The predictor factor of final visual acuity (VA) of acute retrobulbar neuritis patients receiving optic neuritis treatment trial (ONTT) regiment

https://doi.org/10.19106/JMedSci005302202104

Tatang Talka Gani(1*), Melvina Nidya Sandra(2), Indra Tri Mahayana(3), Datu Respatika(4), Hartono Hartono(5)

(1) Department of Ophthalmology, Dr. Sardjito General Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
(2) Department of Ophthalmology, Dr. Sardjito General Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
(3) Department of Ophthalmology, Dr. Sardjito General Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
(4) Department of Ophthalmology, Dr. Sardjito General Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
(5) Department of Ophthalmology, Dr. Sardjito General Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Neuro-Ophthalmology Sub Division, Dr. YAP Eye Hospital, Yogyakarta, Indonesia
(*) Corresponding Author

Abstract


The study aimed to investigate the efficacy of intravenous optic neuritis treatment trial (ONTT) regiment on the treatment ofpatients with acute retrobulbar neuritis.This was a cross sectional studyusing medical records data of patients diagnosed with unilateral or bilateral retrobulbar neuritis by normal funduscopic findings and typical optic neuritis perimetry results within 14 days of onset fromtheNeuro-ophthalmology Clinic, Department of Ophthalmology, Dr. Sardjito General Hospital, Yogyakarta from January to December 2015. Medical records data of patients who received 1000 mg methylprednisolone IV per day for 3 days followed by 11 days 1 mg/kg body weight oral prednisolone were reviewed. Visual acuity (VA) at onset, final VA at time of follow up, delta VA improvement and time of follow up were included in the analyses.Twenty data of patients aged 33.95±8.07 years with VA at onset of 1.96±0.81 (~ 1 mCF) were analyzed in this study. Significantly improvement in final VAafter treatment to be 1.39±1.12 (~5mCF) was reported (p=0.001). The VA at onsetwas a predictive factor for final VA (p <0.001). Every 1.17 increase of final VA for every one-point decreased VA at onset (p<0.001). Time follow up showed to be trend (p=0.059),however, age and sex were not a predictive factorof final VA (p>0.05). In conclusion, there is VA improvement after the treatment of ONTT regiment. The VA at onset is a predictive factorof final VA on patients with acute retrobulbar neuritis.

ABSTRAK

Penelitian ini bertujuan mengkaji efektivitas regimen optic neuritis treatment trial (ONTT) intravena pada pengobatan pasien dengan neuritis retrobulbar faseakut. Penelitian potong lintang ini menggunakan rekam medis pasien yang didiagnosis neuritis retrobulbar unilateral atau bilateral dengan temuan funduskopi normal dan hasil perimetri neuritis optik yang khas dalam waktu 14 haris etelah onset dari Klinik Neuro-optamalmologi, Departemen Oftalmologi, Rumah Sakit Umum Pusat Dr. Sardjito, Yogyakarta dari Januari-Desember 2015. Data rekam medis pasien yang menerima1000 mg metilprednisolon IV per haris elama 3 hari diikuti oleh prednisolon oral selama 11 hari dengan dosis 1 mg/kg berat badan dianalisis. Ketajaman visual (VA) saat onset, VA akhir saat tindaklanjut, peningkatan VA, dan waktu tindak lanjut dianalisis. Sebanyak 20 data pasien berumur 33,95 ±8,07 tahun dengan VA saat onset 1,96 ±0,81 (~ 1 mCF) dianalisis dalam penelitian ini. Perbaikan VA akhir menjadi 1,39±1,12 (~5mCF) dilaporkan (p=0,001). Ketajaman visual saat onset merupakan factor predictor VA akhir (p<0,001). Setiap peningkatan VA akhir sebesar 1,17 menurunkan satu poin VA saat onset (p<0.001). Waktu tindak lanjut cenderung menjadi factor prediktor (p=0,059), namun demikian usia, jenis kelamin bukan factor predictor VA akhir (p>0,05). Dapat disimpulkan, terdapat peningkatan VA pasien setelah pengobatan regimen ONTT. Ketajaman visual saat onset merupakan factor prediktor VA akhir pada pasien dengan neuritis retrobulbar akut.


Keywords


retrobulbar neuritis; optic neuritis; visual acuity; optic neuritis treatment trial; treatment;

Full Text:

PDF


References

  1. Bennett JL. Optic Neuritis. Continuum2019; 25(5):1236-64. https://doi.org/10.1212/CON.0000000000000768
  2. Toosy AT, Mason DF, Miller DH. Optic Neuritis. Lancet Neurol 2014; 13(1):83-99. https://doi.org/10.1016/S1474-4422(13)70259-X
  3. Stübgen JP. A literature review on optic neuritis following vaccination against virus infections. Autoimmun Rev 2013; 12(10):990-7. https://doi.org/10.1016/j.autrev.2013.03.012
  4. MacDonald BK, Cockerell OC, Sander JW, Shorvon SD. The incidence and lifetime prevalence of neurological disorders in a prospective community-based study in the UK. Brain 2000; 123(4):665-76. https://doi.org/10.1093/brain/123.4.665
  5. Rodriguez M, Siva A, Cross S, Obrien P, Kurland L. Optic neuritis: apopulation-based study in Olmsted County, Minnesota. Neurology 1995; 45(2):244-50. https://doi.org/10.1212/wnl.45.2.244.
  6. Beck RW, Cleary PA, Anderson Jr MM, Keltner JL, Shults WT, Kaufman DI, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis Study Group. N Engl J Med 1992; 326(9):581-8. https://doi.org/10.1056/NEJM199202273260901
  7. Anonym. The clinical profile of optic neuritis: experience of the Optic Neuritis Treatment Trial.Optic Neuritis Study Group. Arch Ophthalmol 1991; 109(12):1673-8. https://doi.org/10.1001/archopht.1991.01080120057025
  8. Sorensen TL, Frederiksen JL, Bronnum-Hansen H, Petersen HC. Optic neuritis as onset manifestation of multiple sclerosis: a nationwide, long-term survey. Neurology 1999; 53(3):473-8. https://doi.org/10.1212/wnl.53.3.473
  9. Choy BNK, Ng ALK, Lai JSM. Clinical characteristics of optic neuritis in Hong Kong population: 10-year review. Int Ophthalmol 2018; 38(2):557-64. https://doi.org/10.1007/s10792-017-0491-9
  10. Hoorbakht H, Bagherkashi F. Optic neuritis, its differential diagnosis and management. Open Ophthalmol J 2012; 6:65-72. https://doi.org/10.2174/1874364101206010065
  11. Menon V, Saxena R, Misra R, Phuljhele S. Management of optic neuritis. Indian J Ophthalmol 2011; 59(2):117-22. https://doi.org/10.4103/0301-4738.77020
  12. Shams PN, Plant GT. Optic neuritis: a review. Int MS J 2009; 16(3):82-9.
  13. Beck RW, Cleary PA. Optic neuritis treatment trial: one-year follow-up results. Arch Ophthalmol 1993; 111(6):773-5. https://doi.org/10.1001/archopht.1993.01090060061023
  14. Sethi HS, Menon V, Sharma P, Khokhar S, Tandon R. Visual outcome after intravenous dexamethasone therapy for idiopathic optic neuritis in an Indian population: A clinical case series. Indian J Ophthalmol 2006; 54(3):177-83. https://doi.org/10.4103/0301-4738.27069
  15. Mackay DD. Should patients with optic neuritis be treated with steroids? Curr Opin Ophthalmol 2015; 26(6):439-44. https://doi.org/10.1097/ICU.0000000000000197
  16. Menon V, Mehrotra A, Saxena R, Jaffery NF. Comparative evaluation of megadose methylprednisolone with dexamethasone for treatment of primary typical optic neuritis. Indian J Ophthalmol 2007; 55(5):355-9. https://doi.org/10.4103/0301-4738.33821
  17. De Lott LB, Burke JF, Andrews CA, Costello F, Cornblath WT, Trobe JD, et al. Association of individual-level factors with visual outcomes in optic neuritis: secondary analysis of a randomized clinical trial. JAMA Netw Open 2020; 3(5):e204339. https://doi.org/10.1001/jamanetworkopen.2020.4339
  18. Kapoor R, Miller DH, Jones SJ, Plant GT, Brusa A, Gass A, et al. Effects of intravenous methylprednisolone on outcome in MRI-based prognostic subgroups in acute optic neuritis. Neurology 1998; 50(1):230-7. htpp://doi.org/10.1212/wnl.50.1.230
  19. Sellebjerg F, Nielsen HS, Frederiksen J, Olesen J. A randomized, controlled trial of oral high-dose methylprednisolone in acute optic neuritis. Neurology 1999; 52(7):1479-84. https://doi.org/10.1212/wnl.52.7.1479
  20. Gal RL, Vedula SS, Beck R. Corticosteroids for treating optic neuritis. Cochrane Database Syst Rev 2015; 2015(8):CD001430.
  21. Chrousos GA, Kattah JC, Beck RW, Cleary PA. Side effects of glucocorticoid treatment: experience of the Optic Neuritis Treatment Trial. JAMA 1993; 269(16):2110-2.
  22. Wakakura M, Mashimo K, Oono S, Matsui Y, Tabuchi A, Kani K, 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(2):133-8. https://doi.org/10.1016/s0021-5155(98)00071-9
  23. Zhou H, Zhao S, Yin D, Chen X, Xu Q, Chen T, et al. Optic neuritis: a 5-year follow-up study of Chinese patients based on aquaporin-4 antibody status and ages. J Neurol 2016; 263(7):1382-9. https://doi.org/10.1007/s00415-016-8155-7
  24. Hansapinyo L, Vivattanaseth C. Clinical characteristics, treatment outcomes and predictive factors in optic neuritis. Open Ophthalmol J 2018; 12:247-55. https://doi.org/10.2174/1874364101812010247



DOI: https://doi.org/10.19106/JMedSci005302202104

Article Metrics

Abstract views : 1407 | views : 1611


Bookmark and Share


Copyright (c) 2021 Tatang Talka Gani, Melvina Nidya Sandra, Indra Tri Mahayana, Datu Respatika, Hartono Hartono

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.