Effects Of IntraVenous MethylPrednisolone On Outcome In MRI-Based Prognostic Subgroups In Acute Optic Neuritis
Kapoor R, Miller DH, Jones SJ, Plant GT, Brusa A, Gass A, Hawkins CP, Page R, Wood NW, Compston DA, Moseley IF, McDonald WI
Neurology 1998 Jan;50(1):230-7
Univ, Dept of Clinical Neurology, Institute of Neurology, National Hospital for Neurology and NeuroSurgery, London, UK
UI # 98103722
Treatment of Acute Optic Neuritis with Steroids has been shown to hasten visual recovery without affecting the final degree of recovery.
However, MRI-clinical studies indicate that patients with long Optic Nerve lesions, particularly those that involve the Nerve within the Optic Canal, may have a worse prognosis for recovery of Vision.
Partly because such lesions could lead to swelling and subsequent ischemic Optic Nerve damage, Steroids could have a selective beneficial effect on this subgroup of patients. The present randomized trial was designed to test this possibility.
Sixty-six patients with Acute Optic Neuritis received IV saline or IV MethylPrednisolone. The clinical, psychophysical, electrophysiologic, and MRI outcomes were assessed after 6 months.
Patients with short lesions presented earlier than those with long lesions (involving three or more 5-mm-thick slices of any part of the Optic Nerve.
As well as its IntraCanalicular portion), and lesion length was significantly less in patients presenting within a week of onset of symptoms.
Lesions also tended to lengthen during follow-up in individual patients. Treatment did not limit lesion length in either the long or short lesion subgroup and had no significant effect on final Visual outcome.
We conclude that Steroids do not improve Visual outcome or lesion length in patients with Acute Optic Neuritis.
- Comment in: Neurology 1998 Nov;51(5):1516-7
Optic Neuritis And Vitamin C
Ichibe Y, Ishikawa S
Nippon Ganka Gakkai Zasshi 1996 May;100(5):381-7
Kitasato University, Dept of Ophthalmology, School of Medicine, Kanagawa, Japan
UI # 96253053
Twenty five patients with Optic Neuritis (ON) of unknown etiology were treated with a high dosage of IntraVenous Vitamin C.
We measured blood levels of Vitamin A, B1, B2, B6, B12, C, E, Folate and Zinc. All levels were compared with the normal values of our laboratory.
The blood level of Vitamin C (p < 0.001) was significantly less than the mean value of the normal. The blood levels of Vitamin E, B6 (p < 0.01) and Zinc (p < 0.001) also significantly decreased.
IntraVenous administration of Vitamin C was given in those patients with decreased blood level of Vitamin C.
In order to compare the effect on Vision by this treatment, the amplitude of recovery of Vision, the time needed to attain the maximum Vision, and the speed of Visual recovery were analyzed. The results were compared with groups receiving other treatments.
That is, Group A received IntraVenous administration of high dosage of Vitamin C, Group B, IntraVenous pulse administration of CorticoSterone, Group C, oral administration of CorticoSterone, and Group D, oral administration of Vitamin B12.
Vision was significantly improved in all groups. There was no significant difference in improvement of Visual Acuity.
IntraVenous administration of Vitamin C can be evaluated as the method of choice for the treatment of patients with ON. A possible mode of action by Vitamin C on free radicals is discussed.
IntraVenous MethylPrednisolone In Treatment Of Traumatic Optic Neuropathy
Chen HY, Tsai RK, Wang HZ
Kao Hsiung I Hsueh Ko Hsueh Tsa Chih 1998 Sep;14(9):577-83
Kaohsiung Medical College, Dept of Ophthalmology, Taiwan, Republic of China
UI # 99012294
Traumatic Optic Neuropathy is one of true Ophthalmic emergencies and there is no proven form of treatment for traumatic Optic Neuropathy.
Here we were presented with 30 cases of sudden visual loss following blunt eye trauma seen in Kaohsiung Medical College Hospital, Taiwan from April 1994 to March 1997.
We analyze the treatment style, Visual Acuity, elapsed time since injury and orbit computed tomography retrospectively.
Among them, 21 cases received IntraVenous MethylPrednisolone treatment, 2 cases received Oral Prednisolone.
2 cases underwent Optic Canal decompression in addition to IntraVenous MethylPrednisolone and 5 cases were carefully monitored without any kind of treatment.
Thirteen of the 21 cases (62%) in IntraVenous MethylPrednisolone group got Visual improvement.
Patients with initial Vision better than light perception benefitted more from treatment than did the patients who with no light perception in medical treatment group (85% VS 20%) (p < 0.05).
Thirteen of the 30 cases (53.3%) had Orbit fracture and 2 of the 30 cases (6.7%) had a fracture of the Optic Canal.
These two cases also received Optic Canal decompression surgery in addition to IntraVenous Steroid treatment but the prognosis was poor.
In conclusion, IntraVenous MethylPrednisolone does offer help in traumatic Optic Neuropathy. Whether or not initial Visual Acuity was better than light perception was a key risk factor in the outcome.
In this article, we also compare our results with other series in the literature and found that the value of different treatment in traumatic Optic Neuropathy still needs to be prospectively judged in the future.
Visual Function In Patients With Optic Neuritis Associated With Acute Transverse Myelopathy In Multiple Sclerosis
Harada T, Ohashi T, Fukazawa T, Miyagishi R, Moriwaka F, Chin S, Yoshida K, Matsuda H
Jpn J Ophthalmol 1995;39(3):290-4
Hokkaido Univ, School of Medicine, Dept of Ophthalmology, Sapporo, Japan
The authors reviewed the records of 20 patients with Optic Neuritis, all of whom were diagnosed as having clinically definite Multiple Sclerosis (MS).
They were classified into two subgroups: Group A, consisting of 9 patients who had shown Acute Transverse Myelopathy (ATM); and Group B, 11 patients without ATM.
Four patients (44%) in Group A had complete visual loss, but none in Group B.
Six patients (67%) in Group A had less than 0.1 Visual Acuity in the affected Eye, but only 2 patients (18%) in Group B.
Four patients in Group A showed evidence of AntiCardiolipin AntiBodies.
While both groups were diagnosed as having Clinically Definite MS, there were differences between them in the clinical features.
We assume that the patients with ATM may constitute a different subgroup among MS patients.