Eggenberger Eric
Continuum (Minneap Minn). 2025 Apr 1;31(2):407-435. doi: 10.1212/cont.0000000000001560.
This article reviews the most common and noteworthy inflammatory and infectious optic neuropathies, with an update on newer syndromes.
We have entered an era of antibody-assisted definitions of distinct types of optic neuritis, including aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein-associated disease, with distinct pathophysiologies, prognoses, and management options. It is crucial to distinguish between these entities and other common inflammatory (eg, sarcoid or other granulomatous inflammation) or infectious optic neuropathies as appropriate therapy radically differs. These developments highlight the increasing importance of precision terminology as many of these now distinctly defined syndromes have been previously lumped together as "typical or atypical optic neuritis." An individualized evaluation and treatment approach is required.
Multiple sclerosis-related optic neuritis is the most common form of inflammatory demyelinating optic neuritis, causing short segments of optic nerve inflammation, with an excellent visual prognosis and tendency to improve with or without high-dose steroids.Aquaporin-4 associated optic neuritis causes longitudinally extensive optic nerve inflammation and has a more guarded prognosis for visual recovery, with poor visual outcomes in untreated patients compared with multiple sclerosis or myelin oligodendrocyte glycoprotein-associated disease.Myelin oligodendrocyte glycoprotein optic neuritis also causes longitudinally extensive optic nerve inflammation with a predilection for optic disc edema and tends to be very steroid sensitive, but recurrent. Infectious optic neuropathies are important to recognize; syphilis incidence has doubled in the last decade and requires early aggressive therapy to maximize visual recovery.
本文回顾了最常见且值得关注的炎性和感染性视神经病变，并介绍了一些新综合征的最新情况。
我们已进入一个通过抗体辅助定义不同类型视神经炎的时代，包括水通道蛋白4抗体阳性的视神经脊髓炎谱系障碍和髓鞘少突胶质细胞糖蛋白相关疾病，它们具有不同的病理生理学、预后和治疗选择。区分这些疾病实体与其他常见的炎性（如结节病或其他肉芽肿性炎症）或感染性视神经病变至关重要，因为恰当的治疗方法差异很大。这些进展凸显了精确术语的重要性日益增加，因为许多现在明确界定的综合征以前都被归为“典型或非典型视神经炎”。需要采取个体化的评估和治疗方法。
与多发性硬化相关的视神经炎是炎性脱髓鞘性视神经炎最常见的形式，可导致视神经短节段炎症，视觉预后良好，无论是否使用大剂量类固醇，病情都有改善趋势。水通道蛋白4相关的视神经炎可导致视神经纵向广泛炎症，视觉恢复预后更谨慎，与多发性硬化或髓鞘少突胶质细胞糖蛋白相关疾病相比，未经治疗的患者视觉预后较差。髓鞘少突胶质细胞糖蛋白视神经炎也可导致视神经纵向广泛炎症，易出现视盘水肿，且往往对类固醇非常敏感，但易复发。认识感染性视神经病变很重要；梅毒发病率在过去十年中翻了一番，需要早期积极治疗以最大限度地促进视觉恢复。
