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H. J. Kim, F. Levin, R. E. Turbin, L. Wolansky, L. Bielory, L. P. Frohman; Location of Radiographic Optic Nerve Involvement as a Predictor of Visual Outcome in Sarcoid Optic Neuropathy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):6017.
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To evaluate whether the location of optic nerve (ON) involvement on magnetic resonance imaging (MRI) prognosticates visual outcome in patients with sarcoid optic neuropathy.
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.
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.
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.
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