Abstract
Purpose: :
To evaluate whether the location of optic nerve (ON) involvement on magnetic resonance imaging (MRI) prognosticates visual outcome in patients with sarcoid optic neuropathy.
Methods: :
Retrospective chart review of cases of sarcoid optic neuropathy seen by two of the authors (LF and RT) between 1989 and 2007 was performed. Only those patients who had a final clinical or histological diagnosis of sarcoid optic neuropathy and had their pre-treatment MRI performed at UMDNJ-NJMS after 1/1/93 were included. Each scan was categorized into normal study, involvement of anterior (distal 1 cm of optic nerve in the orbit), posterior (rest of the orbital optic nerve), intracanalicular, and intracranial ON, or involvement of optic chiasm or tract.
Results: :
Seven patients’ charts and scans were recovered who met the study inclusion criteria (4 female, 3 male, mean age 40). Initial and final visual acuity ranged from 20/20 to no light perception (NLP). Afferent pupillary defects were apparent in all patients at presentation and in 2 at the final visit. Magnetic resonance imaging results revealed one normal, 5 unilateral, and one bilateral optic nerve enhancement. The patient whose imaging was normal required no treatment with spontaneous resolution of vision from hand motion (HM) to 20/20. Among the 5 unilateral cases, one patient with anterior ON involvement and another with posterior orbital and intracanalicular ON involvement recovered 20/20 vision from HM and 20/400 vision, respectively, after treatment with corticosteroids alone. The 3 remaining patients had unilateral orbital ON involvement extending to the chiasm. One of these patients had improvement of vision from counting fingers (CF) to 20/400 after receiving methotrexate and steroids. The other two had final acuity of NLP; one never received any treatment, and the other received solumedrol, kenalog and optic nerve irradiation. The bilateral case was treated with steroids and cyclosporine; the vision improved from 20/80 (right eye) and CF (left eye) to 20/20 and 20/25, respectively.
Conclusions: :
The location of radiographic ON involvement may play a role in predicting the final visual outcome in sarcoid optic neuropathy. This may be a consideration in choosing the initial therapeutic regimen.
Keywords: neuro-ophthalmology: optic nerve • imaging/image analysis: clinical • immunomodulation/immunoregulation