Al-Eajailat Suha Mikail, Al-Madani Senior Mousa Victor
Senior ophthalmology specialist at King Hussein Medical Center, Neuro-ophthalmology fellowship, Moorfield's Eye Hospital, London, UK.
Ophthalmology specialist at King Hussein Medical Center, Neuro-ophthalmology fellowship, Addenbrooke's Hospital, Cambridge, UK.
Pan Afr Med J. 2014 Jan 25;17:54. doi: 10.11604/pamj.2014.17.54.2462. eCollection 2014.
To report our experience in management of patients with optic neuritis. The effects of brain magnetic resonance imaging and visual evoked potential on management were investigated.
This is a four years clinical trial that included patients presenting with first attack of optic neuritis older than 16 years with visual acuity of less than 6/60 and presentation within first week of illness. Brain magnetic resonance imaging and visual evoked potentials were done for all patients. Patients were classified into three groups. First group received placebo, second received oral steroids and third received intravenous and oral steroids. Primary outcome measure was improvement in visual acuity.
A total number of 150 patients were enrolled in the study. Ocular pain was seen 127 patients Relative afferent pupillary defect in 142 patients and color vision impairment in 131 patients. Abnormal MRI findings were seen in 84 patients. Pattern reversal VEP was abnormal in all patients. Using oral or intravenous steroid resulted in faster recovery but did not affect the final visual outcome. Recurrence rate was higher in patients with multiple MRI lesions and diminished VEP amplitude. Using intravenous steroids decreased recurrence rate in patients with three and more MRI lesions and non recordable VEP response.
MRI and pattern reversal VEP are recommended to be done in all patients presenting with optic neuritis. We advise to give intravenous methyl prednisolone in patients with multiple MRI white matter lesions and non recordable VEP at presentation.
报告我们对视神经炎患者的治疗经验。研究脑磁共振成像和视觉诱发电位对治疗的影响。
这是一项为期四年的临床试验，纳入年龄大于16岁、首次发作视神经炎、视力低于6/60且在发病第一周内就诊的患者。所有患者均进行脑磁共振成像和视觉诱发电位检查。患者分为三组。第一组接受安慰剂，第二组接受口服类固醇，第三组接受静脉和口服类固醇。主要结局指标是视力改善情况。
共有150例患者纳入研究。127例患者出现眼痛，142例患者出现相对性传入瞳孔障碍，131例患者出现色觉障碍。84例患者磁共振成像检查结果异常。所有患者图形翻转视觉诱发电位均异常。使用口服或静脉类固醇可使恢复加快，但不影响最终视力结果。磁共振成像多发病变且视觉诱发电位波幅降低的患者复发率较高。对于磁共振成像有三个及以上病变且视觉诱发电位无反应的患者，使用静脉类固醇可降低复发率。
建议所有视神经炎患者均进行磁共振成像和图形翻转视觉诱发电位检查。我们建议，对于就诊时磁共振成像有多发白质病变且视觉诱发电位无反应的患者，给予静脉注射甲泼尼龙。
