Diagnosis and classification of optic neuritis.

There is no consensus regarding the classification of optic neuritis, and precise diagnostic criteria are not available. This reality means that the diagnosis of disorders that have optic neuritis as the first manifestation can be challenging. Accurate diagnosis of optic neuritis at presentation can facilitate the timely treatment of individuals with multiple sclerosis, neuromyelitis optica spectrum disorder, or myelin oligodendrocyte glycoprotein antibody-associated disease. Epidemiological data show that, cumulatively, optic neuritis is most frequently caused by many conditions other than multiple sclerosis. Worldwide, the cause and management of optic neuritis varies with geographical location, treatment availability, and ethnic background. We have developed diagnostic criteria for optic neuritis and a classification of optic neuritis subgroups. Our diagnostic criteria are based on clinical features that permit a diagnosis of possible optic neuritis; further paraclinical tests, utilising brain, orbital, and retinal imaging, together with antibody and other protein biomarker data, can lead to a diagnosis of definite optic neuritis. Paraclinical tests can also be applied retrospectively on stored samples and historical brain or retinal scans, which will be useful for future validation studies. Our criteria have the potential to reduce the risk of misdiagnosis, provide information on optic neuritis disease course that can guide future treatment trial design, and enable physicians to judge the likelihood of a need for long-term pharmacological management, which might differ according to optic neuritis subgroups.

Long-term Safety and Efficacy of Conjunctival Pedicle Graft Revision Combined With Repeated Pericardium Allograft for Exposed Glaucoma Drainage Devices.

PURPOSE: To investigate the safety and long-term results of conjunctival pedicle graft (CPG) technique for revision of exposed glaucoma drainage device (GDD). DESIGN: Retrospective noncomparative case series. PATIENTS AND METHODS: All patients with exposed GDD between 2011 and 2016 who underwent tube revision with CPG were included. Data from demographic variables, glaucoma subtype, previous surgeries, GDD type and location, patch graft nature, intraocular pressure, and intraoperative and long-term complications were collected. RESULTS: Eight eyes from 7 patients met the inclusion criteria. Median age was 61 years old (range, 51 to 80), median time to erosion was 23.4 months (range, 5 d to 45.1 mo), median number of operations before exposure was 3 (range, 1 to 5), and 6 tubes had an inferior location (75%). Average follow-up after repair was 24.3 months (range, 5.2 to 59.8 mo). No significant intraoperative adverse events were noted and visual acuity, intraocular pressure, and number of medications remained unchanged at 1 month after repair in all cases. We report 1 case of repeated tube exposure 24 months after CPG in a 51-year-old Afro-Caribbean woman with 5 previous operations. CONCLUSIONS: With an average follow-up of >2 years, we provide additional long-term evidence that CPG is a safe and effective technique for treating exposed tubes. We did not experience any complications and report 1 reexposure case in a young Afro-Caribbean patient with extensive previous conjunctival scarring.