Abstract
Abstract: :
Purpose:To establish the clinical profile of acute bilateral optic neuritis in adults. To document the effectiveness of steroid therapy as well as the time course of recovery by visual acuity, visual field and color vision. To document the visual outcome once steroids were withdrawn. Methods:We performed a retrospective review of patient charts and MRIs who presented with acute bilateral optic neuritis to neuro–ophthalmology service between 2000 and 2003. Exclusion criteria included: known MS, previous treatment for optic neuritis, known systemic diseases associated with inflammatory optic neuropathy, use of medications related to toxic optic neuropathy, uveitis, systemic or intracranial neoplasia. Visual acuity, visual fields, color vision using Ishihara plates, and ophthalmoscopy findings were recorded at baseline, and after stopping prednisone. Baseline MRI, blood serologies, and cerebrospinal results were recorded. Intervention:Patients received IV methylprednisolone, for 3–5 days, followed by oral prednisone for approximately 11 days followed by a gradual dose reduction depending the clinical improvement. Results:There were 7 men and 4 women, between 28–64 years of age, mean of 43. Two related to post viral syndrome, 1 post partum, and 8 of unknown etiology. All patients had lumbar punctures and blood workup that were within normal limits except one that had positive MHA–TP. All but 3 patients presented with ophthalmoscopic evidence of acute bilateral disc swelling, and all presented signs and symptoms of decreased visual acuity, decreased color vision and pain on extraocular movements bilaterally. All 11 patients demonstrated varied defects in Humphrey visual fields (HVF) bilaterally (mean deviation of 11 patients: pre:20.31 OD 23.75 OS). All of the T1 weighted MRIs with gadolinium showed bilateral optic nerve enhancement and only one had intracranial white matter bright signal lesions on T2 weighted images. Follow up was performed, 7 at 6 month, and 4 at 1 year. 82% experienced full recovery, 18% experienced limited recovery (one of the eyes had previous cornea injury 20/200 was his baseline), 2 experienced recurrence, 1 while on tapering oral prednisone therapy and 1 after stopping therapy at 2 weeks with recovery after restarting prednisone. Color vision was fully recovered at discharge or follow up in 9 patients (82%). HVF mean md at follow up were 5.19 OD, 8.14 OS. Conclusion:Acute bilateral optic neuritis without myelopathy is not rare in adults. In the majority of patients, the etiology is presumed to be a post–viral autoimmune process. Vision dysfunction responds to corticosteroid therapy. Good vision outcome is anticipated even after gradual withdrawal of therapy.
Keywords: neuro–ophthalmology: optic nerve