关键词: 筛板前视神经炎, 视神经炎

Abstract:  Objective To summarize the clinical features, treatment and outcome of prelaminar optic neuritis patients. Design Retrospective case series. Participants A total of 18 patients with prelaminar optic neuritis who were hospitalized in the Department of Neurology of Beijing Tongren Hospital from January 2019 to June 2023 were included. Methods The demographic data, past medical history, clinical manifestations, ancillary test results, including visual acuity, visual field, fundus photographs, visual evoked potential (VEP), oligoclonal bands (OB) in cerebrospinal fluid, central nervous system demyelination antibodies, treatment options and visual prognosis of the patients were collected. Main Outcome Measures Best corrected visual acuity (BCVA) at the acute stage of the disease and 3 months after onset, patterns of visual field defects, degrees of optic disc edema, with or without peridisc hemorrhage, latencies and amplitudes of P100, demyelinating antibodies, OB in cerebrospinal fluid, treatment options. Results Among the 18 patients with prelaminar optic neuritis, 13 were females, with an average age of (43.61±2.94) years at onset. There were 20 affected eyes, of which 9 eyes (45%) had BCVA≤0.1 at the worst stage of the disease and 8 eyes (40%) had BCVA≥0.5. Diffuse visual field defects occurred in 8 eyes (40%), irregular patchy visual field defects in 6 eyes (30%), and central scotomas in 3 eyes (15%). Moderate to severe optic disc edema were seen in 10 eyes (50%), and peridisc hemorrhage in 7 eyes (35%). Only the P100 latency was prolonged in 16 eyes (80%), and prolonged latency with decreased amplitudes in 4 eyes (20%). There were 3 cases (16.7%) with positive OB in cerebrospinal fluids, 4 cases (22.2%) with positive MOG antibody in serum, and negative for biomarkers in other 11 cases (61.1%). Three patients received oral prednisone acetate tablets and 15 patients received intravenous high-dose methylprednisolone, and no patients received immunosuppressants. Eleven eyes (55%) showed significant improvement or complete recovery in visual acuity at 3 months, 8 eyes (40%) showed partial improvement, and only 2 eyes (10%) showed no changes in visual acuity. Conclusion Patients with prelaminar optic neuritis have varying degrees of visual impairment, with diffuse visual field defects and severe optic disc edema being more common, but visual function is usually restored well with glucocorticoid therapy. (Ophthalmol CHN, 2024, 33: 140-144)

Key words:  prelaminar optic neuritis, optic neuritis