Analysis Of Clinical Features And Treatment Effect Of Idiopathic Optic Neuritis

Objective:To analysis the clinical features of idiopathic optic neuritis,summarize the clinical features and discuss the therapeutic effect of corticosteroid , improve the understanding of idiopathic optic neuritis.Methods:Retrospective analysis data from 134 patients diagnosed as optic neuritis in General Hospital of PLA from June 2009 to June 2010 ,of which 52 cases were excluded because of data incomplete or followed-up less than 6 months.Complete data were collected 82 patients.The clinical data including history, age, initial events, clinical signs of optic neuritis and myelitis, misdiagnosis status were analyzed. Each patient underwent a detailed history collection, and conducted routine ophthalmic and neurological examination, most patients received perimetry,VEP,MRI examination, some patients received mitochondrial DNA mutation screening and other tests to analyze the cause of the disease. According to ONTT, all patients diagnosed got intravenousmethyl prednisolone pulse therapy for three days, then given tapering oral steroid treatment, and Outpatient followed-up 6 months or more.Analysis the relevance of different course of optic neuritis and the visual recovery after steroid pulse therapy,χ2 contingency table test different course of recovery of visual acuity, P <0.05 indicated statistical significance.Results:Among 82 patients, 60 were unilateral cases and 12 simultaneous bilateral cases, 10 patients had interval bilateral disease, interval 2 weeks to 1 month. Average age: 31.8±15.1 years old, 20 to 50 age group accounted for 67.1% of the total number of incidence. 35 male,47 female cases (57.3%), male and female ratio was 1:1.34.All patients come to the hospital within one month after the onset , 70 patients (79.2%) had no obvious symptom prior to the onset, 7 patients had a cold before the onset ,6 cases had decline in visual acuity after over-exertion and 1 young women had bilateral visual loss after the mood swings. 1 female patient had bilateral visual loss in lactation. 74 patients with acute vision loss as the first symptom, and 5 patients (7 eyes) appears shadow of decreased visual acuity before the onset of the visual loss, 3 patients (3 eyes) with color vision defects as the first symptoms.80 eyes (76.9%) had abnormal color vision. Among them, 11 eyes (10.5%) saw objects only in black and white. 29 eyes (27.8%) showed achromatopsia, 40 eyes(38.4%) showed decreased color vision. 67 eyes(64.4%) had acute vision loss associated with eye pain or pain with eye movement . Patients with bilateral disease, the eye with poorer visual acuity can demonstrate RAPD(+). Both eyes with no light perception, the pupil was ankylosing positive. Among 82 cases with 104 eyes ,44 eyes(42.3%) with optic disc edema in early stage , only 5 patients with spot, line bleeding on the optic disc surface or edge. The remaining 60 eyes were normal.A total of 74 patents receice the examination of perimetry , central scotoma, expansion of the blind spot, arcuate scotoma were the most common visual field defect. VEP showed latency delay and amplitude decreased in 91 eyes (87.5%), there was no waveform in 4 eyes (3.8%), 15 cases (14.4%) with monocular visual loss,the other eye showed latencies delayed. In bilateral cases,latency delay even greater in the poorer visual acuity .55 cases got head or orbital magnetic resonance imaging scan with gadolinium enhanced scans , of which 34 cases (61.8%) had abnormal signal of optic nerve enhancement, mainly elongated T2 change. 8 patients (9.7%)had periventricular demyelination, of which 5 cases were clinically diagnosed of MS, 3 cases does not meet the diagnostic criteria still need clinical observation. 2 cases had physical or sensory dysfunction, with spinal cord mag- netic resonance imaging found that more than three spinal segments long T1, longT2 signal change, clinical diagnosis of NMO. All patients diagnosed got intravenous methylprednisolone pulse therapy for three days, then given tapering oral steroid treatment, and outpatient followed-up 6 months or more.The results showed that the shorter the d- uration the higher the cure rate, duration of less than 7 days cure rate is as high as 77.6% , while 7 to 14 days the cure rate is 58.6%, duration of longer than 14 days cure rate is 23.5%, no efficiency increased with the incidence of time. There were significant differ- ences among the groups(P<0.001). The number of monocular and binocular cases were close, no significant difference between the two types of effects (P>0.05), shows the incidence of monocular and binocular recovery of patients is not different.Conclusions: (1)Idiopathic optic neuritis occurs more in femail, mostly in young adults aged 20 to 50; (2)initial symptoms characteristic by acute visual loss associated with abnormal color vision, eye pain, or pain with the eye movement as the; (3) central scot- oma is the most common visual field defect , other types may also occur; (4) VEP lat- encies delay is the most common, and latency delay persists even when visual acu- ity recoved; (5) the glucocorticoid significantly improve the visual acuity when treated early, and treated sooner, visual acuity recover better.