Detection of mild papilloedema in posterior uveitis using spectral domain optical coherence tomography.

OBJECTIVE: To compare two methods for diagnosing mild papilloedema (PO) using peripapillary total retinal (PTR) and retinal nerve fibre layer (RNFL) thickness measurement by spectral domain optical coherence tomography (OCT) in patients suffering from posterior uveitis. METHODS: 17 eyes in 17 patients with PO caused by posterior uveitis, 15 eyes in 15 patients with uveitis but with no PO based on slit lamp analysis were studied. High-quality OCT fundus images were analysed and graded by three masked observers using the Modified Frisén Scale. Eyes with PO were divided into two subgroups: mild (n=15) and moderate-severe PO (n=2). Two measurement methods were evaluated and compared: RNFL and PTR thickness measurements centred on the optic disc. Thickness values were calculated overall and for each quadrant and compared between groups. The main outcome measures were RNFL and PTR thickness, and thickness variation between control and affected patients for both protocols. RESULTS: Average RNFL and PTR thickness in the moderate-severe PO, mild PO and control groups were 274.5±54.45 µm, 134±31.69 µm, 97.4±14.43 µm and 722.25±29.34 µm, 437.53±84.47 µm, 327.8±25.92 µm, respectively. Mild PO differed from the control groups according to both the RNLF (p=0.0006) and the PTR (p=0.0002) measurements. The average thickness variation between control and mild PO was significantly different between RNFL and PTR measurements: 36.6 µm vs 109.73 µm (p<0.0001), respectively. CONCLUSIONS: PTR thickness measurement increases the sensitivity of detection of mild PO and could be useful for diagnosing and monitoring papillitis. A new protocol should be developed to measure PTR in the same 3.5 mm disc as the RNFL measurement.

Persistent ocular motor manifestations and related visual consequences in multiple sclerosis.

Abnormal eye movements in multiple sclerosis (MS) are often persistent and known to be associated with general disability. However, there is no precise knowledge concerning their incidence and resulting visual handicap. The aim of our study was to describe the persistent ocular motor manifestations in MS and relate them to visual functions tested with visual acuity and with a vision-related questionnaire. We selected 24 MS patients complaining of persistent visual disability associated with ocular motor manifestations without any anterior visual pathway deficit. Internuclear ophthalmoplegia was the most frequently observed symptom, followed by gaze-evoked nystagmus, saccadic hypermetria, and then pendular nystagmus. Pendular nystagmus, saccadic hypermetria, and the association of internuclear ophthalmoplegia and gaze-evoked nystagmus were associated with decreased visual acuity and visual functional scores. There was a correlation between the number of abnormal eye movements and visual functions. This study demonstrates that ocular motor dysfunction in MS induces specific visual dysfunction and handicap.