Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada.
Eye (Lond). 2019 Jun;33(6):974-979. doi: 10.1038/s41433-018-0326-6. Epub 2019 Feb 13.
BACKGROUND/OBJECTIVES: No guidelines exist for the investigation of treatable causes of chronic optic neuropathy, including sarcoidosis, lupus, and syphilis. The purpose of this study was to determine the diagnostic yield of screening blood work (ACE (Angiotensin Converting Enzyme) for sarcoidosis, Antinuclear Antibodies (ANA) for lupus, CMIA (chemiluminescence microparticle enzyme immunoassay) for syphilis) and contrast-enhanced MRI brain and orbits in atypical unilateral chronic optic neuropathy.
SUBJECTS/METHODS: Retrospective review from February 2012 to June 2018 at a neuro-ophthalmology practice. Six hundred and eighty-three consecutive charts with optic neuropathy were reviewed. Inclusion criteria were unilateral chronic optic neuropathy and a work-up including contrast-enhanced MRI brain and orbits, CBC, ESR, CRP, ANA, CMIA, and ACE. Exclusion criteria were optic nerve swelling in either eye on initial assessment or an established cause of optic neuropathy. The main outcome measure was diagnostic yield.
Fifty-seven patients were included. One patient had elevated ACE, seven had positive ANA titers, and three had positive CMIA. Zero patients were diagnosed with sarcoidosis, one patient was diagnosed with lupus-related optic neuropathy, and one patient was diagnosed with syphilitic optic neuropathy. The diagnostic yield of ACE was 0%, ANA was 1.75%, and CMIA was 1.75%. MRI revealed planum sphenoidale meningioma causing compressive optic neuropathy in one patient, giving it a diagnostic yield of 1.82%.
Routine screening blood work (ACE, ANA, CMIA) and MRI brain and orbits for chronic idiopathic unilateral optic neuropathy has low diagnostic yield, especially if clinical suspicion for syphilis, lupus, and sarcoidosis is low. MRI should still be performed in all cases in order to rule out compressive lesions.
背景/目的：目前尚缺乏针对慢性视神经病变（包括结节病、狼疮和梅毒）的可治疗病因的检查指南。本研究旨在确定在非典型单侧慢性视神经病变患者中，筛查血液检查（结节病的 ACE（血管紧张素转换酶）、狼疮的抗核抗体、梅毒的 CMIA（化学发光微粒子酶免疫分析法））和对比增强 MRI 脑和眼眶的诊断效果。
对象/方法：回顾性分析 2012 年 2 月至 2018 年 6 月在神经眼科诊所就诊的 683 例连续视神经病变患者。纳入标准为单侧慢性视神经病变，且已行对比增强 MRI 脑和眼眶、全血细胞计数、ESR、CRP、抗核抗体、CMIA 和 ACE 等检查。排除标准为初次评估时双眼视神经肿胀或已确诊视神经病变的患者。主要观察指标为诊断效果。
57 例患者符合纳入标准。1 例 ACE 升高，7 例抗核抗体滴度阳性，3 例 CMIA 阳性。无患者被诊断为结节病，1 例被诊断为狼疮相关性视神经病变，1 例被诊断为梅毒性视神经病变。ACE 的诊断效果为 0%，抗核抗体为 1.75%，CMIA 为 1.75%。1 例患者 MRI 显示蝶骨嵴脑膜瘤导致压迫性视神经病变，诊断效果为 1.82%。
针对慢性特发性单侧视神经病变，常规筛查血液检查（ACE、抗核抗体、CMIA）和 MRI 脑和眼眶的诊断效果较低，尤其是当梅毒、狼疮和结节病的临床怀疑较低时。为排除压迫性病变，仍应在所有病例中进行 MRI 检查。
