急性視神經炎之臨床觀察

Clinical Study on Acute Optic Neuritis

楊燕飛(Yen-Fei Yang) ； 侯平康(Ping-Kang Hou)

《中華民國眼科醫學會會刊》 6卷 (1967/05) Pp. 47-55

https://doi.org/10.30048/ACTASOS.196705.0006

並列摘要

A clinical study of 40 patients (67 eyes) who were diagnosed as acute optic neuritis in the National Taiwan University Hospital, during the past ten years was reported. In order to make the diagnosis certain the following procedures were carried out.
1) Ophthalmological examination including examination of the external eye, determination of visual acuity, refraction, ophthalmoscopic examination perimetry, scotometry, and slitlamp examination
2) Medical examination and laboratory tests including serologic test for syphilis and cerebrospinal fluid examination.
3) Neurologic examination
4) Oto-rhinolarygological examination
5) X-ray of skull, chest and accessory nasal sinuses.
Certain diseases, such as pseudoneuritis, papilledema and longstanding hypertensive disc were carefully excluded.
The majority of these patients were 10 to 30 years old. (The average age being male 27.7 and female 26.1). The incidence was a little higher in male than in female (male: female=22:18). No definite seasonal variation of incidence was found. Twenty-eight cases were clinically diagnosed papillitis and 12 cases were retrobulbar neuritis. Bilateral form of optic neuritis was noted in 27 case5 and monocular neuritis in. 13 among this series of 40 patients.
As to the clinical feature, sudden failure of vision and defect of visual field were occurred in all instances. The visual acuity decreased below to 0.1 in 85%. Peripheral visual field defect was not so common, while caecocentral scotoma was the characteristic findings in 68.6%.
As to the subjective symptoms, headache, vertigo, pain in and around the eye which aggravated by eyeball movement were the most frequent complaints. Ophthalmoscopically all cases revealed nearly normal appearance on the onset of the disease in the group of retrobublar neuritis, however in the group of papillitis we found papillary hyperemia 100%, papilledema 67.3%, venous engorgement 57.1% and perivascular sheathing 14.5%. Temporal discoloration of the disc, edema of the retinal central area and arterial attenuation were observed in the various stages in both groups.
Etiologic study according to Duke Elder's classification was done. Etiological factors such as infectious, toxic (exogenous), metabolic or nutritional and heredodegenerative were all excluded after thorough study in this group. The principal causes of these 40 cases were almost classified as cryptogenic except 6 cases who were demyelinating in nature.
We used corticotropin or corticosteroid in treating 36 patients (61 eyes). These drugs greatly accelerated the healing process and led to rapid clearing of scotoma and improvement of vision. After termination of this treatment the number of cases with vision below 0.1 highly decreased from 85% to 33%. The visual field recovered to almost normal range in 75% of the cases.
Twenty-three cases of the total patients were recovered satisfactory within one month after the onset of the disease.
The length of follow up study varied from 6 months to 8 years. Three of the 40 cases had second attack, and one cases experienced 3 times of acute phase of optic neurtis. During the follow up study two cases developed manifest neuromyelitis optica of Devic and four showed multiple sclerosis clinically. The remaining 34 cases were classified as cryptogenic. (Two of the four with multiple sclerosis exhibited neurologic distubances at the time of optic neuritis. The another two showed neurologic abnormalities at the follow up period.) All of these diagnosis was clinically one without pathological confirmation.
Since multiple sclerosis has been regarded as rare or nonexistent among orientals by various authors and the lack of postmortem confirmation here in Taiwan have made physicians hesitate to make diagnosis of multiple sclerosis. It deserves special mention that an increasing number of clinically diagnosed multiple sclerosis has been found in National Taiwan University Hospital in recent years. This fact may help us to abandon the previous -concept that multiple sclerosis among Chinese is a rarity. It is the authors' conviction that more cases of multiple sclerosis will be found if we pay attention to the early signs of multiple sclerosis such as visual impairment and other neurologica1 deficits at follow up examination.
Finally emphasis must be placed on that any patient with acute octic neuritis between the age from 15 to 50 years should be carefully examined for neurological deficit especially for demyelinating process. We believe that at the long time follow up other signs of demyelinating process can be expected to develop in acute optic neuritis which temporarily classified as cryptogenic in cause.