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.

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.

Bilateral atypical optic neuritis associated with tuberculosis in an immunocompromised patient

A 27 year-old lady,presented with sudden loss of vision in the right eve tor a week.It was followed In poor vision in the left eye alter 3 days.It involved the whole entire visual field and was associated with pain on eye movement.She was diagnosed to have miliary tuberculosis and retroviral disease 4 months ago.She was started on anti-TB since then but defaulted highly active anti-retroviral therapy(HAART).On examination.her visual acuity was no perception of light in the right eye and 6/120(pinhole 3/60) in the lelt eye.Anterior segment in both eyes was unremarkable.Funduscopy showed bilateral optic disc swelling with presence ot multiple foci of choroiditis in the peripheral retina.The vitreous and relinal vessels were normal.Chest radiography was normal.CT scan of orbit and brain revealed bilateral enhancement of the optic nerve sheath that suggest the diagnosis of bilateral atypical optic neuritis.This patient was managed with infectious disease team.She was started on HAART and anti-TB treatment was continued.She completed anti-TB treatment alter 9 months without any serious side effects.During follow up the visual acuity in both eyes was not improved.However.funduscopy showed resolving ol disc swelling and choroiditis following treatment.

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.

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.

Tumor necrosis factor-alpha in experimental autoimmune neuritis

Tumor necrosis factor-α （TNF-α） plays a key role in the pathogenesis of experimental autoimmune neuritis （EAN） as well as Guillain-Barre syndrome. The proposed pathogenesis of TNF-α associated neuropathies involves immune-mediated attack to blood-nerve barrier, aggravated production of pro-inflammatory cytokines, and the induction of Schwann cells apoptosis. TNF-α may play a regulatory role by increasing production of interleukin-1 in macrophages, attenuating T cell receptor signaling and regulating apoptosis of potentially autoreactive T cells in EAN. The data suggest that antagonizing TNF-α functions or suppressing TNF-α production may be useful in the acute phase of EAN treatment, but further studies are required.

THIRTY-SIX CASES OF NEURITIS OF LATERAL CUTANEOUS NERVE OF THIGH TREATED BY MAGNETIC ROUND PLUM-BLOSSOM NEEDLE PLUS INFRARED RADIATION

Thirty-six cases of neuritis of lateral cutaneous nerve of thigh were treated by mag-netic round plum-blossom needle plus infrared radiation and it was compared with simpleacupuncture treatment.Statistical analysis indicated that there was no significant difference in thetheraPeutic effects between the two methods,but magnetic round Plum-blossom needle Plus in-frared radiation had as high therapeutic effect as simple acupuncture treatment and with themethod pateints suffered less without infection and it was easily to be accepted by patients.

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.

Optic perineuritis as an initial presentation of ocular toxoplasmosis:a case report

Dear Editor,Ocular toxoplasmosis,caused by Toxoplasma gondii infection,is one of the most common causes of posterior uveitis worldwide[1].It typically manifests as white focal retinitis with overlying vitreous inflammation that results in a chorioretinal scar and associated scotoma[2].However,the diagnosis of ocular toxoplasmosis can be challenging when it presents as an isolated papillitis without other typical signs of retinochoroiditis or vitritis[2].Although optic nerve involvement in ocular toxoplasmosis was present in 5.3%of cases,isolated papillitis was extremely rare(3 eyes out of 926 patients)and was only considered a presumed diagnosis in such cases given the presence of old toxoplasmic retinochoroiditis lesions[3].Few reports have described optic nerve involvement preceding toxoplasmic retinochoroiditis,while perineuritis,an uncommon form of orbital inflammatory disease involving the optic nerve sheath,has not been reported at all[4-5].Herein,we describe a case of ocular toxoplasmosis that initially presented with optic perineuritis followed by typical retinochoroidal inflammation.To our knowledge,this is the first case report of ocular toxoplasmosis with perineuritis in an immunocompetent individual.

Inferior vestibular neuritis in a fighter pilot:A case report

Pilot spatial disorientation is a leading factor contributing to many fatal flying accidents. Spatial orientation is the product of integrative inputs from the proprioceptive, vestibular, and visual systems. Vestibular neuritis (VN) can lead to sudden pilot incapacitation in flight. VN is commonly diagnosed by demonstration of unilateral vestibular failure, as unilateral loss of caloric response. As this test reflects the function of the superior part of the vestibular nerve only, cases of pure inferior nerve neuritis will be lost. This paper describes a fighter pilot with symptoms suggestive of VN but with normal caloric test results. Further test showed unilateral loss of vestibular evoked myogenic potential. We believe that the pilot suffered from pure inferior nerve vestibular neuritis. VEMP plays a major role in the diagnosis of inferior nerve vestibular neuritis in pilots. Aeromedical concerns are also discussed.

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.

Ethambutol Induced Optic Neuritis Associated with Tenofovir Nephrotoxicity

Morbidity and mortality associated with human immunodeficiency virus (HIV) has decreased with highly active anti-retroviral therapy (HAART). Tenofovir is a nucleotide reverse transcriptase inhibitor (NRTI) that is preferred by the Department of Health and Human Services (DHHS) HIV treatment guidelines and is widely used for the initial treatment of HIV. Although tenofovir is generally well-tolerated, it has been associated with rare cases of acute nephrotoxicity. HIV-infected patients frequently have co-morbidities that require treatment, thus adding another level of complexity due to drug interactions and medication adverse effects with antiretrovirals. We present a patient who suffered an acute deterioration in renal function from tenofovir, leading to an accumulation of co-administered ethambutol, thus resulting in optic neuritis.

Inguinal Neuritis in Open Recurrent Hernia Repair

PURPOSE: To investigate the pattern of occurrence of inguinal neuritis in recurrent inguinal hernia. We hypothesize that neuritis will occur in more nerves with a wider distribution than in primary repair. METHODS: Retrospective chart review of thirty consecutive recurrent inguinal hernia repairs concentrating on the occurrence of inguinal neuritis. These are not chronic pain patients. Nerves suspected of containing inguinal neuritis were sent for histologic examination. Ilioinguinal nerves were routinely resected. Operative parameters and nerve pathology reports were reviewed. These data were compared with a recent series of one hundred consecutive primary inguinal hernia repairs with a 34% incidence of inguinal neuritis. An independent statistician from Whitman University reviewed the data. RESULTS: Twenty patients were found to have inguinal neuritis among thirty recurrent open inguinal hernia repairs (66%). This compares to 34% among primary repairs, but it is a similar rate (P > 0.42) assuming that the damaged nerve was left intact in 34% of these recurrences during the primary repair. In recurrent inguinal hernia 69% of neuritis occurred in the ilioinguinal nerve compared to 88% of damaged ilioinguinal nerves in the primary hernia. A test for the difference in proportions gives P > 0.10. The most common site of neuritis occurrence in recurrent hernias with nerve damage to the ilioinguinal nerve was at the external oblique neuroperforatum among 70% of patients compared to 83% in primary cases. A test for difference in proportions gives P > 0.36. Two separate nerves were found to exhibit neuritis in six patients (20%) significantly higher than 1% among primary hernias (P < 0.01). CONCLUSION: The overall incidence of inguinal neuritis was 66% in recurrent inguinal hernia repairs. The ilioinguinal nerve was most commonly affected in these recurrent hernias. Inguinal neuritis occurs more commonly in recurrent hernia compared with primary inguinal hernia;however, it has a similar distribution. Neuritis occurs in two nerves with 20% frequency (P < 0.01), so all nerves should be assessed during recurrent herniorrhaphy. The data support the hypothesis.

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.