and retina nerve fiber layer （RNFL） thickness were measured.Mann Whitney-Wilcoxon test was used to compare continuous variables and Chi-square test or Fisher＇s exact test was to compare proportions.Results ON combined with SS patients had higher incidence rates in middle-aged women who have binocular damage and heavier visual function damage or when there is an easy relapse,and the patients are often hormone dependent.The patients are more likely anti-aquaporin-4 IgG seropositive （70.4％）.They are liable to form a centrocecal scotoma and tubular vision.The times of relapse decreased in patients who used immunosuppressant,and a significant difference was found between immunosuppressant and non-immunosuppressant groups in visual acuity recovery during 6-month followup period （P ＜0.05）; however,the RNFL thickness at the four quadrants was not significantly different.Conclusions The effect of immunosuppressant plus corticosteroid on the early onset of ON combined with SS was to provide ON remedy and to prevent recurrence in clinics.This study provides a significant reference for the prevention and treatment of ON on the basis of immunosuppressant and corticosteroid.

Relationship between serum bilirubin levels and optic neuritis

Background Bilirubin is the end product of heme catabolism and has strong antioxidant properties. Serum bilirubin levels are reported to be reduced in patients with multiple sclerosis （MS） and neuromyelitis optica （NMO）. The pathophysiology of optic neuritis （ON） resembles that of MS; however, the role of endogenous bilirubin in ON is unclear. The aim of this study is to measure serum bilirubin levels in patients with ON, and to investigate the correlation between ON and serum antioxidant status of bilirubin. Methods Serum levels of bilirubin were measured in 42 patients with ON, 50 patients with multiple sclerosis （MS）, 48 patients with neuromyelitis optica （NMO） and 48 healthy control subjects. Results Serum total bilirubin （Tbil）, direct bilirubin （Dbil） and indirect bilirubin （Ibil） levels in patients with ON were significantly lower than those in the healthy controls. However, no statistical significance was found between levels in the ON and MS, ON and NMO, and MS and NMO groups. In patients with ON, serum Tbil, Dbil, and Ibil levels were lower in those with recurrence or those with ON for a longer duration （〉1 year）. Moreover, Tbil, Dbil, and Ibil concentrations were lower in patients with papillitis than in those with retrobulbar type ON, but the differences were not statistically significant. Conclusions Low antioxidant status may exist in patients with ON. But serum levels of Tbil, Dbil, and Ibil did not correlate with clinical presentations, such as recurrence, duration of disease and subtypes of ON. Low antioxidant status already existed in MS or NMO patients before systemic symptoms appeared.

Clinical and pathological features of acute optic neuritis in Chinese patients

Background The incentives and the factors that affect the onset and outcome of optic neuritis （ON） are not very clear. The aim of this study is to define and get a comprehensive understanding of the clinical profile of ON, and to identify the factors that were related to the prognosis of the patients. Methods Medical records of patients with diagnosis of ON at Huashan Hospital, Fudan University between March 2008 and June 2011 were reviewed. Clinical features, ophthalmologic and neurologic assessments, neuroimaging studies, laboratory examinations, visual recovery, and final outcome of the patients were evaluated by the authors. Results Records of 50 patients （32 females and 18 males）, aged 15-56 years, were reviewed, in which 22% patients had a previous onset of ON. Maximal visual deficit was severe in 72.5% （〈20/200）. Abnormal rates of hormone levels and rheumatoid indicators were found in 54.2% and 25.0%. ANA test returned positive in 40%, oligoclonal banding （OCB） was identified in 31.3%, and Serum neuromyelitis optica （NMO）-IgG studies were abnormal in 25% of the patients. Neuroimaging abnormalities associated with ON were documented in six patients. Three of the 50 patients have been diagnosed with multiple sclerosis, and two with NMO. Visual acuity was 20/20 or better in 26.1% and 20/100 or worse in 39.1% affected eyes at the last visit. Poor visual acuity at onset is the main factor that would affect the final outcome of vision （P 〈0.05）. Conclusions Vision defects of this group of patients were severe. Females had a higher incidence of ON than males. Hormone levels, rheumatoid indicators and immune parameters may be related to the onset of ON. The severe reduction of visual acuity at onset may be related to the poor outcome of vision in ON patients.