Journal List > J Korean Ophthalmol Soc > v.52(9) > 1008883

TOOLS
Cha, Kim, Kim, Choung, and Yu: Clinical Features and the Effect of High-Dose Steroid Therapy in Korean Optic Neuritis Patients
Original Article

J Korean Ophthalmol Soc 2011;52(9):1083-1088.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.9.1083

Clinical Features and the Effect of High-Dose Steroid Therapy in Korean Optic Neuritis Patients

Dong Min Cha, MD1, 2, Seong Joon Kim, MD, PhD1, 2, Jeong Hun Kim, MD, PhD1, 2, Ho Kyung Choung, MD, PhD1, 3, Young Suk Yu, MD, PhD1, 2

1Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

2Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea

3Department of Ophthalmology, Seoul Metropolitan Boramae Hospital, Seoul, Korea

Address reprint requests to Seong Joon Kim, MD, PhD Department of Ophthalmology, Seoul National University Hospital #28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea Tel: 82-2-2072-2438, Fax: 82-2-741-3187, E-mail: ophjun@gmail.com

Received 28 June 2010       Revised 22 February 2011       Accepted 6 July 2011

Copyright © 2011 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the clinical manifestation and response to high-dose steroid therapy in Korean optic neuritis patients.

Methods

We retrospectively reviewed the medical records of 13 patients diagnosed with optic neuritis who were treated with high-dose steroid and who were followed-up for more than three months in Seoul National University Hospital between January 2005 and December 2008.

Results

Pain on extraocular movement (EOM) and disc swelling were observed in 61% (8/13) patients diagnosed with optic neuritis. Visual acuity (VA) improved to more than 20/40 in 77% (10/13) of patients after high-dose steroid therapy. The patients who resolved within one month recovered VA a mean of 18 days after onset. The recovery period had nothing to do with the initial time of high-dose steroid therapy.

Conclusions

Pain on EOM was less frequently observed and disc swelling was more frequent in Korean patients than have been reported in Caucacian patients. The recovery period of optic neuritis was not influenced by the initial time of high-dose steroid therapy.

Keywords: Methylprednisolone, Optic neuritis, Pulse steroid therapy

References

1. Optic Neuritis Study Group. Multiple sclerosis risk after optic neuritis: final optic neuritis treatment trial follow-up. Arch Neurol. 2008; 65:727–32.
2. Beck RW, Gal RL, Bhatti MT, et al. Visual function more than 10 years after optic neuritis: experience of the optic neuritis treatment trial. Am J Ophthalmol. 2004; 137:77–83.
3. Visual function 5 years after optic neuritis: experience of the Optic Neuritis Treatment Trial. The Optic Neuritis Study Group. Arch Ophthalmol. 1997; 115:1545–52.
4. Rizzo JF 3rd, Lessell S. Risk of developing multiple sclerosis after uncomplicated optic neuritis: a long-term prospective study. Neurology. 1988; 38:185–90.
5. Beck RW, Cleary PA. Optic neuritis treatment trial. One-year follow-up results. Arch Ophthalmol. 1993; 111:773–5.
6. Confavreux C, Vukusic S, Moreau T, Adeleine P. Relapses and progression of disability in multiple sclerosis. N Engl J Med. 2000; 343:1430–8.
crossref
7. Kira J. Multiple sclerosis in the Japanese population. Lancet Neurol. 2003; 2:117–27.
crossref
8. Isayama Y, Takahashi T, Shimoyoma T, Yamadori A. Acute optic neuritis and multiple sclerosis. Neurology. 1982; 32:73–6.
crossref
9. Lin YC, Yen MY, Hsu WM, et al. Low conversion rate to multiple sclerosis in idiopathic optic neuritis patients in Taiwan. Jpn J Ophthalmol. 2006; 50:170–5.
crossref
10. Wang JC, Tow S, Aung T, et al. The presentation, aetiology, management and outcome of optic neuritis in an Asian population. Clin Experiment Ophthalmol. 2001; 29:312–5.
crossref
11. Lim SA, Goh KY, Tow S, et al. Optic neuritis in Singapore. Singapore Med J. 2008; 49:667–71.
12. Wakakura M, Minei-Higa R, Oono S, et al. Baseline features of idiopathic optic neuritis as determined by a multicenter treatment trial in Japan. Optic Neuritis Treatment Trial Multicenter Cooperative Research Group (ONMRG). Jpn J Ophthalmol. 1999; 43:127–32.
13. Lee YJ, Chang BL. Clinical manifestation of optic neuritis. J Korean Ophthalmol Soc. 1997; 38:1969–74.
14. Ahn BC, Kim HS, Ahn HS. Clinical profile of the optic neuritis in Korea. J Korean Ophthalmol Soc. 1997; 38:1827–33.
15. Beck RW, Cleary PA, Anderson MM Jr, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. N Engl J Med. 1992; 326:581–8.
16. Beck RW, Trobe JD, Moke PS, et al. High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis: experience of the optic neuritis treatment trial. Arch Ophthalmol. 2003; 121:944–9.
17. Wakakura M, Mashimo K, Oono S, et al. Multicenter clinical trial for evaluating methylprednisolone pulse treatment of idiopathic optic neuritis in Japan. Optic Neuritis Treatment Trial Multicenter Cooperative Research Group (ONMRG). Jpn J Ophthalmol. 1999; 43:133–8.
18. The clinical profile of optic neuritis. Experience of the Optic Neuritis Treatment Trial. Optic Neuritis Study Group. Arch Ophthalmol. 1991; 109:1673–8.
19. Chan CK, Lam DS. Optic neuritis treatment trial:10-year follow-up results. Am J Ophthalmol. 2004; 138:695.
crossref
20. Boomer JA, Siatkowski RM. Optic neuritis in adults and children. Semin Ophthalmol. 2003; 18:174–80.
crossref
21. de la Cruz J, Kupersmith MJ. Clinical profile of simultaneous bilateral optic neuritis in adults. Br J Ophthalmol. 2006; 90:551–4.
crossref

Figure 1.
Improvement in visual acuity in early pulse steroid treatment group. ▲ Time to start steroid pulse therapy.
jkos-52-1083f1.tif
Figure 2.
Improvement in visual acuity in late pulse steroid treatment group. ▲ Time to start steroid pulse therapy.* Patient 9 received pulse steroid treatment, although her visual acuity of the right eye was 0.6, because the visual acuity of her left eye was not improved for 23 days without any treatment.
jkos-52-1083f2.tif
Table 1.
Demographics of patients
Characteristics Number of patients (%)
Sex
Male 4
Female 9
Age (yr)
Mean ± SD 39.6 ± 11.1
Range 16–55
Laterality
Mono-ocular 9
Binocular 4
Recurrence
Primary cases 9
Recurrent cases 4
Table 2.
Clinical characteristics of patients
Characteristics Number of patients or eyes (%)
The worst visual acuity (eye)
0.003 5 (29)
0.005 ≤ < 0.01 7 (41)
0.01 ≤ < 0.02 3 (17)
0.02 ≤ < 0.1 0 (0)
0.1 ≤ 2 (12)
Disc swelling (patient) 8 (61)
* EOM pain (patient) 8 (61)
† Abnormal MRI finding (patient) 10 (77)
History of ‡ URI (patient) 6 (46)

* EOM = extraocular movement

† Abnormal MRI finding = optic nerve enlargement and increase of T2 signal intensity

‡ URI = upper respiratory infection.

Table 3.
Comparison between early and late pulse steroid treatment groups
* Early treatment group (Group A) † Late treatment group (Group B) ‡ p-value
Number of patients & eyes 4 patients 6 eyes 5 patients 5 eyes
Time from onset to pulse steroid treatment (mean ± SD, day) 4.83 ± 2.40§ (5, 2–7) 14.2 ± 5.21 (14, 9–22) 0.006
Time from steroid treatment to recovery (mean ± SD, day) 12.83 ± 5.98 (11, 10–25) 4.4 ± 3.58 (4, 0–10) 0.011
Time from onset to recovery (mean ± SD, day) 17.66 ± 4.80 (17, 14–27) 18.6 ± 3.43 (20, 13–22) 0.355

* Early treatment group = the group who received pulse steroid treatment within 7 days from the onset

† Late treatment group = the group who received pulse steroid treatment after 8 days from the onset

‡ Mann-Whitney U test

§ Median, range.

TOOLS
Similar articles