Myelin oligodendrocyte glycoprotein (MOG) associated optic neuritis in a patient with idiopathic intracranial hypertension (IIH) and compressive optic neuropathy case report.

BACKGROUND: Myelin oligodendrocyte glycoprotein-associated disease (MOGAD) has a wide phenotypic expression and should be considered in a differential diagnosis of patients with optic disc edema and increased intracranial pressure because MOGAD can mimic IIH and compressive optic neuropathy. CASE PRESENTATION: A 53-year-old woman with a history of presumed idiopathic intracranial hypertension ("IIH") presented with new headache and visual loss. She had a BMI of 35.44 kg/m2 and a past medical history significant for depression, hepatitis C, hyperlipidemia, and uterine cancer post-hysterectomy. She had undergone multiple lumboperitoneal shunts for presumed IIH and had a prior pituitary adenoma resection. Her visual acuity was no light perception OD and counting fingers OS. After neuro-ophthalmic consultation, a repeat cranial MRI showed symmetric thin peripheral optic nerve sheath enhancement of the intra-orbital optic nerves OU. Serum MOG antibody was positive at 1:100 and she was treated with intravenous steroids followed by plasma exchange and rituximab. CONCLUSIONS: This case highlights the importance of considering MOGAD in the differential diagnosis of optic neuropathy. Although likely multifactorial, we believe that the lack of improvement in our case from presumed IIH and despite adequate neurosurgical decompression of a pituitary adenoma with compression of the optic apparatus reflected underlying unrecognized MOGAD. Clinicians should consider repeat imaging of the orbit (in addition to the head) in cases of atypical IIH or compressive optic neuropathy especially when the clinical course or response to therapy is poor or progressive.

Dynamic corneal biomechanics in different cell layers: in keratoconus and normal eyes.

PURPOSE: This study aimed to determine the relationship between corneal cellular structures and biomechanical deformation parameters in keratoconic (KC) and healthy eyes. METHODS: In this prospective comparative study, 29 eyes of 29 KC patients were age- and gender-matched with 28 eyes of 28 healthy individuals using frequency matching. Corneal parameters examined included the density of basal epithelial cells, anterior keratocytes, posterior keratocytes and endothelial cells as assessed by in vivo corneal confocal microscopy (HRT III-RCM, Heidelberg Engineering, www.heidelbergengineering.com). Additionally, the coefficient of variation of endothelial cell size (CV) and the percentage of hexagonal endothelial cells (HEX%) were measured by specular microscopy (Konan NSP-9900, Konan Medical, www.konanmedical.com). Further, biomechanical deformation parameters were derived from Corvis Scheimpflug Technology (Corvis ST, Oculus, www.oculus.de). All cellular and biomechanical deformation parameters in KC and normal groups were compared, and the relationship between cellular and biomechanical parameters calculated. RESULTS: In the KC group, the highest concavity (HC) delta arc length and maximum delta arc length were associated with endothelial cell density (Beta = -0.39, p = 0.03 and Beta = -0.60, p Ë‚ 0.001, respectively). Furthermore, there was a significant association between HC deflection length and HEX% (Beta = -0.67, p = 0.001). In the normal group, HC delta arc length and HC deflection length were significantly associated with endothelial cell density (Beta = 0.46, p = 0.02; and Beta = -0.51, p = 0.01, respectively). HC time, HC deformation amplitude and applanation 1 delta arc length were associated with CV (Beta = 0.50, p = 0.01; Beta = 0.27, p = 0.009; and Beta = -0.57, p = 0.002, respectively). Applanation 1 and applanation 2 deformation amplitudes were associated with HEX% (Beta = -0.49, p = 0.005; and Beta = -0.46, p = 0.02). CONCLUSIONS: Biomechanical deformation parameters were significantly correlated with endothelial cell properties in both KC and normal groups, thereby indicating the importance of the integrity of endothelial cells to the biomechanical properties of both KC and normal corneas.

The effect of systemic erythropoietin and oral prednisolone on recent-onset non-arteritic anterior ischemic optic neuropathy: a randomized clinical trial.

BACKGROUND: To evaluate the effect of systemic erythropoietin, as well as oral steroids, in the management of recent-onset non-arteritic anterior ischemic optic neuropathy (NAION). METHOD: Patients diagnosed with NAION within 5 days were randomized into group A (systemic erythropoietin), group B (oral steroids), and group C (control). Group A received 10,000 units of erythropoietin twice a day for 3 days. Group B received oral prednisone 75 mg daily tapered off in 6 weeks. RESULTS: The mean best-corrected visual acuity (± SD) at the time of presentation was 1 ± 0.56, 1.01 ± 0.6, and 0.94 ± 0.47 logMAR in groups A, B, and C, respectively (P = 0.140); corresponding values at 6-month follow-up were 0.70 ± 0.44, 0.73 ± 0.35, and 0.75 ± 0.39 logMAR, respectively (P = 0.597). Fifty-five percent of patients in group A versus 34.3% in group B and 31.2% in group C had an improvement of at least 3 lines in the best-corrected visual acuity values at the 6th month of follow-up visit (P = 0.04). Peripapillary retinal nerve fiber layers at presentation were 189 ± 58, 193 ± 64, and 199 ± 62 micrometers, respectively (P = 0.779), which decreased to 88 ± 12, 74 ± 25, and 71 ± 18, respectively at 6-month follow-up (P = 0.041). CONCLUSION: The findings of our study indicate the beneficial effects of systemic erythropoietin in preserving the function and structure of the optic nerve in recent-onset NAION. TRIAL REGISTRATION: Clinical registration number: IR.SBMU.ORC.REC.1397.18.

Low iris and anterior chamber volume is associated with deepening after laser peripheral iridotomy in primary angle closure suspects.

PURPOSE: To evaluate the association between baseline ocular variables and the widening of the anterior chamber angle by laser peripheral iridotomy (LPI) in primary angle closure suspects (PACS) using a new Fourier-domain swept-source anterior segment optical coherence tomography (FD-ASOCT). METHOD: Sixty-six PACS eyes of 41 individuals were enrolled in this prospective interventional case series. An FD-ASOCT (Casia SS-1000 OCT; Tomey, Nagoya, Japan) was used to measure biometric baseline variables and at 1 month after the LPI. Paired t test was used to compare the difference between pre-and post-LPI measurements. Multivariate regression analysis was used to test for an association between baseline iris thickness and volume, anterior chamber depth and volume, and lens vault with a widening of the angle after an LPI. Changes in trabecular iris space area and angle opening distance after the LPI were main outcome measures. RESULTS: The mean age of participants was 58.6 ± 8.7 years, 68.2% of whom were female. The angle opening distance, recess area, and trabecular iris surface area at 500 µm increased by 48 to 73% (all P < 0.001). Lens vault and iris volume did not change. A low anterior chamber volume and low iris volume were associated with angle greater deepening by LPI. CONCLUSION: Eyes with a shallow anterior chamber and thinner irises are more likely to experience angle opening from an LPI.

The Ocular Hypotensive Efficacy of Topical Fasudil, a Rho-Associated Protein Kinase Inhibitor, in Patients With End-Stage Glaucoma.

To investigate the effects of topical administration of a selective Rho-associated kinase (ROCK) inhibitor, fasudil 0.5% and 1.2% in glaucomatous patients. In this interventional case series study, 4 eyes of 4 patients with unilateral end-stage primary open-angle glaucoma and no light perception vision were assigned to receive topical fasudil 0.5% (in 3 eyes) or 1.2% (in 1 eye) ophthalmic solution twice daily for 8 weeks. At weeks 1, 2, 3, 4, and 8, intraocular pressure (IOP) and adverse events were evaluated. Baseline mean IOP was 53.5 ± 3.4 mm Hg and mean IOP reductions of the last visit were -8.25 ± 1.2 mm Hg at 2 hours and -8.75 ± 2.2 mm Hg at 4 hours. Mean IOP reductions were clinically and statistically significant with 0.5% and 1.2% fasudil and peak effects occurred 2-4 hours after application (P = 0.0002). The largest IOP reductions were produced by 1.2% fasudil (up to -12 mm Hg). Conjunctival hyperemia was found in 1 patient with 1.2% fasudil. Topical administration of fasudil in end-stage primary open-angle glaucoma patients, caused reduction in IOP and was well tolerated. ROCK inhibitors could be considered as a candidate for glaucoma therapy in future.