Clinical profile and challenges faced in the management of optic neuritis: the Indian scenario.

PURPOSE: Optic neuritis (ON) is a relatively common ophthalmic disease that has recently received renewed attention owing to immunological breakthroughs. We studied the profile of patients with ON with special reference to antibody-mediated ON and the challenges faced in its management. METHODS: Case records of patients with ON presenting to a tertiary eye-care center in South India were analyzed. Data on demographics, presenting visual acuity (VA), clinical features, seropositivity for aquaporin-4 immunoglobulin G (AQP4-IgG) and myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG), details of magnetic resonance imaging (MRI) of orbits and brain, and treatment were collected. RESULTS: Among 138 cases with acute ON, male: female ratio was 1:2. Isolated ON was present in 41.3% of cases. Antibody testing of sera was performed in 68 patients only due to financial limitations. Among these, 48.5% were MOG-IgG-seropositive, 11.76% were AQP4-IgG-seropositive, and 30.88% samples were double seronegative. Other causes included multiple sclerosis (n = 4), lactational ON (n = 4), tuberculosis (n = 2), invasive perineuritis (n = 2), COVID-19 vaccination (n = 2), and COVID-19 (n = 1). The mean presenting best corrected visual acuity (BCVA) was 1.31 ± 1.16 logMAR (logarithm of the minimum angle of resolution). The mean BCVA at 3 months was 0.167 ± 0.46 logMAR. Only initial VA ≤ 'Counting fingers' (CF) had a significant association with the visual outcome for final VA worse than CF. The steep cost of investigations and treatment posed challenges for many patients in the management of ON. CONCLUSION: MOG-IgG-associated ON is common in India. Unfortunately, financial constraints delay the diagnosis and timely management of ON, adversely affecting the outcome.

Clinical Profile of Patients with Hemifacial Spasm at a Tertiary Eye Care Center in South India: A Retrospective Study.

Purpose: To assess the incidence and clinical profile of hemifacial spasm (HFS) and the association between HFS and systemic diseases. Methods: This retrospective study was carried out on 85 patients with HFS, presenting at a tertiary eye care center in South India. Demographic and clinical details were recorded for all patients. Of these, the patients who had undergone magnetic resonance imaging (MRI) of the brain were analyzed for primary and secondary HFS. Results: The mean age of the patients was 56.11 ± 12.51 years. The age at onset of HFS was 54.9 ± 12.7 years. The disease duration was 9.51 ± 7.28 years. Male:female ratio was 1:1.17. The right side was involved in 31 patients (36.47%) and the left side in 54 patients (63.52%). MRI was performed in 54 (63.52%) patients and showed neurovascular conflict in 22 (40.74%) patients and space-occupying lesions in 2 (3.70%) patients. Forty-nine (57.64%) patients had primary HFS, while five (5.88%) patients had secondary HFS due to old facial palsy in 3 and space-occupying lesions in two patients. Twenty (23.52%) patients received botulinum toxin A with a good response. Type of HFS had a significant association with hypertension (P = 0.046) while no significant association was present between laterality of HFS and systemic diseases (P > 0.05 each). Multivariate analysis showed a marginally significant association between type of HFS and hypertension (P = 0.057). Conclusions: Primary HFS was the main type of HFS with female dominance and predilection for the left side. Hypertension had a relationship with HFS that needs to be investigated further for its causal nature.