Monteiro Mário Luiz R, Hokazono Kenzo, Cunha Leonardo P, Biccas Neto Laurentino
Division of Ophthalmology and Laboratory of Investigation in Ophthalmology (LIM 33), University of São Paulo Medical School, São Paulo, Brazil.
Federal University of Paraná, Curitiba, Paraná, Brazil.
BMC Ophthalmol. 2018 Oct 26;18(1):278. doi: 10.1186/s12886-018-0949-1.
Sudden visual loss and optic disc edema caused by optic neuritis (ON) is usually followed by significant visual recovery. However, little or no recovery occurs when the loss is caused by atypical ON, especially in patients with neuromyelitis optica (NMO). Optic disc drusen (ODD) is a cause of pseudo optic disc edema and may be a predisposing factor for non-arteritic anterior ischemic optic neuropathy (NAION), thereby mimicking atypical ON. In such cases, if globular concretions are seen protruding from the disc substance, ODD may be suspected. The purpose of this paper is to describe two patients with acute visual loss followed by optic disc atrophy initially labeled as atypical ON. Though not suspected on clinical examination, optical coherence tomography (OCT) revealed deeply buried ODD as a predisposing factor for NAION.
Case 1: A 48-year-old woman had bilateral sequential visual loss associated with optic disc edema. Despite treatment, vision did not improve and severe disc pallor ensued. Atypical ON was suspected. Eventually, she was started on immunosuppressant therapy based on a tentative diagnosis of NMO-spectrum disorder. On examination 5 years later, only severe optic disc pallor was observed, but OCT radial B-scans showed ovoid hyporeflective areas in the retrolaminar region of both eyes, compatible with ODD; this led to a diagnosis of NAION and deeply buried ODD. Case 2. A 35-year-old woman with suspicion of ON in the left eye and a history of previous atypical ON in the right eye was referred for neuro-ophthalmic examination which revealed diffuse optic disc pallor and a dense arcuate visual field defect in the right eye. OCT B-scans passing through the disc showed large ovoid areas of reduced reflectivity in the retrolaminar region of the optic disc in the right eye. These findings helped confirm the diagnosis of NAION in one eye, with deeply buried ODD as predisposing factor.
Deeply buried ODD may be associated with NAION causing irreversible visual loss and optic disc pallor, a condition easily mistaken for atypical ON. Awareness of such occurrence is important to avoid unnecessary testing and minimize the risk of mismanagement.
视神经炎（ON）所致的突发视力丧失和视盘水肿通常会伴随显著的视力恢复。然而，当视力丧失由非典型性ON引起时，视力恢复很少或根本不会发生，尤其是在视神经脊髓炎（NMO）患者中。视盘玻璃疣（ODD）是假性视盘水肿的一个病因，可能是非动脉性前部缺血性视神经病变（NAION）的一个易感因素，从而酷似非典型性ON。在这种情况下，如果看到有球形硬结从视盘组织中突出，则可能怀疑为ODD。本文的目的是描述两名急性视力丧失后出现视盘萎缩的患者，最初被诊断为非典型性ON。尽管临床检查未怀疑，但光学相干断层扫描（OCT）显示深部埋藏的ODD是NAION的一个易感因素。
病例1：一名48岁女性先后出现双侧视力丧失并伴有视盘水肿。尽管进行了治疗，但视力并未改善，随后出现严重的视盘苍白。怀疑为非典型性ON。最终，基于NMO谱系障碍的初步诊断，她开始接受免疫抑制治疗。5年后检查时，仅观察到严重的视盘苍白，但OCT径向B扫描显示双眼视网膜后区域有卵圆形低反射区，与ODD相符；这导致诊断为NAION和深部埋藏的ODD。病例2：一名35岁女性，左眼怀疑患有ON，右眼有既往非典型性ON病史，前来接受神经眼科检查，检查发现右眼视盘弥漫性苍白和致密的弓形视野缺损。通过视盘的OCT B扫描显示右眼视盘视网膜后区域有大的卵圆形反射率降低区域。这些发现有助于确诊一只眼患有NAION，深部埋藏的ODD是易感因素。
深部埋藏的ODD可能与NAION相关，导致不可逆的视力丧失和视盘苍白，这种情况很容易被误诊为非典型性ON。认识到这种情况的发生对于避免不必要检测和降低管理失误风险很重要。
