Parmley V C, Schiffman J S, Maitland C G, Miller N R, Dreyer R F, Hoyt W F
Arch Neurol. 1987 Oct;44(10):1045-8. doi: 10.1001/archneur.1987.00520220047015.
Neuroretinitis, a form of optic neuritis, is characterized by papillitis and a stellate macular exudate, or "macular star." The star implies the presence of a disc vasculopathy and secondary leakage of lipoproteinaceous material into the macula. Demyelinating optic neuritis would not be expected to produce a secondary macular exudate. We reviewed the literature on the risk of multiple sclerosis developing in a patient after an attack of optic neuritis, and rarely found a comment on the presence of a macular star. We then reviewed two series of 40 patients who had neuroretinitis and added ten patients of our own. Signs of multiple sclerosis had not developed in the 13 patients contacted retrospectively, nor in the patients followed up prospectively. We also noted that in our patients, neuroretinitis may be accompanied by other neurologic manifestations; neuroretinitis may be bilateral and may be staggered; papillitis may present without a macular star, only to have typical exudates develop up to two weeks later; and the macular exudate may take up to 12 months to resolve. We suggest that patients who demonstrate acute papillitis with a normal macula be reevaluated within two weeks for the development of a macular star. Its presence militates strongly against the subsequent development of multiple sclerosis.
视神经视网膜炎是视神经炎的一种形式，其特征为视乳头炎和星芒状黄斑渗出，即“黄斑星”。黄斑星提示存在视盘血管病变以及脂蛋白样物质继发性渗漏至黄斑区。脱髓鞘性视神经炎预计不会产生继发性黄斑渗出。我们查阅了关于视神经炎发作后患者发生多发性硬化风险的文献，很少发现有关黄斑星存在情况的描述。然后我们回顾了两组各40例患有视神经视网膜炎的患者，并加入了我们自己的10例患者。在回顾性联系的13例患者以及前瞻性随访的患者中，均未出现多发性硬化的体征。我们还注意到，在我们的患者中，视神经视网膜炎可能伴有其他神经系统表现；视神经视网膜炎可能是双侧的，且可能呈间歇性；视乳头炎可能在没有黄斑星的情况下出现，直至两周后才出现典型渗出；黄斑渗出可能需要长达12个月才能消退。我们建议，对于表现为急性视乳头炎且黄斑正常的患者，应在两周内重新评估是否出现黄斑星。黄斑星的存在强烈提示后续不会发生多发性硬化。
