Workshop on Different optic Neuropathies and Novel Treatments
Umur Kayabasi,
Bahcesehir University, Turkey
Abstract
The aim of this workshop
is to discuss the diagnosis, treatment and follow- up of different optic
neuropathies. Meanwhile images from the new technology devices like OCT and the
conventional machines like Perimetry will be shown. Also MR images of the orbit
and brain and images of optic nerve problems will be the subjects of the main
topic. There are some new developments in the treatment of the optic
neuropathies and different ideas about novel treatments will be shared.
OPTİC
NEUROPATHİES:
Optic neuritis ( demyelination of the optic nerve): Acute, painful
vision loss. Occurs mainly in women within the age range of 18- 45. Responds
well to high dose intravenous steroids. Approximately 1/3 of the cases are seen
with disc edema, 2/3 are retrobulber. Retrobulber cases progress to multiple
sclerosis (MS ) more frequently. The possibility of a woman patient to
develop MS after isolated optic neuritis is about % 70 in ten years. The
progression of optic neuritis to MS can be detected by OCT.
Anterior
ischemic optic neuropathy (non- arteritic): Acute, painless
visual loss due to a stroke on the optic nerve head. Disc edema is present.
Patients usually have hypertension or diabetes. Visual field defect is altitudinal.
Cup to disc ratio is small. No definite treatment. Intravitreal injections
(triamcinolone and anti- VEGF) may be tried in acute cases.
Traumatic
optic neuropathy: Occurs after a direct or indirect trauma
to the optic nerve. Steroids are not recommended if there is head concussion.
Surgery of the optic canal to decompress the nerve may be tried in early
stages. There are reports about success with intravenous erythropoietin.
Toxic
optic neuropathy: Central, bilateral visual loss. There is
a new report about improvement after methanol toxicity with the combination of
erythropoietin and steroids.
Radiation
optic neuropathy: Bilateral visual loss months or years
after radiation therapy of a brain tumor. There are new reports of improvement
of vision with intravenous bevacizumab tharapy.
Leber’
s optic neuropathy: Painless,bilateral visual loss with
central scotomas. Inherited by the maternal mitochondrial DNA mutations:
m.11778, m.14484, m.3460. Idebenone treatment in early stage Leber?s disease
have been shown to be beneficial.
Chronic
relapsing inflammatory optic neuropathy: Steroid sensitive optic
neuropathy which recurs after steroid withdrawal. Long term steroids or other
immunosuppressive agents are used. There are other optic neuropathies with
inflammatory, infectious, etc. etiology which can be discussed, too.