Long-term structural retinal changes in patients with optic neuritis related to multiple sclerosis.

PURPOSE: To evaluate the long-term structural and functional outcome in patients with multiple sclerosis (MS) with and without a history of optic neuritis (ON). METHODS: This was a cross-sectional study of 82 patients diagnosed with MS between 2000 and 2006 from a tertiary hospital center in Denmark. Patients gave a self-reported history of ON, and functional (visual acuity and color vision) and structural (spectra domain optical coherence tomography) markers of vision were tested. RESULTS: Median age and MS duration at the time of the clinical examination were 49.9 years (range 30.7-72.6 years) and 13 years (range 9-15 years), respectively. ON was not associated with impairment of visual acuity or color vision. Twenty-three patients had a history of ON in at least one eye. Compared to non-affected patients, these had a lower inferior (109 vs 113 µm, P=0.04) and temporal retinal nerve fiber layer (RNFL) thickness (56 vs 67 µm, P=0.01). In an age- and sex-adjusted logistic regression model, lower inferior and temporal RNFL were associated with a higher risk of ON (odds ratio [OR] 1.56 [95% confidence interval {CI} 1.01-2.41] and OR 1.74 [95% CI 1.10-2.77] per 10 µm decrement in RNFL thickness, respectively). Twenty patients had a history of ON in one eye. Compared to the non-affected eye, this eye had a lower RNFL (109 vs 115 µm, P=0.04) and a higher central retinal thickness/mean RNFL ratio (2.7 vs 2.4, P=0.04). CONCLUSION: Although patients with long-term MS and a previous history of ON did not have any functional loss of vision, structural neurodegeneration could be demonstrated in the affected eye.

[Traumatic optic neuropathy after fall with a bamboo stick]. / Udvikling af opticusneuropati efter beskedent øjetraume.

Traumatic optic neuropathy (TON) is a rare and potentially vision-threatening condition caused by ocular or head trauma. The treatment of TON is controversial with no evidence-based guidelines. We describe a case of an eight-year-old boy, who lost his vision on the right eye after having had a trauma of his left lower eyelid when he fell with a bamboo stick. Vision loss was not detected until ten days after the accident, where there were no light perception and a relative afferent pupillary defect. We attributed the vision loss to TON and no treatment was given. Within months optic disc pallor developed.