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Practice parameter: The role of corticosteroids in the management of acute monosymptomatic optic neuritis [RETIRED]

2000; Lippincott Williams & Wilkins; Volume: 54; Issue: 11 Linguagem: Inglês

10.1212/wnl.54.11.2039

1526-632X

David I. Kaufman, Jonathan D. Trobe, Eric Eggenberger, John N. Whitaker,

Retinal and Optic Conditions

Optic neuritis (ON) is an inflammatory disorder of the optic nerve.Most cases are idiopathic or associated with MS.ON can be associated with a variety of systemic or ocular disorders and is the most common acute optic neuropathy in adults younger than 46 years.[3][4][5][6][7][8][9][10][11][12][13] Acute ON often presents as an isolated clinical event without contributory systemic abnormalities (monosymptomatic ON).Clinical features include periocular pain, abnormal visual acuity and fields, reduced color vision, a relative afferent pupillary defect, and abnormal visual evoked potentials.The fundus may appear normal or demonstrate edema of the optic nerve head (papillitis). 12-180][21][22] The visual deficit of ON may worsen over 1 to 2 weeks and usually begins improving over the next month.Lack of improvement in visual function by 30 days is unusual. 23][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Differential diagnosis includes compressive, ischemic, hereditary, toxic, or other inflammatory optic neuropathies (e.g., sarcoid).These conditions usually do not exhibit the same clinical pattern (table 1) or rate of recovery as monosymptomatic ON. [1][2][3][4][5][6][7][8][9][10][11][12][13] Treatment of monosymptomatic ON has included oral, retrobulbar, and IV steroids, immunoglobulin, and acupuncture. Monomptomatic acute ON is not rare and because the usefulness of oral prednisone in this disorder has recently been questioned, 23,[78][79][80][81][82] this practice parameter was developed to provide recommendations regarding the management of this common neurologic problem.Evidence review.A literature search was conducted using Medline and Healthstar from 1966 to July 1, 1999.ON was cross-referenced with treatment and therapy.Citations earlier than 1966 were searched by cross-referencing techniques and an Index Medicus hand search.A total of 582 different citations dealing with ON and some aspect of therapy were identified and reviewed.Only literature published in well-disseminated journals dealing specifically with MS-related or idiopathic ON involving at least three patients was retained.Both retrospective and prospective data were reviewed.Citations were excluded when they simply described a small number of individual case reports or reviewed "ON" due to diseases such as sarcoid, lupus, anterior ischemic optic neuropathy, trauma, hereditary optic neuropathy, optic nerve compression, or other unrelated optic neuropathy.Definitions for the classification of evidence.Class I. Evidence provided by well-designed, randomized, controlled clinical trials, including overviews (meta-analyses) of such trials.Class II.Evidence provided by well-designed observational studies with concurrent controls (e.g., case control and cohort studies).Class III.Evidence provided by expert opinion, case series, case reports, and studies with historical controls.All pertinent studies are listed in table 2.Results.[58][59][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][83][84][85] The ONTT enrolled 457 patients with acute ON, age 18 to 46 years,