[Etiologic analysis of 487 cases of ophthalmoplegia].

OBJECTIVE: To study the etiology of ophthalmoplegia cases. METHODS: A retrospective case series study. We summarized and analyzed etiological diagnosis of 487 ophthalmoplegia patients from January 2005 to September 2010 in Beijing Tongren Hospital of Capital Medical University and Beijing Tongren Eye Center. Clinical data included the case history, clinical manifestations, and results of examinations of neurology, ophthalmology, endocrinology and iconography. The analysis of variance (ANOVA) and Chi-Square test were used in our study. RESULTS: Nineteen different kinds of causes were identified. In terms of age onset, microvascular ischemic (MVI) patients were the oldest (60.38 +/- 11.16) in all groups. It significantly distinguished from myasthenia gravis (MG) and local non-specific inflammation (F = 24.46, P = 0.000). From the view of ophthalmoplegia characters, bilateral asymmetry ophthalmoplegia was the character of MG. We also found that all MVI patients had lesions in unilateral single ocular movement nerve. Unilateral multiple nerves or muscles lesions were the main feature of local non-specific inflammation. In addition, from the view of concomitant symptoms, local aching was very frequent in local non-specific inflammation (all 60 cases) and MVI (44 cases) patients (Chi2 = 36.346, P = 0.000). The mild pupil changing could be found in about one half patients of the two diseases (Chi2 = 0.026, P = 0.875). CONCLUSIONS: The causes of ophthalmoplegia are very complicate. MG, MVI and local non-specific inflammation are the most frequent causes. In more than half of patients, the lesions are located in neurological system, about one third located in neuromuscular junction and the least in the muscles.

[Clinical characteristic of optic neuritis and its relevancy with human leukocyte antigen].

OBJECTIVE: To investigate clinical characteristics of optic neuritis and its association with HLA (human leukocyte antigen). METHOD: The clinical data of 42 patients with optic neuritis were collected and flow polymerase chain reaction-reverse sequence specific oligonucleotide probe (PCR-rSSOP) was used to determine the genotype of HLA-DRB1. RESULTS: Two patients confirmed as Leber hereditary optic neuropathy by gene sequencing were excluded from the study. The complaint of pain was found in the patients (31/40) of optic neuritis. The visual field defect varied with patients and central and pericentral scotoma were demonstrated in 7 patients of 17. Of 40 patients with optic neuritis, 20 (50.0%) showed multifocal brain lesions in white matter by MR scanning. 26 of 38 patients had increased STIR signals. Inflammatory demyelinating changes were found in cerebral spinal fluid in 21 patients (80.8%). Out of demonstrated brain abnormal was revealed in 29 (72.5%) patients using MRI and/or CSF examination. The rate of HLA-DRB1(*)15 in the patients (35.0%) was much higher than control (19.4%), (chi(2) = 4.2328, P = 0.0397). Frequencies of HLA-DRB1(*)15 increased significantly in 26 female patients. The increased frequencies of HLA-DRB1(*)15 were associated with CSF abnormality and no relevancy was found with onset times, brain MR changes and increase of optic nerve signals. Acute optic neuritis responded well to intravenous megadose of methylprednisolone or immunoglobulin. CONCLUSIONS: Most of optic neuritis was characterized as clinical inflammatory demyelinating disease. HLA-DRB1(*)15 might correlated with genetic susceptibility of female patients with optic neuritis.