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.

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.

Clinical Observation on Treatment of Acute Retrobulbar Optic Neuritis with Integrated Traditional Chinese and western medicine

Objective: To evaluate the clinical effect of integrated Chinese and Western medicine in treating acute retrobulbar optic neuritis. Methods: Combined Therapy of modified prescription of Danzhi Xiaoyao San and Taohong Siwu Decoction and Mailuoning was applied to 12 patients (13 diseased eyes) and changes of such criteria as visual acuity, optic fundus, visual field, fundus fluorescein angiogram, pattern visual evoked potential and contrast sensitivity were observed. Results: 5 eyes (38. 46 % ) were cured, 5 (38. 46% ) markedly effective, 2 (15. 38% ) effective and 1 ineffective, the total effective rate being 92. 31 %. After treatment, visual acuity of 10 eyes was elevated to over 1. 0, and the other criteria were also improved in various degrees. Conclusion: The program of integrated therapy was effective in treating acute retrobulbar optic neuritis.