[Abstract] optic neuritis and multiple sclerosis is one of the common diseases of neuro Ophthalmology, foreign to the understanding and trea
[Abstract] optic neuritis and multiple sclerosis is one of the common diseases of neuro Ophthalmology, foreign to the understanding and treatment of domestic counterparts is unified, there are many disputes and misunderstandings in the concept and diagnosis and treatment. A correct understanding of the concept and diagnosis of optic neuritis and multiple sclerosis treatment, reasonable standard, is an eye doctor's responsibility to save the visual function of these patients, the beneficial exploration and the necessary dispute will be helpful to the further understanding of the disease, more in line with China's national conditions treatment method. programme
[Key words] optic neuritis of multiple sclerosis / diagnosis; optic neuritis and multiple sclerosis / therapy
Devote much attention the on diagnosis treatment of optic neuritis and multiple and to study sclerosis
Wei Shi-hui. of Ophthalmology, General Hospital PLA, Beijing, 100853, China, of, Department
Corresponding author: WEI Shi-hui, Email:email@example.com
Optic neuritis and multiple sclerosis are common diseases of neuro-ophthalmolgy. It is concord for doctors in the recognition, diagnosis and therapy of optic neuritis abroad. But there is much debate about the concept, diagnosis and therapy in optic neuritis and multiple sclerosis in china. Correct cognition in the concept and diagnosis and reasonable, normative therapy to save visual function is the responsibility of Ophthalmologist. Active exploration and necessary disputing are beneficial to recognize this disease and to obtain the best therapy program that is consistent with China.
[Key word] optic and multiple sclerosis/diagnosis; optic and multiple neuritis sclerosis/therapy (neuritis)
In 1884 Nettleshis first described the optic neuritis, optic neuritis became more than a century term commonly used eye doctor diagnosis. Optic neuritis is generally considered to be caused by infection of the optic nerve, but in fact a lot of etiological study have confirmed that most of the etiology of optic nerve primary demyelinating disease, multiple sclerosis and the same pathophysiological changes, and pathophysiology of infection or non demyelinating nonspecific inflammatory change. Many domestic fellow eye in terms of understanding and deviation of this point, even the wrong concept. This paper mainly discusses the diagnosis and progress of demyelinating optic neuritis and multiple sclerosis caused by the.
Epidemiology, optic neuritis
Optic neuritis is the most common acute optic nerve disease, more common in young adults. The incidence is about 5/100000, up to 115/100000 the incidence of the epidemic, the incidence rate of female is higher than male, male and female ratio is about 1:3. The average onset age was about 30 years old. In the North American research literature, female patients accounted for 77%, white people accounted for 85%, the average age of patients was 32 years old.
Two, clinical research
The most common symptoms of optic neuritis with decreased visual acuity, visual contrast sensitivity, color vision, vision, pupil and optic disc changes. Unilateral optic neuropathy can occur decreased visual acuity and color vision abnormalities, relative afferent pupillary disturbance and visual field defect. In acute phase, optic disc can be normal (such as retrobulbar neuritis, can also occur when) (such as ball segment edema neuritis). About 1/3 of optic neuritis occurred in patients with diffuse mild optic disc edema and hemorrhage. Optic atrophy is not a specific sign, and many optic nerve diseases can eventually lead to optic atrophy.
The typical symptoms of optic neuritis is unilateral acute or subacute visual loss, loss of vision in a few hours to several days. The majority of patients with orbital pain, especially when the eye movement pain, usually disappear after a few days. Most patients with optic neuritis vision appeared central scotoma and corresponding visual acuity decreased, a small number of patients with narrow concentric visual field. Optic neuritis patients often consciously photopsia. Other optic neuropathy with the same level of visual acuity compared with optic neuritis relative afferent pupillary disorder and color loss was more significant. The intensity of light is weakened, and a strong sense of flash. Visual field change is most central scotoma. 2% patients with dumbbell shaped scotoma connected with the blind spot, 8% patients with paracentral scotoma, 4% patients with hemianopia. 35% patients with acute papillitis with optic disc edema is relatively serious, but not associated with optic disc hemorrhage, if have diagnosis of hemorrhage can be suspected of optic neuritis. The optic nerve and retina was normal in 65% patients. Optic neuritis took place after 4 ~ 6 weeks had optic nerve atrophy. In addition, asymptomatic contralateral eyes often appear abnormal visual function, 15% patients with visual acuity decrease, 22% patients with abnormal color vision, 48% patients with visual field change. These symptoms can disappear after a few months of acute demyelination.
Sub acute optic neuritis often occurs in patients with multiple sclerosis, without these patients complained of decreased visual acuity, tiny optic nerve lesions such as relative afferent pupillary defect, visual acuity and color vision of the mild decline is difficult to be found.
The treatment of acute optic neuritis, three
Acute optic neuritis treatment included intravenous methylprednisolone pulse therapy and supportive therapy. Shock therapy can accelerate the recovery of vision, but it is not the final result. The treatment scheme of North American research group ONTT: 250mg intravenous injection of methylprednisolone (1 /6 hours), for 3 consecutive days, every day after oral prednisone 1mg/kg a total of 11 days, and then decreased. Also to methylprednisolone 1000mg/, for 3 consecutive days, long-term steroid therapy of optic neuritis has no effect. At present, many domestic ophthalmic hospital has accepted the impact program, but the chronic side effects of steroid hormones are becoming more common, such as insomnia, weight gain, personality changes, gastrointestinal diseases, but also more serious side effects visible, including mental abnormalities, hypertension, pancreatitis, depression, necrosis of femoral head.
For recurrent optic neuritis can be given daily oral prednisone 1mg/kg, advocates of optic neuritis were treated with large doses of steroid therapy should be individualized, weigh the pros and cons of patients, but also need to consider the side effects and the patient's visual function, MRI inspection. In addition, nerve nutrition, improve microcirculation and other supportive therapy can also be used together. At present, optic neuritis and multiple sclerosis also need multicenter study, treatment as soon as possible to adapt to the situation of China.
Four, the treatment of optic neuritis in chronic phase
Foreign studies have confirmed that the application of interferon in the treatment of symptoms of optic neuritis is single demyelinating lesions in patients with clinically isolated, can reduce the incidence of abnormal MRI. The application of immunosuppressive agents such as interferon therapy in patients with demyelinating diseases requires individualization. Now the domestic Department of Neurology in the use of gamma globulin instead of interferon, the price is cheap, there are many papers report effects really, also not a prospective multicenter case-control study results were clinical experience.
Five, prognosis and evaluation
For a typical inflammatory demyelinating optic neuritis patients, the system tests such as ANA, Lyme, ACE, FTA, etc., there is no value to clinical diagnosis, in the absence of established or bilateral optic neuropathy cases, VEP examination can help the diagnosis.
The majority of patients after treatment of optic neuritis, or untreated cases, after a period of time there will be a significant recovery of visual acuity. Visual acuity improved in 80% of patients in the North American study after 3 weeks. If there is no improvement in vision after 5 weeks, the doctor should reconsider the diagnosis. The majority of patients with visual acuity can occur in the first two months of onset, further visual improvement can occur after the onset of the disease for 1 years. 95% patients were treated with or without steroid treatment, after 1 years to improve the visual acuity of more than 20/40 and 50% were increased to more than 20/20, only 2% patients with visual acuity less than 20/200. However, the majority of patients with optic neuritis persistent visual function disorder, including relative afferent pupillary defect, dyschromatopsia, and the light intensity is weakened. After the cure of patients with optic neuritis, tired or fever can occur after a transient decrease of visual acuity.
Usually can be seen in multiple sclerosis patients with optic neuritis (MS), which can be used as an assessment of the prognosis factors. Magnetic resonance imaging (MRI) examination can determine whether patients with optic neuritis MS. MRI normal 5 years, the probability of occurrence of MS is from 1 to 15%. Check the MRI T2 visible lesions less than 3, 5 years, the probability is 50% MS. Normal MRI 10 years MS 22% probability, MRI check the T2 visible lesions less than 1, 10 years MS probability is 56%. Methylprednisolone can reduce optic neuritis in the next 2 to 3 years the incidence of MS, but after 5 years the incidence has no effect. The only symptom of optic neuritis in MRI like T2 may appear abnormal. Another performance of the two common symptoms of MS for intermittent ophthalmoplegia. Most of the MRI can be found in retrobulbar neuritis of optic nerve thickening, signal enhancement. MRI patients, the incidence of MS is lower.
Optic neuritis is one of the main factors of vision loss in young adults, the main symptom is pain of monocular visual loss. A few weeks after the general visual function can be improved, 95% patients after using or not using steroid hormone treatment, within 12 months the visual acuity can be increased to more than 20/40. Single symptom in patients with optic neuritis, MRI can assess the probability of MS. If more than 3 MRIT2 visible lesions, 5 year MS rate was 50%. The probability of MRI in normal MS decreased to 22%. Painless patients with optic neuritis and optic disc edema, hemorrhage, serious exudation or spots, such as normal MRI, lower incidence of MS. High dose steroid (methylprednisolone) pulse therapy in patients with optic neuritis can accelerate the recovery of visual acuity, but the treatment should be individualized. Interferon, gamma globulin for high-risk patients occurred in MS.
1 Zhang Xiaojun, Wang Wei, Wang Qian, et al. Clinical analysis of optic neuritis etiology. Chinese Journal of ocular fundus diseases, 2006, 22, 6: 367-369.
2 Xu Xianhao. Recent advances of multiple sclerosis. Chinese Journal of Neurology, 2004, 37, 1: 3-4.
3 Franklin GM., Nelson L. risk in sclerosis. Neurology multiple, 2003, 61: 1032-1034., Environmental, factors
4 Miller NR, Newman NJ, Walsh, et al. neuro-ophthalmology: Optic neuritis, 15th ED1, Baltimore: Williams & Wilking, 1999: 1196-2201., Clinical
5 Zhang Xiaojun, Wei Wenbin. A first diagnosis of acute optic neuritis decreased visual acuity. Etiology analysis of 81 cases of Ophthalmology, 2004, 13: 148-152.
6 Gray OM, McDonnell GV, Forbes RB. immunoglobulins multiple Cochrane Database Syst Rev. 2003; (3): CD002936. sclerosis. (for)
7 Ruprecht BK, Klinker E, Dintelmann T, et al. exchange severe neuritis Treatment of patients. Neurology, 2004, 63: Plasma, 1081-1083., for, optic