Visual field characteristics in neuromyelitis optica in absence of and after one episode of optic neuritis.

PURPOSE: Optic neuritis (ON) observed during neuromyelitis optica (NMO) is in most cases very severe and with poor prognosis. This study's objective was to analyze visual field (VF) abnormalities observed in the absence of ON and post-ON episode. METHODS: Twenty-seven cases of both NMO and multiple sclerosis (MS) were selected. Thorough ophthalmologic exam was performed at least 6 months post-ON attack. The VF was collected using the Humphrey 750 perimeter. We used the central threshold tests 24-2 with FASTPAC strategy. The abnormalities were categorized based on the Optic Neuritis Treatment Trial classification. RESULTS: After one ON, 40% of the NMO group's eyes showed total VF loss (P = 0.01), 21% showed abnormalities of neurologic aspect, and 27% showed fascicular abnormalities of which 12% were altitudinal. Given the total VF loss, the positive predictive value in favor of an NMO was 92.8% and the negative predictive value was 47.3%. CONCLUSION: Alterations of the VF during the NMO differ from those observed in the course of the MS. One ON, blinding from the first attack, must call to mind an NMO. The altitudinal deficits point to a vascular mechanism.

Treatment of optic neuritis by plasma exchange (add-on) in neuromyelitis optica.

OBJECTIVE: To assess the contribution of plasma exchange (PE) in association (add-on) with pulsed intravenous corticosteroids in acute optic neuritis of neuromyelitis optica (NMO) and limited forms of NMO. METHODS: Thirty-six patients with optic neuritis were treated from January 1, 1995, through December 31, 2010, with pulsed intravenous corticosteroids and 16 with pulsed intravenous corticosteroids plus PE. The ophthalmologic examination was performed at least 6 months after optic neuritis treatment. Visual acuity and visual field assessed with the Snellen scale and the logarithmic scale of the Early Treatment Diabetic Retinopathy Study were measured using standard automated perimetry and frequency doubling technology perimetry. Retinal peripapillary fiber thickness was measured using optical coherence tomography. RESULTS: Final visual acuity was 20/400 in the corticosteroid group and 20/50 in the PE group (P=.04). The gain in visual acuity was 20/200 in the corticosteroid group and 20/30 in the PE group (P=.01). A poor final visual acuity outcome (≤20/200) was found in 19 of 36 patients (53%) in the corticosteroid group and 2 of 16 patients (13%) in the PE group (P=.008). Mean (SD) thickness of peripapillary retinal nervous fibers was 63.1 (20.4) µm in the corticosteroid group and 70.3 (20.3) µm in the PE group (P=.16). The mean (SD) thickness in the temporal quadrant was 38.5 (14.1) µm in the corticosteroid group and 44.5 (12.7) µm in the PE group (P=.02). In multivariate analysis, PE treatment was the only independent factor associated with a visual acuity greater than 20/200. CONCLUSION: In optic neuritis associated with NMO, sequential treatment with pulsed intravenous corticosteroids and PE is more effective than standard monotherapy with corticosteroids on visual acuity outcome.

Anatomic and functional correlation of frequency-doubling technology perimetry (FDTP) in multiple sclerosis.

To study the correlation between the results of frequency-doubling technology perimetry (FDTP), visual function (visual acuity, contrast vision, standard automated perimetry (SAP)) and the thickness of the retinal nerve fiber layer (RNFL) throughout the course of multiple sclerosis (MS). Sixty-six eyes of thirty-three patients suffering from MS were chosen. Thirty-five eyes had a previous history of optic neuritis (ON group) and thirty-one eyes had no previous history of optic neuritis (non-ON group). The FDTP was performed with the N-30 screening program. Visual acuity was determined with the Snellen scale and the ETDRS (Early Treatment Diabetic Retinopathy Study) scale, the contrast vision with the Pelli-Robson and Sloan tests and the SAP with the Humphrey 750 perimeter. The thickness of the RNFL was measured using the STRATUS OCT™ optical coherence tomography (OCT). The visual field FDTP was divided into three sectors corresponding to the three SAP sectors and to the three RNFL quadrants of the OCT. The FDTP was significantly correlated (P<0.0001) to the contrast vision and to the SAP results (mean deviation (MD) and the different sectors among themselves). In the ON group, the MD FDTP was significantly correlated to the average RNFL thickness (r=0.44, P=0.0091). A decrease of 5 decibels (dB) of the MD FDTP corresponded to a decrease of 11.7 µm of the average RNFL thickness (Y=2.34×X+87.5). The strong correlation with SAP and RNFL confirms the value of FDTP in assessing optic nerve damage throughout the course of MS.

[Alternatives to mutilating surgery. ]. / Une alternative à la chirurgie mutilante.

OBJECTIVE: The purpose of this study is to suggest an alternative surgery to mutilating exenteration and enucleation surgeries in the management of nonfunctional, unattractive, and painless eyes. The suggested alternative is lamellar keratectomy with conjunctiva recovery. DESIGN: Retrospective study. PARTICIPANTS: Four patient cases in a unit with the benefit of this technique. METHODS: The surgical processes and results of the four cases were reviewed. RESULTS: Postoperative results were most satisfactory with good esthetic results and, above all, a better psychological experience of surgery. CONCLUSIONS: For a nonfunctional, unattractive, and painless eye, lamellar keratectomy with conjunctiva recovery appears to be an appealing alternative to nonconservative eyeball surgeries.

Retinal nerve fiber layer thickness and spatial and temporal contrast sensitivity in multiple sclerosis.

PURPOSE: To measure peripapillary retinal nerve fiber layer (RNFL) thickness and spatial and temporal contrast sensitivity in multiple sclerosis (MS) taking into account previous history of optic neuropathy (ON). METHODS: Thirty patients (60 eyes) with relapsing-remitting MS were selected (MS group). The MS ON group was composed of 31 eyes with previous history of optic neuropathy and the MS non-ON group of 29 eyes was without previous history of optic neuropathy. Thickness of the RNFL was measured with optical coherence tomography (OCT) with the Stratus OCT. As for sensitivity to spatial contrast,we used Pelli-Robson and Sloan charts. Sensitivity to temporal contrast was explored using frequency doubling technology perimetry (FDTP). RESULTS: The average thickness of RNFL in the MS, MS ON, MS non-ON, and control groups were 88.2 +/= 18.9 microm, 80.81 +/- 18.4 microm, 96.7 +/- 15.8 microm, and 106 +/- 12.2 microm, respectively. The spatial contrast vision and FDTP results were less in the MS non-ON group than in the control group. The average thickness of RNFL correlated to the scores of spatial and temporal contrast vision. CONCLUSIONS: MS is accompanied by visual function alteration even in the absence of acute optic neuropathy. The important correlation between functional and anatomic aspect confirms the value of OCT to appreciate the subclinical involvement of the optic nerve. Associated with tests exploring visual function, the OCT could reveal itself pertinent in evaluation of the different therapeutics used in MS ON.

Retinal peripapillary nerve fiber layer thickness in neuromyelitis optica.

PURPOSE: To measure the thickness of retinal peripapillary nerve fibers throughout the course of neuromyelitis optica (NMO). METHODS: This study was of a cross-sectional design, examining the thickness of the retinal peripapillary nerve fiber layer by optical coherence tomography, in patients with NMO (n = 15; 30 eyes), patients with multiple sclerosis (MS; n = 15; 30 eyes), and a control group (n = 23; 46 eyes). The thicknesses were acquired according to protocol with the fast RNFL (Retinal Nerve Fiber Layer) procedure. The study of visual function includes for each eye a determination of refraction, measurement of visual acuity, measurement of contrast vision, an analysis of color vision, and a frequency-doubling technology perimetry (FDTP). The main outcome measurements were the thickness of the retinal peripapillary nerve fibers, visual acuity, and scores of contrast vision. RESULTS: The average thickness of retinal peripapillary nerve fibers was respectively in the NMO, MS, and control group: 65.44 +/- 24.19, 83.85 +/- 24.12, and 106.24 +/- 12.46 microm (P = 0.01). The average thickness of retinal peripapillary nerve fibers correlated to visual acuity, the scores of contrast vision, the scores of FDTP, and the number of episodes per patient (r = -0.58, P = 0.03). CONCLUSIONS: This is the first study to produce measurements of the thickness of retinal peripapillary nerve fibers during optic neuropathies of NMO. The optic neuropathies of NMO are also accompanied by an acute and chronic axonal loss, as clearly illustrated by the OCT.

Familial bilateral polypoidal choroidal vasculopathy.

PURPOSE: Description of the clinical and angiographic manifestations of polypoidal choroidal vasculopathy (PCV) in two brothers of West Indian origin. METHOD: Case reports. RESULTS: In Case 1 (82-year-old), the disease presented when the patient was 50 years old with decreased visual acuity in the right eye. Onset of symptoms in the left eye occurred 30 years later. Visual acuity was limited to good luminous orientation in both eyes. In Case 2 (78-year-old), the disease presented in the right eye when the patient was about 68 years old. Visual acuity in the right eye was reduced to good luminous orientation. Symptoms in the left eye appeared 10 years later. Visual acuity in the left eye was 20/100. In both patients, medical history was significant only for arterial hypertension. There was no intraocular inflammation or ocular hypertonicity. Indocyanine green angiography revealed hyperfluorescent polypoidal dilatations at early and intermediate phases, characteristic of PCV. CONCLUSION: These observations argue in favor of a genetic component in PCV.

Natural history of the visual impairment of relapsing neuromyelitis optica.

PURPOSE: To describe the clinical features and natural history of the visual impairment of relapsing neuromyelitis optica. DESIGN: Prospective observational case series. PARTICIPANTS: Thirty patients of Afro-Caribbean origin with neuromyelitis optica and 47 patients with multiple sclerosis. METHODS: A complete ophthalmologic examination was performed with each ocular attack and during a remission period at least 6 months after the last attack. MAIN OUTCOME MEASURES: Incidence of unilateral and bilateral optic neuritis and incidence of unilateral and bilateral severe visual loss, defined as visual acuity (VA) < or = 20/200. RESULTS: Twenty-eight patients (93%) with neuromyelitis optica were female and 2 (7%) were male. The mean age of onset was 30+/-10.5 years. Mean disease duration was 9.5+/-5.4 years. Neuromyelitis optica first manifested by an episode of optic neuritis in 23 cases (76.6%), bilateral in 4. The average number of ocular attacks per patient was 2.7+/-1.6. Twenty-one patients (70%) showed impairment in both eyes. Median times from onset to unilateral optic neuritis, bilateral optic neuritis, mono-ocular severe visual loss, and binocular severe visual loss were 0+/-0.08, 1+/-1.6, 2+/-0.8, and 13+/-3 years, respectively. Fifteen patients (50%) experienced severe visual loss in both eyes and 6 (20%) in one eye. Severe visual loss occurred in as few as 2 attacks. CONCLUSION: This study is the largest series of relapsing neuromyelitis optica in a population of African descent. Neuromyelitis optica's visual impairment is very severe; it contrasts drastically with that typically observed in multiple sclerosis. We confirmed that the prognosis for optic neuritis in patients with neuromyelitis optica is worse than the prognosis in patients with multiple sclerosis.

Prevalence of open angle glaucoma in a diabetic population in Martinique

OBJECTIVE: To determine the prevalence of open angle glaucoma in a hospital-based sample of diabetic people living in Martinique. DESIGN: Retrospective study during 23 months. PARTICIPANTS: A total of 917 patients were examined and received a complete eye examination for diabetes. MAIN OUTCOME MEASURES: A form was established with all examination data, patient ID, non ophthalmological data (blood pressure, body mass index, type of diabetes...) and ophthalmological data with intra-ocular pressure and optic disc cup. RESULTS: Glaucoma was present in about 9.8 percent of patients and there were 3.28 times more females than male. With regard to the type of diabetes, 1.11 percent were type 1, 18.89 percent were type 2, and 80 percent were insulin treated but not all insulin dependent. The prevalence of diabetic retinopathy is similar in the glaucomatous group and in the non-glaucomatous group. High blood pressure was present in 80 percent of glaucoma patients versus 58.8 percent in the non-glaucoma group. CONCLUSION: This 9.8 percent prevalence of glaucoma is the only data on open angle glaucoma so far available in Martinique. High blood pressure is a main risk factor for glaucoma in Martinique. Diabetes represents also a risk factor for glaucoma in Martinique. The sex ratio showed 3 times more females than males in the diabetic population. (AU)

Ocular alkali burns: limbal autograft

The authors present five patients treated with limbal autograft for serious recent ocular alkali burns, in four of whom it has permitted healing of recurrent corneal ulcers or the reduction in the period of conjunctival recovery. Functional amelioration is also important and this intervention has permitted a useful visual acuity. One case was complicated by bacterial keratitis, but our experience has confirmed the efficacy of the technique for managing surface ocular disorders. However there have been few reports hitherto of the use of limbal autografts for serious ocular burns, and our study has demonstrated its usefulness in this setting and the appropriate timing. VIDEOTAPES(U-Matic or VHS): The authors report their surgical technique of limbal autograft use in recent and severe ocular burn, a modification of Kenyon and Tseng's technique. The physical signs used as indicators for surgery, the selection of the limbal region and methods of following the graft, are presented.(AU)