Saitakis George, Chwalisz Bart K
Division of Neuro-Ophthalmology, Department of Ophthalmology, Massachusetts Eye & Ear Infirmary/Harvard Medical School, Boston, Massachusetts, USA.
Athens Eye Hospital, Athens, Greece.
Curr Opin Ophthalmol. 2022 Nov 1;33(6):519-524. doi: 10.1097/ICU.0000000000000900. Epub 2022 Aug 26.
This review paper aims at discussing pathogenesis, etiology, clinical features, management, and prognosis of OPN.
Optic perineuritis (OPN) is an inflammatory process primarily involving the optic nerve sheath. Clinically, OPN usually presents with unilateral, gradual decline of visual function, eye pain, and/or pain on eye movements, disc edema and various features of optic nerve dysfunction, including visual field defects. It can mimic typical optic neuritis. In most cases of OPN, the disease is isolated with no specific etiology being identified, however, it can also occur secondary to a wide range of underlying systemic diseases. OPN is clinically diagnosed and radiologically confirmed based on the finding of circumferential perineural enhancement of the optic nerve sheath on magnetic resonance imaging (MRI).
Unlike optic nerve, OPN is not typically self-limited without treatment. High-dose oral corticosteroids are the mainstay of treatment in OPN. The initiation of therapy usually causes rapid and dramatic improvement in signs and symptoms. In general, OPN usually has a relatively good visual prognosis, which is influenced by delays between the onset of visual loss and the initiation of steroid therapy as well as the presence of underlying systemic diseases.
本综述旨在探讨视神经周围炎（OPN）的发病机制、病因、临床特征、治疗及预后。
视神经周围炎（OPN）是一种主要累及视神经鞘的炎症过程。临床上，OPN通常表现为单侧、视力功能逐渐下降、眼痛和/或眼球运动时疼痛、视盘水肿以及视神经功能障碍的各种特征，包括视野缺损。它可模仿典型的视神经炎。在大多数OPN病例中，该病为孤立性，未发现特定病因，然而，它也可继发于多种潜在的全身性疾病。基于磁共振成像（MRI）上视神经鞘周围环形强化的表现，OPN通过临床诊断及影像学确诊。
与视神经炎不同，OPN若不治疗通常不会自限。大剂量口服糖皮质激素是OPN治疗的主要手段。治疗开始后通常会使体征和症状迅速显著改善。一般而言，OPN通常具有相对较好的视力预后，这受到视力丧失发作与开始使用类固醇治疗之间的时间延迟以及潜在全身性疾病的影响。
