Thamotaran Tinesh, Ngoo Qi Zhe, Wan Hitam Wan-Hazabbah, Yaakub Azhany, Koh Yi Ni
Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS.
Ophthalmology Department, Hospital Raja Permaisuri Bainun, Ipoh, MYS.
Cureus. 2022 Aug 31;14(8):e28651. doi: 10.7759/cureus.28651. eCollection 2022 Aug.
The aim of this study is to report an interesting case of bilateral idiopathic optic perineuritis (OPN) presented with severe visual loss. A 64-year-old male with underlying hypertension, hypercholesterolemia, and schizophrenia presented with consecutively sudden onset of the right eye (RE) painless blurring of vision for two weeks and left eye (LE) painless blurring of vision for three days. The patient has no other symptoms such as red-eye, floaters, or headache. The patient had constitutional symptoms of loss of weight for the past three months; otherwise, he has no loss of appetite or persistent low-grade fever. Upon examination, RE visual acuity was no perception to light (NPL) at all quadrants, LE 6/36, and not improved with pinhole. The relative afferent pupillary defect (RAPD) was positive over the RE. Optic nerve functions of the RE were absent; meanwhile, over LE was reduced. The anterior segment was unremarkable, with no evidence of uveitis or dense cataract. Fundus examination showed diffuse 360-degree optic disk swelling with peripapillary splinter hemorrhage, mild tortuous vessel, and minimal vitreous hemorrhage inferiorly, with no evidence of neovascularization. The LE showed diffuse 360-degree optic disk swelling with normal macula and vessel. Magnetic resonance imaging (MRI) of the brain and orbit showed bilateral optic nerve sheath (ONS) enhancement with doughnut sign and tram-track sign. The patient was treated with bilateral OPN and started on intravenous methylprednisolone 1 g OD for five days followed by oral prednisolone 1 mg/kg OD with a tapering dose for one month. Patient visual acuity regained to RE 6/18 but did not improve with pinhole and LE 6/9 with full recovery of optic nerve function. Bilateral idiopathic OPN is a rare idiopathic inflammatory condition of ONS that typically presents with recurrent painless loss of vision with good recovery outcomes with intravenous steroids.
本研究旨在报告一例有趣的双侧特发性视神经周围炎（OPN）病例，该病例表现为严重视力丧失。一名64岁男性，患有高血压、高胆固醇血症和精神分裂症，右眼（RE）连续两周突然无痛性视力模糊，左眼（LE）无痛性视力模糊三天。患者无眼红、飞蚊症或头痛等其他症状。患者在过去三个月有体重减轻的全身症状；除此之外，他没有食欲减退或持续低热。检查时，RE视力在所有象限均无光感（NPL），LE为6/36，针孔镜检查无改善。RE存在相对性传入瞳孔障碍（RAPD）。RE的视神经功能缺失；同时，LE的视神经功能减退。眼前节无异常，无葡萄膜炎或致密白内障迹象。眼底检查显示360度弥漫性视盘肿胀，伴有视乳头周围片状出血、轻度迂曲血管，下方有少量玻璃体积血，无新生血管形成迹象。LE显示360度弥漫性视盘肿胀，黄斑和血管正常。脑部和眼眶的磁共振成像（MRI）显示双侧视神经鞘（ONS）强化，呈甜甜圈征和轨道征。该患者接受双侧OPN治疗，开始静脉注射甲泼尼龙1g每日一次，共五天，随后口服泼尼松龙1mg/kg每日一次，逐渐减量，持续一个月。患者视力恢复至RE为6/18，但针孔镜检查无改善，LE为6/9，视神经功能完全恢复。双侧特发性OPN是一种罕见的ONS特发性炎症性疾病，通常表现为反复无痛性视力丧失，静脉注射类固醇治疗后恢复良好。
