The Effect of Corticosteroids for Acute Optic Neuritis on the Subsequent Development of Multiple Sclerosis

Rw, Beck; Pa, Cleary; Trobe, Jonathan D.; Di, Kaufman; Mj, Kupersmith; Dw, Paty; Ch, Brown

doi:10.1056/nejm199312093292403

Cited by 516 publications

(212 citation statements)

References 30 publications

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“…[1][2][3] Benefit from treatment with intravenous steroid in prevention from multiple sclerosis (MS) has also been extensively analyzed. [4][5][6][7] However, these studies were mostly confined to young adults. Optic neuritis in children is considered to be a totally different entity in contrast to adults.…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics of optic neuritis in Taiwanese children

Sun

et al. 2011

Eye

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Section: Introductionmentioning

confidence: 99%

Clinical characteristics of optic neuritis in Taiwanese children

Sun

et al. 2011

Eye

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“…Recovery of visual function, visual field testing abnormalities, pain induced by ocular movements, cup-to-disc ratio, presence and/ or distribution of optic disc oedema and fluorescein angiography together which age at diagnosis may help to differentiate optic neuritis (ON) and nonarteritic anterior ischemic optic neuropathy of disc oedema, young age (≤ 35 years), ocular pain associated with eye movements, recovery of visual function in the first month of follow up, no other ocular pathology, no neurological diseases that might influence or explain the patient's visual symptoms; history or detection of multiple sclerosis confirmed the diagnosis [17].…”

Section: Discussionmentioning

confidence: 99%

Mass Dimension Evaluation of the Optic Nerve Head Microvascularity in Non-Glaucomatous Optic Neuropathies

Bianciardi¹

2016

Int J Oral Craniofac Sci

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In several diseases, fractal analysis has been proven useful to give contribution in diagnosis and prognosis of the patient and to improve treatments. In the present work we have evaluated the mass dimension of the vascular pattern of optic nerve head in non-glaucomatous optic neuropathic patients and healthy controls. Static fluorescein angiogram was performed and the images of the early venous phase were saved. A manual outline of the trajectories of the two-dimensional vascular network was performed down to vessels of 20 micron diameter, processed to threshold the vessel network without background interference and converted into an outline of single pixels and then the fractal analysis was performed. Mass dimension evaluation of the optic nerve head microvascularity was able to differentiate health condition vs. non-glaucomatous neuropathies (p<0.01), as well optic neuritis vs. nonarteritic anterior ischemic optic neuropathy (p<0.01), with high sensitivity and specificity (p<0.0001; p<0.0001). Mass dimension index shows a significantly increased vascular complexity of the optic nerve head in cases compared with controls, also permitting to distinguish between patients affected by optic neuritis vs. nonarteritic anterior ischemic optic neuropathy. This new, fast, unexpensive, methodology may be used in helping the clinician to perform the differential diagnosis between the pathologies and to study the effect of therapies during the follow up of the patient.(NAION) is difficult to be performed on clinical grounds, both giving overlapping clinical profiles [15]. However, it is fundamental to establish an early differential diagnosis, having the ON patient a clear tendency to develop multiple sclerosis, a disease where therapies should be performed as early as possible [16]. In order to verify whether the fractal analysis of the optic nerve head microvascularity could help in the differential diagnosis between ON and NAION, we have evaluated the mass dimension of the optic nerve head vascular pattern, as revealed by fluorescein angiography. SubjectsPatients with unilateral NAION or unilateral idiopathic ON were recruited from the Department of Ophthalmology of the University of Siena. Each patient underwent a complete neuro-ophthalmic examination, including assessment of visual acuity, colour vision, papillary reaction, slit-lamp examination, applanation tonometry, Goldman visual field testing, visual evoked potentials, dilated fundoscopy and fluorescein angiogram.The criteria for patients' admittance with NAION to the study were: unilateral disc swelling with clinical features consistent with NAION [16], no recovery of visual function in the first month of follow up, exclusion of arteritic anterior ischemic optic neuropathy either on clinical grounds or following a negative temporal artery biopsy, negative magnetic resonance imaging of the brain and orbits, no other ocular pathology, no neurological diseases that might influence or explain the patient's visual symptoms. The patient admittance criteria wi...

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“…All patients were admitted and received intravenous methylprednisolone (250 mg every 6 h for 3 days) followed by oral prednisolone (1 mg/kg) for 11 days. 15 Patients with any of the following conditions were excluded from the study: a known history of MS or other demyelinating events, bilateral ON, recurrent ON, age < 20 or 465 years, refractive error of < − 6.0 diopters or 4+3.0 diopters (spherical equivalent), media opacities, intracranial lesion or neurologic disorder, systemic medication that may induce optic neuropathy, a history of ocular surgery, and other ocular pathology that may affect OCT measurements including glaucoma and retinal disease. Patients who underwent any treatment before the visit to our clinic and who had a previous history of visual loss or other ocular abnormalities that cause visual loss were also excluded.…”

Section: Diagnosis Of Onmentioning

confidence: 99%

Retinal ganglion cell and axonal loss in optic neuritis: risk factors and visual functions

Lee

Park

et al. 2016

Eye

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Purpose The peripapillary retinal nerve fiber layer (pRNFL) and the macular ganglion cellinner plexiform layer (GCIPL) are important predictive factors for the prognosis of optic neuritis (ON). We investigated the risk factors for pRNFL and GCIPL thinning in ON and its relationship with visual function. Patients and methods We analyzed 33 eyes of 33 patients with a first attack of unilateral ON. Patients were divided into two groups according to pRNFL and GCIPL thinning, using spectral-domain optical coherence tomography. We evaluated patients' age, sex, color vision, visual acuity (VA), optic nerve findings on MRI, elapsed period from onset of visual symptoms to steroid treatment, visual field (VF) mean deviation (MD), average pRNFL thickness, and GCIPL thickness. Results There was no patient with residual VF defect in the groups without pRNFL or GCIPL thinning. Significant correlations were found between pRNFL (some sectors) and GCIPL (all sectors) thickness and BCVA and VF MD (Po0.03 for all). Multivariate logistic regression analysis revealed that only worse initial VF MD was a significant risk factor of pRFNL and GCIPL thinning after ON (OR, 0.841; 95% CI, P = 0.017 and OR, 0.871; 95% CI, P = 0.046, respectively). Conclusion Retinal ganglion cell and axonal losses occurred in ON cases showing severe initial VF loss. Therefore, it is necessary to pay more attention to the degree of initial VF loss in ON while considering the possibility of residual VF loss accompanying pRNFL and GCIPL thinning.

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The Effect of Corticosteroids for Acute Optic Neuritis on the Subsequent Development of Multiple Sclerosis

Abstract: In patients with acute optic neuritis, treatment with a three-day course of high-dose intravenous methylprednisolone (followed by a short course of prednisone) reduces the rate of development of multiple sclerosis over a two-year period.

Cited by 516 publications

References 30 publications

Clinical characteristics of optic neuritis in Taiwanese children

Clinical characteristics of optic neuritis in Taiwanese children

Mass Dimension Evaluation of the Optic Nerve Head Microvascularity in Non-Glaucomatous Optic Neuropathies

Retinal ganglion cell and axonal loss in optic neuritis: risk factors and visual functions

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