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 2...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.展开更多
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 im...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.展开更多
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 ...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.展开更多
Objective:To explore the clinical effect of acupuncture combined with traditional Chinese medicine on optic nerve atrophy caused by neuromyelitis optic(NMO).Methods:the patients with optic atrophy caused by NMO with o...Objective:To explore the clinical effect of acupuncture combined with traditional Chinese medicine on optic nerve atrophy caused by neuromyelitis optic(NMO).Methods:the patients with optic atrophy caused by NMO with optic neuritis who visited the ophthalmology or neuro-ophthalmology clinic of our hospital from March 2016 to December 2019 were collected.The patients were treated with acupuncture and traditional Chinese medicine for 8 weeks before and after treatment.The best corrected visual acuity and dynamic visual field were tested before treatment,4 weeks and 8 weeks after treatment,respectively,to evaluate the effect of acupuncture combined with traditional Chinese medicine on the visual function of patients;Results:after 4 weeks of treatment,the visual acuity of 8 eyes improved more than 2 lines,the total effective rate was 91.67%.after 8 weeks of treatment,the visual acuity of 12 eyes improved more than 2 lines,the total effective rate was 100%;after 4 weeks of treatment,the mean defect(MD)and mean sensitivity(MS)of dynamic visual field were improved,but the difference was not statistically significant(MD:t=1.579,P=0.121;MS:t=-1.500,P=0.140);after 8 weeks of treatment,the MD was significantly decreased(t=2.65,P<0.05),and the MS was significantly improved and statistically significant(t=-2.58,P<0.05).Conclusion:the combination of acupuncture and Chinese medicine can significantly improve the visual function of patients with optic atrophy caused by NMO,improve the best corrected visual acuity and dynamic visual field sensitivity,and reduce the visual field defect.展开更多
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 ...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.展开更多
Neuromyelitis optica spectrum disorders, or neuromyelitis optica(NMO), is an autoimmune disease of the central nervous system that must be distinguished from multiple sclerosis. Therapeutic approaches to relapse preve...Neuromyelitis optica spectrum disorders, or neuromyelitis optica(NMO), is an autoimmune disease of the central nervous system that must be distinguished from multiple sclerosis. Therapeutic approaches to relapse prevention in NMO include immunosuppressants and monoclonal antibodies. Rituximab, a monoclonal antibody that targets CD20 antigen expressed on the surface of pre-B, mature B-lymphocytes and a small subset of T-lymphocytes, has been widely used for the treatment of NMO. In this review, we aim to summarize global experience with rituximab in NMO. We identified 13 observational studies that involved a total of 209 NMO patients treated with rituximab. Majority of rituximab-treated patients evidenced stabilization or improvements in their disability scores compared to pre-treatment period and 66% of patients remained relapse-free during treatment period. Monitoring rituximab treatment response with CD19+ or CD27+ cell counts appears to improve treatment outcomes. We offer clinical pointers on rituximab use for NMO based on the literature and authors' experience, and pose questions that would need to be addressed in future studies.展开更多
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...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.展开更多
Ankylosing spondylitis （AS）, which primarily affects the sacroiliac joints, spine, and enthuses, is a chronic inflammatory rheumatic disorder. Acute anterior uveitis is the most common ophthalmologic involvement, wh...Ankylosing spondylitis （AS）, which primarily affects the sacroiliac joints, spine, and enthuses, is a chronic inflammatory rheumatic disorder. Acute anterior uveitis is the most common ophthalmologic involvement, whereas optic neuritis （ON） rarely coexists with AS.r^j ON is an immune-mediated inflammation of the optic nerve, which could be the initiated symptom of multiple sclerosis （MS） or neuromyelitis optica （NMO）. Bilateral simultaneous ON with long enhanced optic nerve lesions in magnetic resonance imaging （MRI） was considered as features of NMO spectrum disorders （NMOSDs）. However, comprehensive review of the current literature showed little evidence of AS as an accompanied autoimmune condition in NMO,121 and the specific biomarker aquaporin-4 antibody （AQP4-Ab） was negative in our patient. In the current report, we present the first case of ON with active AS in a Chinese male patient. The association between the two diseases remains to be evaluated.展开更多
Background:To evaluate the feature of different retinal layer segmentation in neuromyelitis optica spectrum disorders(NMOSD)with spectral-domain optical coherence tomography(SD-OCT)and to compare it with that in multi...Background:To evaluate the feature of different retinal layer segmentation in neuromyelitis optica spectrum disorders(NMOSD)with spectral-domain optical coherence tomography(SD-OCT)and to compare it with that in multiple sclerosis(MS),healthy controls(HC),and idiopathic optic neuritis(ION).Methods:We retrieved four electronic databases,including Pubmed,Embase,Cochrane Library,and Web of Science from inception to September 1st,2021.A meta-analysis was performed to compare different retinal layer segmentation thicknesses between patients with or without a history of optic neuritis(ON)in NMOSD and the control group,including patients with MS,HC,and ION.Results:Forty-two studies were included and the interval between the last ON onset and examination was greater than 3 months.Compared with that in HC eyes,the loss of retinal nerve fiber layer(RNFL)and macular ganglion cell and inner plexiform layer(GC-IPL)was serious in NMOSD eye especially after ON.Moreover,compared with that in ION eyes or MS-related-ON eyes,the injury to the peripapillary retinal nerve fiber layer(pRNFL)was severe in NMOSD-related-ON eyes.In addition,the correlation coefficient between pRNFL and prognostic visual acuity was 0.43.However,the one-arm study revealed the inner nuclear layer(INL)was thickened in NMOSDrelated-ON eyes compared with HC eyes.Conclusions:Inclusion of the RNFL and macular GC-IPL is recommended for monitoring disease progression and attention should be paid to changes in the INL.展开更多
目的：总结儿童视神经炎（ON）的临床特点和预后。方法：回顾性分析2007年1月至2013年1月我院确诊为 ON 的患儿共31例（52眼）的临床资料及随访结果，比较不同临床特征对 ON 转化为多发性硬化（MS）或视神经脊髓炎（NMO）的影响。结果...目的：总结儿童视神经炎（ON）的临床特点和预后。方法：回顾性分析2007年1月至2013年1月我院确诊为 ON 的患儿共31例（52眼）的临床资料及随访结果，比较不同临床特征对 ON 转化为多发性硬化（MS）或视神经脊髓炎（NMO）的影响。结果：10例（32.3%）病前1-3周有上呼吸道感染史，21例（67.7%）双眼起病，初诊视力下降至≤0.1共29眼（55.8%），13例（41.9%）出现视乳头炎；治疗后视力恢复至逸1.0者共21眼（40.4%）。平均随访时间为43.6月（12~84月），9例（29.0%）在随访期间转化为 MS 或 NMO，其中6例诊断为 MS，3例诊断为 NMO。2组复发比例差异有统计学意义（P=0.015）。结论：儿童 ON 双眼起病多见，视力下降严重，治疗后恢复良好。展开更多
基金Municipal Science and Technology Plan Project of Xingtai City,Hebei Province,No.2022ZC232 and No.2022ZC129.
文摘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.
文摘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.
基金National High Level Hospital Clinical Research FundingElite Medical Professionals project of China-Japan Friendship Hospital(No.ZRJY2021-QM24)National Natural Science Foundation of China(No.82174440)。
文摘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.
基金General Project of National Natural Science Foundation of China(No.81574029)。
文摘Objective:To explore the clinical effect of acupuncture combined with traditional Chinese medicine on optic nerve atrophy caused by neuromyelitis optic(NMO).Methods:the patients with optic atrophy caused by NMO with optic neuritis who visited the ophthalmology or neuro-ophthalmology clinic of our hospital from March 2016 to December 2019 were collected.The patients were treated with acupuncture and traditional Chinese medicine for 8 weeks before and after treatment.The best corrected visual acuity and dynamic visual field were tested before treatment,4 weeks and 8 weeks after treatment,respectively,to evaluate the effect of acupuncture combined with traditional Chinese medicine on the visual function of patients;Results:after 4 weeks of treatment,the visual acuity of 8 eyes improved more than 2 lines,the total effective rate was 91.67%.after 8 weeks of treatment,the visual acuity of 12 eyes improved more than 2 lines,the total effective rate was 100%;after 4 weeks of treatment,the mean defect(MD)and mean sensitivity(MS)of dynamic visual field were improved,but the difference was not statistically significant(MD:t=1.579,P=0.121;MS:t=-1.500,P=0.140);after 8 weeks of treatment,the MD was significantly decreased(t=2.65,P<0.05),and the MS was significantly improved and statistically significant(t=-2.58,P<0.05).Conclusion:the combination of acupuncture and Chinese medicine can significantly improve the visual function of patients with optic atrophy caused by NMO,improve the best corrected visual acuity and dynamic visual field sensitivity,and reduce the visual field defect.
文摘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.
基金Supported by The National Multiple Sclerosis Society(NMSS),Guthy-Jackson Charitable Foundation,EMD-Serono/Pfizer,Biogen Idec,Serono and Novartis,and served on advisory board for Biogen Idec(Kister I)
文摘Neuromyelitis optica spectrum disorders, or neuromyelitis optica(NMO), is an autoimmune disease of the central nervous system that must be distinguished from multiple sclerosis. Therapeutic approaches to relapse prevention in NMO include immunosuppressants and monoclonal antibodies. Rituximab, a monoclonal antibody that targets CD20 antigen expressed on the surface of pre-B, mature B-lymphocytes and a small subset of T-lymphocytes, has been widely used for the treatment of NMO. In this review, we aim to summarize global experience with rituximab in NMO. We identified 13 observational studies that involved a total of 209 NMO patients treated with rituximab. Majority of rituximab-treated patients evidenced stabilization or improvements in their disability scores compared to pre-treatment period and 66% of patients remained relapse-free during treatment period. Monitoring rituximab treatment response with CD19+ or CD27+ cell counts appears to improve treatment outcomes. We offer clinical pointers on rituximab use for NMO based on the literature and authors' experience, and pose questions that would need to be addressed in future studies.
文摘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.
文摘Ankylosing spondylitis （AS）, which primarily affects the sacroiliac joints, spine, and enthuses, is a chronic inflammatory rheumatic disorder. Acute anterior uveitis is the most common ophthalmologic involvement, whereas optic neuritis （ON） rarely coexists with AS.r^j ON is an immune-mediated inflammation of the optic nerve, which could be the initiated symptom of multiple sclerosis （MS） or neuromyelitis optica （NMO）. Bilateral simultaneous ON with long enhanced optic nerve lesions in magnetic resonance imaging （MRI） was considered as features of NMO spectrum disorders （NMOSDs）. However, comprehensive review of the current literature showed little evidence of AS as an accompanied autoimmune condition in NMO,121 and the specific biomarker aquaporin-4 antibody （AQP4-Ab） was negative in our patient. In the current report, we present the first case of ON with active AS in a Chinese male patient. The association between the two diseases remains to be evaluated.
基金supported by China-USA intergovernmental Cooperation program(2018YFE0113900).
文摘Background:To evaluate the feature of different retinal layer segmentation in neuromyelitis optica spectrum disorders(NMOSD)with spectral-domain optical coherence tomography(SD-OCT)and to compare it with that in multiple sclerosis(MS),healthy controls(HC),and idiopathic optic neuritis(ION).Methods:We retrieved four electronic databases,including Pubmed,Embase,Cochrane Library,and Web of Science from inception to September 1st,2021.A meta-analysis was performed to compare different retinal layer segmentation thicknesses between patients with or without a history of optic neuritis(ON)in NMOSD and the control group,including patients with MS,HC,and ION.Results:Forty-two studies were included and the interval between the last ON onset and examination was greater than 3 months.Compared with that in HC eyes,the loss of retinal nerve fiber layer(RNFL)and macular ganglion cell and inner plexiform layer(GC-IPL)was serious in NMOSD eye especially after ON.Moreover,compared with that in ION eyes or MS-related-ON eyes,the injury to the peripapillary retinal nerve fiber layer(pRNFL)was severe in NMOSD-related-ON eyes.In addition,the correlation coefficient between pRNFL and prognostic visual acuity was 0.43.However,the one-arm study revealed the inner nuclear layer(INL)was thickened in NMOSDrelated-ON eyes compared with HC eyes.Conclusions:Inclusion of the RNFL and macular GC-IPL is recommended for monitoring disease progression and attention should be paid to changes in the INL.
文摘目的：总结儿童视神经炎（ON）的临床特点和预后。方法：回顾性分析2007年1月至2013年1月我院确诊为 ON 的患儿共31例（52眼）的临床资料及随访结果，比较不同临床特征对 ON 转化为多发性硬化（MS）或视神经脊髓炎（NMO）的影响。结果：10例（32.3%）病前1-3周有上呼吸道感染史，21例（67.7%）双眼起病，初诊视力下降至≤0.1共29眼（55.8%），13例（41.9%）出现视乳头炎；治疗后视力恢复至逸1.0者共21眼（40.4%）。平均随访时间为43.6月（12~84月），9例（29.0%）在随访期间转化为 MS 或 NMO，其中6例诊断为 MS，3例诊断为 NMO。2组复发比例差异有统计学意义（P=0.015）。结论：儿童 ON 双眼起病多见，视力下降严重，治疗后恢复良好。
