Hudzaifah-Nordin Mohammad, Wendy-Ong Chin Feng, Nurul-Ain Masnon, Wan Hitam Wan-Hazabbah
Department of Ophthalmology and Visual Sciences, Universiti Sains Malaysia School of Medical Sciences, Kelantan, MYS.
Faculty of Medicine, Universiti Sultan Zainal Abidin, Terengganu, MYS.
Cureus. 2022 Mar 28;14(3):e23571. doi: 10.7759/cureus.23571. eCollection 2022 Mar.
Introduction Optic neuritis (ON) is a blinding inflammatory disease of the optic nerve, typically affecting young adults as described in the Optic Neuritis Treatment Trial (ONTT). However, there is limited information describing ON in patients older than 45 years of age. The aim of this study was to determine the clinical profile of ON in this age group in Malaysia. Methods A retrospective case series study was performed between January 2014 and December 2018 among patients older than 45 years old, treated as ON in Hospital Universiti Sains Malaysia, Kelantan, Malaysia. Clinical features, visual acuity, imaging, laboratory results, aetiologies, and visual outcomes were analyzed. Results This study comprised 17 patients (20 eyes) with a gender distribution of eight males and nine females. The mean age of ON onset was 55.8 ± 7.7 years (46-80 years). Most patients (94.1%) presented with reduced vision and retroorbital pain, and three patients (17.6%) had bilateral eye involvement. Papillitis was observed in 13 eyes (65%), retrobulbar ON in five eyes (25%), and optic atrophy in two eyes. Presenting visual acuity was moderately correlated with final visual outcome (rs= 0.47, n = 20, p < 0.05). Post-treatment visual improvement (good and slight) was reported in 14 eyes (70%), four (20%) had no improvement while the remaining two eyes (10%) had worsening best-corrected visual acuity (BCVA). Infective causes accounted for 23.5% of cases (one ocular syphilis, two ocular tuberculosis, and one case of toxoplasmosis). Most cases (70.6%) were idiopathic ON, and only one case was diagnosed with neuromyelitis optica spectrum disorder (NMOSD). Conclusion ON in Malaysian patients older than 45 years of age has no gender predilection and is most likely to be idiopathic; however, infective ON must still be ruled out. Overall visual outcomes were satisfactory. Among the infective causes, ocular tuberculosis caused poor visual recovery as compared with syphilitic and toxoplasmosis-related ON cases.
视神经炎（ON）是一种致盲性视神经炎症性疾病，如视神经炎治疗试验（ONTT）所述，通常影响年轻人。然而，关于45岁以上患者视神经炎的信息有限。本研究的目的是确定马来西亚该年龄组视神经炎的临床特征。方法：2014年1月至2018年12月间，对马来西亚吉兰丹州马来西亚理科大学医院收治的45岁以上被诊断为视神经炎的患者进行了一项回顾性病例系列研究。分析了临床特征、视力、影像学、实验室检查结果、病因及视力转归。结果：本研究共纳入17例患者（20只眼），其中男性8例，女性9例。视神经炎发病的平均年龄为55.8±7.7岁（46 - 80岁）。大多数患者（94.1%）出现视力下降和眶后疼痛，3例（17.6%）双眼受累。13只眼（65%）表现为视乳头炎，5只眼（25%）为球后视神经炎，2只眼为视神经萎缩。初诊视力与最终视力转归呈中度相关（rs = 0.47，n = 20，p < 0.05）。14只眼（70%）治疗后视力有改善（明显和轻微），4只眼（20%）无改善，其余2只眼（10%）最佳矫正视力（BCVA）恶化。感染性病因占病例的23.5%（1例眼梅毒、2例眼结核和1例弓形虫病）。大多数病例（70.6%）为特发性视神经炎，仅1例被诊断为视神经脊髓炎谱系障碍（NMOSD）。结论：马来西亚45岁以上患者的视神经炎无性别倾向，最可能为特发性；然而，仍必须排除感染性视神经炎。总体视力转归令人满意。在感染性病因中，与梅毒和弓形虫病相关的视神经炎病例相比，眼结核导致视力恢复较差。
