Diffuse unilateral subacute neuroretinitis in children:Report of three cases

Rationale:Diffuse unilateral subacute neuroretinitis is a form of posterior uveitis and has a few clinical presentations according to the onset of presentation.Patients’concern:A girl(5-year-old)and 2 boys(both 12-year-old)were included in this report.Upon presentation,the visual acuity ranges from 6/12 to 6/60.All three cases had different symptoms(case 1:floaters;case 2:eye redness and pain;case 3:central scotoma).All of them had variable posterior uveitis features(case 1:vitritis and focal retinitis;case 2:subretinal larva track;case 3:choroiditis).Diagnosis:Diffuse unilateral subacute neuroretinitis.Intervention:All 3 patients were treated with oral albendazole.Outcome:All patients showed remarkable resolution of inflammatory reactions of the eye and also improvement of vision.Lesson:High index of suspicion should be made for children and young adults who are previously healthy but presented with suddenly onset of reduced vision with clinical features of posterior uveitis of variable degree.Clinical features together with a full blood picture can help to diagnose the problem when other parameters are negative.

Neuroretinitis: Update on a visual emergency and role of technology in its diagnosis

Neuroretinitis is one of the forms of optic neuritis characterized by swelling of optic nerve head and adjoining retinal nerve fiber layer resulting in a macular star configuration. The underlying pathophysiology involves increased permeability of disc vasculature, but the etiology is not fully defined. Neuroretinitis may occur due to an infectious process involving the disc, a postviral or autoimmune mechanism or sometimes idiopathic. Technological advances like ophthalmoscopy, slit-lamp examination, fluorescein angiography, magnetic resonance imaging and immunodiagnostic tests all come handily and are often imperative in making an accurate diagnosis. Conditions mimicking neuroretinitis include papilledema, anterior ischemic optic neuropathy, and infiltration of the optic disc by tumor and systemic hypertension. Neuroretinitis is usually a self-limited disorder with a good visual prognosis. Treatment of neuroretinitis is required only when there is an underlying infectious or inflammatory condition.

Bartonella henselae neuroretinitis in a patient without cat scratch

Neuroretinitis is characterized by optic disc swelling with macular star,and affects 1%-2%of the patients with Bartonella henselae infection.This condition needs to be considered in the differential diagnosis of unilateral optic neuropathy in young adults.A 44-year-old woman presented with a progressive visual loss in right eye that was described as a central scotoma with altered color perception.Medical history was negative except for Hashimoto's thyroiditis.The examination evidenced a relative afferent pupillary defect in right eye and marked papillary oedema involving the macular region.Brain and orbits magnetic resonance imaging were normal,and fundoscopy showed star-shaped hard exudates.Autoimmune and infective screening revealed IgM and IgG antibodies against Bartonella henselae,suggesting for recent cat-scratch disease.She was treated with high-dose intravenous steroids and doxycycline.One month later she fully recovered,and she had no relapses.We diagnosed a Bartonella henselae neuroretinitis(finally the patient recalled she had stroked stray cats,not being scratched).In conclusion time course and absence of pain differentiate neuroretinitis from other optic neuropathies.Fundoscopic image of macular star is a clue for diagnosis,and visual recovery is usually excellent.

Ophthalmic manifestations of cat scratch disease

Cat scratch disease(CSD)is a worldwide distributed zoonosis caused by Bartonella henselae and other Bartonella spp.The reservoirs of Bartonella are domestic animals,especially cats,and the transmission to humans is thought to occur from a cat scratch or even through the cat flea Ctenocephalides felix.With more and more pet owners,the physicians should keep in mind signs and symptoms of CSD.A widespread infection may occur in 5-14%of cases,and ocular involvement,called ocular bartonellosis,is a quite common consequence of disseminated CSD.Although the most typical manifestations of ocular Bartonellosis are Parinaud’s oculoglandular syndrome,neuroretinitis and retinochoroiditis,many other ophthalmic conditions have been reported.The diagnosis of CSD is often based on history of contact with a cat and high serum titers of immunoglobulin G antibodies against B.henselae.Polymerase chain reaction could be helpful for CSD diagnosis when serology is negative but clinical findings are suggestive for the disease.Multimodal imaging,including fundus autofluorescence,fluorescein and indocyanine green angiography,optical coherence tomography(OCT)and OCT angiography,can be used for diagnosis and monitoring of ocular Bartonellosis.Since CSD is more often a self-limited infection in immunocompetent individuals,no antibiotic treatment is usually needed.However,when a therapy is prescribed,doxycycline is the most used antibiotic.The aim of this article is to review the current literature relating to epidemiology,systemic and ocular manifestations,diagnosis,treatment and prognosis of bartonellosis,in order to give the ophthalmologists a useful tool for daily practice.

Neuroretinal dysfunction in patients affected by neurofibromatosis type 1

AIM:To examine neuroretinal function by using the multifocal electroretinography(mf ERG)test in patients with neurofibromatosis type 1(NF1)without optic pathway gliomas(OPGs).METHODS:This study was conducted on 35 patients(35 eyes)with NF1 and 30 healthy subjects(30 eyes)for the control group.Each subject underwent a complete ophthalmological examination including spectral domainoptical coherence tomography(SD-OCT)and mf ERG.The 1.5-Tesla magnetic resonance imaging(MRI)scan of the brain was performed in NF1 patients to assess the presence of OPGs.All participants were recruited having a best corrected visual acuity(BCVA)of no less than 20/20 in each eye.The amplitude and implicit time of the P1 wave(first-order Kernel component)were evaluated on mf ERG.Data analysis was carried out in the two central degrees and in the four quadrants from two to 25 degrees of visual field.RESULTS:Statistically significant results were obtained for the P1 wave amplitudes in the 4 quadrants in NF1 patients compared to healthy controls,while the reduction was not significant in the 2 central degrees between the groups.A statistically significant difference was observed among the P1 wave amplitudes as recorded in the 4 quadrants within the NF1 group,with lower amplitudes detected in the nasal quadrants.No differences in the implicit times were recorded in the 2 central degrees and in the 4 quadrants as compared between NF1 patients and controls.CONCLUSION:Impaired neuroretinal function in NF1 patients is expressed in a decreased amplitude of the P1-wave between 2 and 25 central retinal degrees on mf ERG.Altered intracellular signal transduction due to abnormal neurofibromin-mediated cyclic adenosine monophosphate(c AMP)generation,can be involved.The possible use of mf ERG as subclinical retinal damage indicator has a potential utility in clinical practice for the follow-up of NF1 patients.

Efficacy of 1/3-Dose Verteporfin Photodynamic Therapy for Subacute Central Serous Chorioretinopathy

Purpose: To study the safety and efficacy of 1/3-dose verteporfin photodynamic therapy (PDT) for subacute central serous chorioretinopathy (CSC). Methods: In this case series, 59 eyes (59 patients) diagnosed with subacute CSC in Shenyang the 4th hospital from January 2014 to December 2015 were treated with 1/3-dose verteporfin PDT and followed up for at least 1 year. The symptoms and the diagnosed history were more than 3 months but shorter than 6 months. The central foveal thickness (CFT), neuroretinal thickness (NRT), height of subfoveal retinal fluid (SRF), and subfoveal choroidal thickness (SCT) were observed at baseline and after treated at 1, 2, 3, 6 and 12 months with EDI-OCT, Best-corrected visual acuity ( BCVA) was also studied at the same time. Results: After 1, 2, 3 and 6 months of 1/3-dose verteporfin PDT treatment, the BCVA improved significantly (P 0.05). The height of SRF changed significantly. There was no retinal pigment epithelium atrophy and choroidal neovascularization (CNV) in all cases after more than 12 months follow-up. Conclusion: Treatment of 1/3 dose verteporfin PDT could safely and effectively reduce expansion of choroidal vessel and choroidal choriocapillary, promoting absorbance of subretinal fluid for subacute CSC. 1/3-dose verteporfin PDT may be an alternative method to treat the subacute CSC.

A virtual model of the retina based on histological data as a tool for evaluation of the visual fields

Background:To settle the fundamentals of a numerical procedure that relates retinal ganglion-cell density and threshold sensitivity in the visual field.The sensitivity of a generated retina and visual pathways to virtual stimuli are simulated,and the conditions required to reproduce glaucoma-type defects both in the optic-nerve head(ONH)and visual fields are explored.Methods:A definition of selected structural elements of the optic pathways is a requisite to a translation of clinical knowledge to computer programs for visual field exploration.The program is able to generate a database of normalized visual fields.The relationship between the number of extant receptive fields and threshold sensitivity is plotted for background sensitivity and corresponding automated perimetry.A solution in two planes to the 3D distribution of axons in the ONH is proposed.Visual fields with induced damage in the optic disc are comparable in pattern and quantity to glaucomatous records.Results:The two-level simulation of the ONH facilitates the analysis of optic-cup/retinal defects.We can generate the virtual optic pathways tailored to the age and morphology of the patient’s eye,and it is possible to reproduce glaucomatous damage by“reverse engineering”engineering.The virtual cortical model renders a quantitative relationship between visual defect and neural damage.Conclusions:A two-level computing of the retina/optic nerve facilitates the analysis of neuroretinal defects and can be incorporated to automatic perimeters to facilitate visual field analysis.