Int J Ophthalmol, Vol. 14, No. 3, Mar.18, 2021 www.ijo.cn Tel: 8629-82245172 8629-82210956 Email: [email protected] ·Brief Report· Clinical observations of acute onset of myopic optic neuropathy in a real-world setting Li Liao1,2, Rui Fang3, Fang Fang1, Xiao-Hua Zhu1,2 1Department of Ophthalmology, the Second Xiangya Hospital, of intraocular pressure (IOP) were not obvious before and Central South University, Changsha 410011, Hunan Province, after treatment (18.68±5.30 vs 19.55±5.34 mm Hg, China P>0.05). There was no recurrence during long-term follow- 2Changsha Aier Eye Hospital, Changsha 410015, Hunan up observation. Province, China ● CONCLUSION: The acute onset of myopic optic 3Department of Orthopedics, the Second Xiangya Hospital, neuropathy is characterized by BCVA and VF abnormalities Central South University, Changsha 410011, Hunan Province, in bilateral eyes. Retrobulbar and systemic glucocorticoid China therapy is effective. Correspondence to: Xiao-Hua Zhu. Department of ● KEYWORDS: acute onset of myopic optic neuropathy; Ophthalmology, the Second Xiangya Hospital, Central South glucocorticoid; visual field University, 139 Renmin Road, Changsha 410011, Hunan DOI:10.18240/ijo.2021.03.21 Province, China. [email protected] Received: 2020-01-10 Accepted: 2020-06-24 Citation: Liao L, Fang R, Fang F, Zhu XH. Clinical observations of acute onset of myopic optic neuropathy in a real-world setting. Int J Abstract Ophthalmol 2021;14(3):461-467 ● AIM: To describe the clinical features of acute myopic onset of optic neuropathy and observe the effects of INTRODUCTION retrobulbar and systemic glucocorticoid therapy in a real- igh myopia is very common and is one of the major world setting. H causes of blindness, especially in East Asian countries[1]. ● METHODS: A retrospective observational case series Previous studies have shown that the number of myopia has included 18 patients with a clinical diagnosis of acute onset increased year by year in parts of East and Southeast Asia, of myopic optic neuropathy in a real-world setting. While the and by 2050, half of the world’s population will be affected[2]. patients were using retrobulbar and systemic glucocorticoid However, no effective intervention is available to prevent therapy, various imaging examination data were analysed, the development of myopia[3]. It is clear that myopia may and the clinical features of myopic optic neuropathy were also cause progressive abnormalities in retinal nerve fibres. summarized for 6mo to 2y. Ohno-Matsui[4] proposed that this myopic optic neuropathy ● RESULTS: The included group of patients with acute is not found in emmetropic eyes. We found that retrobulbar onset of myopic optic neuropathy consisted mostly of glucocorticoid therapy effectively improved best corrected females (n=11). The visual field (VF) showed abnormalities visual acuity (BCVA) in high myopia after cataract surgery. in bilateral eyes, including the spread of physiological blind Therefore, we conducted a real-world study to observe the spots, central and paracentral dark spots, and centripetal treatment effects of retrobulbar glucocorticoid therapy in peripheral VF reduction; but central vision with no subjective myopia optic neuropathy patients. Real-world research is based changes. The visual evoked potential (VEP) was abnormal on the actual conditions of patients who are not randomly chosen in all eyes with vision loss. The best corrected visual for treatment measures but are instead evaluated for a long acuity (BCVA) was improved from 1.04±0.63 to 0.47±0.57 time, during which attention is paid to treatment outcomes[5-9]. (logMAR) after glucocorticoid treatment (P<0.05). In This original article aims to describe the clinical features of patients with a short course (within 1wk), recovery was acute onset of myopic optic neuropathy and observe the effects fast and achieved the same BCVA as recorded before the of retrobulbar and systemic glucocorticoid therapy in a real- onset within 6d. However, in patients with the long course world research setting. These data are meaningful for further (1 to 2wk), recovery was slow and did not achieve the evaluating the external validity authenticity and security of BCVA recorded before the onset within 10d. The changes treatments. 461 Acute onset of myopic optic neuropathy Figure 1 The treatment procedures of patients (A) and average BCVA change is 0.57 (95%CI 0.34-0.79) logMAR (B). SUBJECTS AND METHODS Germany), and OCT was performed using Heidelberg Ethic Approval This article followed ethical guidelines that Spectralis-OCT (Germany). was approved by Ethics Committee of the Second Hospital Methods As mentioned, we selected retrobulbar and of Central South University and the principles outlined in the systemic glucocorticoid therapy. The former was the main Declaration of Helsinki (2008). We also have informed consent treatment because it is widely prescribed for patients with which was obtained from the subjects. cataracts or vitrectomy during the perioperative time[11]. In Patient Information A total of 18 cases (22 eyes) of myopic the real word, patients received a retrobulbar injection of optic neuropathy, including 11 females and 7 males, who dexamethasone (5 mg) once a week for 2 to 3wk and were were admitted to the Second Xiangya Hospital of Central then changed to triamcinolone acetonide (5 mg) once a month South University between January 2000 and December 2017 for 2 to 3mo. If someone who was in the early stages of disease were recruited. All eyes underwent a basic inspection, such as development received systemic glucocorticoid treatment uncorrected visual acuity, optometry, or slit lamp and fundus with methylprednisolone (500 mg), shock treatment was examinations. Twelve eyes underwent a visual field (VF) administered for 3d. The treatment procedures of patients are examination, 11 underwent optical coherence tomography shown in Figure 1A. (OCT) examination, 10 underwent visual evoked potential Follow-up The timepoints at which vision were evaluated at (VEP) examination, 9 cases underwent a pupillary light reflex 1, 2wk, 1, 2, 3, 6mo, 1 and 2y. In some cases, regular checks examination, and 9 cases underwent a fundus fluorescein (i.e., BCVA, VF, VEP and other examinations) needed to angiography (FFA) examination; additionally, 3 cases underwent be performed. Findings were generally stable after 6mo of magnetic resonance imaging (MRI) examination, and 4 cases treatment, and the follow-up observation period was from 6mo had AQP4 antibody detection[10]. Factually, we excluded any to 2y. The time of each visit was determined by communication previous neurological episodes and any macular or retinal between the patient and the doctor. pathology in all eyes. Statistical Analysis All data analyses were performed using Imaging The fundus color photography was performed SPSS 22.0. Paired t-test was used for statistical difference analysis using a TOPCON TRC-NW300, VF examinations were in our study. P<0.05 was considered statistical significance. performed using a Humphrey Field Analyzer 860 perimeter, RESULTS electrophysiological examinations were performed using a The age ranged from 14 to 72 years old (average, 44.09±3.86 METROVISION MonpackONE, FFA was performed using years old). The duration of the disease was 2 to 21d (average, Heidelberg fundus angiography system (HRA and HRAII; 10±2.1d). The range of spherical equivalent was -3 to -21 D 462 Int J Ophthalmol, Vol. 14, No. 3, Mar.18, 2021 www.ijo.cn Tel: 8629-82245172 8629-82210956 Email: [email protected] Table 1 Data from 22 eyes BCVA (logMAR) IOP, mm Hg MD, dB PSD, dB Age, Refraction, No. Gender y D Before After Before After Before After Before After treatment treatment treatment treatment treatment treatment treatment treatment 1 F 72 -10.8 2.00 0.52 15 14 -8.87 -5.9 1.58 2.41 2 F 55 -10.0 2.00 1.30 14 14 -2.08 -0.79 1.35 1.22 3 M 40 -9.0 2.00 0.00 17 19 -12.15 -10.33 5.99 7.45 4 M 49 -14.0 0.52 0.30 27 29 -21.04 -18.16 9.7 12.31 5 F 28 -3.0 0.52 0.00 13 11 -23.43 -4.99 11.2 5.08 6 F 33 -5.5 1.00 0.60 15 16 -20.45 -8.19 12.2 8.46 7 M 32 -2.5 0.70 0.00 25 29 -23.12 -13.53 10.42 10.5 8 F 63 -3.5 0.40 0.00 13 12 -17.01 -9.24 11.43 9.01 9 F 63 -3.5 0.40 0.00 15 17 -12.15 -6.9 8.34 6.85 10 F 65 -3.4 2.00 1.40 18 16 -6.72 -2.5 8.25 2.92 11 F 65 -3.4 2.00 1.70 19 20 -17.75 -20.02 4.26 5.26 12 M 15 -7.2 0.00 0.00 16 15 -18.75 -17.69 5.06 3.69 13 F 54 -3.0 1.00 0.00 33 37 -6.86 -6.86 3.83 1.99 14 M 45 -3.2 1.22 1.00 16 17 -7.6 -4.96 5.93 3.46 15 M 14 -8.25 1.22 1.10 26 29 -4.33 -1.36 1.69 2.48 16 M 14 -8.5 1.00 1.30 18 20 -2.5 -1.56 2.93 4.65 17 M 72 -3.25 0.40 0.22 16 15 -3.73 -0.63 3.05 1.62 18 F 42 -10.5 1.00 0.52 17 18 -5.95 -1.91 2.34 3.76 19 F 42 -10.6 0.52 0.05 15 15 -15.37 -7.76 10.47 7.72 20 F 35 -21.0 1.22 0.00 19 20 -11.17 -8.85 6.13 6.03 21 F 30 -21.0 0.52 0.00 26 30 -7.53 -3.21 8.03 7.11 22 F 42 -21.0 1.22 0.30 18 17 -3.65 -2.64 1.92 2.18 BCVA: Best corrected visual acuity; IOP: Intraocular pressure; MD: Mean deviation; PSD: Pattern standard deviation; F: Female; M: Male.