A Case of Posterior Ischemic Optic Neuropathy Accompanied by Carotid Artery Plaque

PURPOSE: To report a case of posterior ischemic optic neuropathy accompanied by carotid artery plaque in a patient with retrobulbar optic neuritis. CASE SUMMARY: A 48-year-old man visited our clinic complaining of headache, decreasing visual acuity and defect of inferior visual field in his left eye for 3 days. The best corrected visual acuity was 1.0 in the right eye and 0.1 in the left eye. The anterior segment state, intraocular pressure, fundus examination and optical coherence tomography were normal in both eyes. Relative afferent pupillary defect, color vision deficiency and total scotoma were observed in his left eye. The results of the laboratory test and brain magnetic resonance imaging were normal. He was discharged from the hospital after 3 days of systemic steroid treatment on the basis of retrobulbar optic neuritis. A week later, fluorescent angiography and carotid ultrasonography were performed because of his history memory loss and left upper limb weakness before admission. A focal filling defect of the peripapillary area was found on fluorescent angiography. A plaque with a thickness of 1.9 mm and a length of 1.4 cm was found on carotid ultrasonography. After 6 months, the best corrected visual acuity was 0.4 in the left eye and the visual field showed a partially improved defect. CONCLUSIONS: Fluorescent angiography is recommended for potential posterior ischemic optic neuropathy in patients with retrobulbar optic neuritis, even though it is rare. Carotid ultrasonography is useful in finding atherosclerosis to prevent stroke or cardiovascular disease if ischemic cause is suspected on fluorescent angiography.

Caracterización de los pacientes con neuritis óptica que consultaron al servicio de oftalmología del Hospital de San José / Clinical features of optic neuritis patients at Hospital de San José ophthalmology department

Objetivo: describir y caracterizar los pacientes con neuritis óptica que asisten al servicio de oftalmología del Hospital de San José. Diseño: estudio observacional retrospectivo. Métodos: se revisaron historias clínicas de pacientes que asistieron a la consulta de oftalmología desde septiembre de 2007 hasta agosto de 2012 y se tomaron todos los pacientes con diagnóstico de neuritis óptica. Se revisaron en total 174 historias clínicas, de las cuales 78 cumplieron los criterios de inclusión y 96 fueron excluidas. Resultados: La mayoría de los pacientes con neuritis óptica en este estudio, tuvieron esclerosis múltiple (34%). Al inicio del episodio agudo, la mayoría de los pacientes tenían AV entre MM y CD, con recuperación visual significativa a 20/70 o mejor (55%). Los pacientes presentaron comúnmente defecto pupilar aferente relativo, saturación al rojo disminuida y alteraciones del campo visual. El tipo de neuritis más frecuente fue la neuritis óptica retrobulbar. Conclusiones: la neuritis óptica es una patología que presenta características clínicas variables y su etiología puede corresponder a gran variedad de patologías según su clasificación. De la realización de una buena historia clínica y un adecuado examen oftalmológico, la evaluación interdisciplinaria, se puede hacer un diagnóstico adecuado y rápido para el manejo y estudio de ésta patología; disminuyendo así las complicaciones que puedan afectar definitiva e irreversiblemente la calidad de vida de los pacientes que la presentan.

Objective: to describe and characterize patients with optic neuritis attending the ophthalmology department of the Hospital de San José. Design: retrospective observational study. Methods: review of medical records of patients attending the ophthalmology department from September 2007 until August 2012. All patients diagnosed with optic neuritis were reviewed. A total of 174 records; 78 of them met the inclusion criteria and 96 were excluded. Results: 34% of patients with optic neuritis in this study had multiple sclerosis. At the beginning of the episode, most patients had visual acuity between HM and CF, with significant visual recovery to 20/70 or better (55%). Patients frequently presented relative afferent pupillary defect, decreased in red saturation and visual field defects. The most common type of neuritis found was retrobulbar optic neuritis.

Additional Retrobulbar Triamcinolone Acetonide Injection for Retrobulbar Optic Neuritis Patients

PURPOSE: To evaluate the effect of additional retrobulbar triamcinolone acetonide (TA) injection on early recovery of visual acuity in retrobulbar optic neuritis patients. METHODS: A prospective, randomized clinical study including 30 patients with retrobulbar optic neuritis was conducted between March 2003 and June 2007. Patients were divided into 2 groups: Group 1 (n = 9) with retrobulbar triamcinolone (TA, 40 mg/1 ml) injection on the first day of ONTT protocol, and group 2 (n = 21) with conventional ONTT protocol. The following parameters were measured and analyzed: patient's sex, age, pupillary reactions, color vision, visual field, and best-corrected visual acuity before treatment, and after 1 day, 1 week, 2 weeks, 1 month, and 3 months of follow-up. RESULTS: Mean visual acuity before treatment was 1.00 +/- 0.89 log MAR units in group 1 and 0.98 +/- 0.75 log MAR units in group 2. One day after injection, visual acuity was better in group 1 (0.50 +/- 0.42 log MAR units) than in group 2 (0.73 +/- 0.61 log MAR units), however, there was no statistically significant difference between the 2 groups (p = 0.07). There was no significant difference in visual acuity, recovery of RAPD, color vision, or visual field at 3 months of follow-up. No serious side effect related to retrobulbar TA injection was observed. CONCLUSIONS: Additional retrobulbar TA injection may help optic neuritis patients who have a need for prompt visual recovery. However, further studies are required to ascertain whether this procedure can help early recovery of visual acuity in retrobulbar optic neuritis patients.

Ret robulbar Optic Neuritis Associated with Multiple Sclerosis: Two Cases

Optic neuritis is one of the most important clinical manifestations of multiple sclerosis. We experienced 2 cases of retrobulbar optic neuritis associated with multiple sclerosis. One was a 14-year-old female patient who presented with decreased visual acuity and visual field defect in right eye followed by paralysis of both lower extremities and the other was a 39-year-old female patient who presented with repeated paresthesia and motor weakness of upper and lower extremities then rapid decrease in visual acuity in both eyes. Both patients had relative afferent pupillary defect, color perception abnormality, variable visual field defect and abnormality in VEP. In fundus exam and fluorescene angiography, there was no specific abnormal finding. T2 weighted MRI showed multiple high signals corresponding to plaques. These two patients were diagnosed as multiple sclerosis. We should keep in mind that retrobulbar optic neuritis could be associated with multiple sclerosis as a presenting sign or as a manifestation during its clinical course.