Journal of Neuro-Ophthalmology最新文献

{"title":"Nonarteritic Anterior Ischemic Optic Neuropathy After Recreational PDE5 Inhibitor Use in a Healthy Patient: More Evidence for Causation.","authors":"Natalie Brossard-Barbosa, Zoë R Williams","doi":"10.1097/WNO.0000000000002159","DOIUrl":"10.1097/WNO.0000000000002159","url":null,"abstract":"","PeriodicalId":16485,"journal":{"name":"Journal of Neuro-Ophthalmology","volume":" ","pages":"e109-e111"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optic Nerve and Optic Nerve Sheath Biopsy Indications and Outcomes.","authors":"Reilly A Coombs, John J Chen, Diva R Salomão, Deena A Tajfirouz, Eric R Eggenberger, Marie A DiNome, Jacqueline A Leavitt, Misha L Pless, James A Garrity, Sasha A Mansukhani","doi":"10.1097/WNO.0000000000002329","DOIUrl":"https://doi.org/10.1097/WNO.0000000000002329","url":null,"abstract":"<p><strong>Background: </strong>This study describes the clinical presentation, diagnostic yield, and outcomes of patients who have undergone optic nerve or nerve sheath biopsies.</p><p><strong>Methods: </strong>A total of 72 patients undergoing an optic nerve or optic nerve sheath biopsy at Mayo Clinic, Rochester, MN; Jacksonville, FL; or Scottsdale, AZ were included. Patients were identified by searching the pathology database between January 1, 2000, and December 31, 2023. Charts were reviewed to confirm the site of biopsy and review the patient's presentation, clinical course, and indication for biopsy. The main outcome measure was the diagnostic yield.</p><p><strong>Results: </strong>Of the 72 patients included, 32 underwent optic nerve and 40 optic nerve sheath biopsies. The median age at biopsy was 34 years (range, 1-81 years), and 44 patients (61%) were female. The median preoperative visual acuity was no light perception (NLP) (range, 20/20 to NLP). Prebiopsy optic disc appearance was pallor in 32 (44%), edema in 18 (25%), normal in 11 (15%), and edema with pallor in 5 (7%) patients. Surgical approach was by orbitotomy in 43 (60%), craniotomy in 25 (35%), and trans-nasal in 4 (5%) patients. A definitive diagnosis was achieved on 48 biopsies of 72 patients with an unexplained optic neuropathy, thus giving a diagnostic yield of 67%, higher in optic nerve biopsies (81%) compared with nerve sheath biopsies (55%). The most common diagnoses were meningioma in 23 (32%), glioma in 9 (13%), and sarcoidosis in 6 (8%) patients. For all patients, postbiopsy complications occurred in 11 patients (18%), including strabismus in 5 (7%) patients and acute unexpected vision loss in 4 (6%) patients. The patients in this cohort were followed for a median of 3.3 years, and visual acuity at most recent visit was NLP (range, 20/20 to NLP).</p><p><strong>Conclusions: </strong>Based on our study, the diagnostic yield of optic nerve and optic nerve sheath biopsies was 67%. The potential diagnostic benefits of an optic nerve and optic nerve sheath biopsies may be offset by the possible permanent postsurgical complications.</p>","PeriodicalId":16485,"journal":{"name":"Journal of Neuro-Ophthalmology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contraceptive Counseling Prior to Neuro-Ophthalmology Referral in Idiopathic Intracranial Hypertension.","authors":"Douglas W Snyder, Maggie Xing, Leanne D Stunkel, Gregory P Van Stavern","doi":"10.1097/WNO.0000000000002333","DOIUrl":"https://doi.org/10.1097/WNO.0000000000002333","url":null,"abstract":"<p><strong>Background: </strong>Patients with idiopathic intracranial hypertension (IIH) have reported being told to discontinue their hormonal contraceptive, despite a lack of evidence in the literature. We aimed to determine the frequency of this counseling and explore the content of discussion that other providers gave to patients with idiopathic intracranial hypertension regarding their use of hormonal contraception before neuro-ophthalmic assessment.</p><p><strong>Methods: </strong>A survey of female subjects, aged 18-50 years, who had been advised or counseled regarding idiopathic intracranial hypertension and hormonal contraception. They were asked additional questions depending on their responses.</p><p><strong>Results: </strong>Attempted contact of 230 subjects resulted in a response rate of 37% for a total of 85 respondents. Twenty four subjects declined participation. The total number of subjects surveyed was 61. Nearly half of all surveyed subjects reported taking a form of contraception at the time of their idiopathic intracranial hypertension diagnosis. Nearly 1 in 4 subjects reported being counseled regarding idiopathic intracranial hypertension and contraception. One in 10 of subjects who reported taking a contraceptive at the time of their diagnosis recalled a recommendation to cease their contraceptive recommendation before seeing a neuro-ophthalmologist.</p><p><strong>Conclusions: </strong>Nearly 10% of patients with idiopathic intracranial hypertension in our study who were taking contraception were inappropriately counseled to cease their use before neuro-ophthalmic referral. Ophthalmologists and neuro-ophthalmologists can help further benefit their patients by providing proactive education illustrating the lack of convincing evidence establishing a causal relationship between hormonal contraceptives and idiopathic intracranial hypertension.</p>","PeriodicalId":16485,"journal":{"name":"Journal of Neuro-Ophthalmology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined 6th and 12th Cranial Nerve Palsies (Godtfredsen Syndrome) due to Clival Lesions.","authors":"Rhys T Ishihara, Zhenyang Zhao, Sibi Rajendran, Ardalan Sharifi, Alexander Tseng, Zachary DeZeeuw, David S Baskin, Andrew G Lee","doi":"10.1097/WNO.0000000000002233","DOIUrl":"https://doi.org/10.1097/WNO.0000000000002233","url":null,"abstract":"<p><strong>Background: </strong>Godtfredsen syndrome (GS), originally described by Dr. Erik Godtfredsen in 1946, is the combination of cranial nerve (CN) 6th and 12th palsies. The most common etiology of GS is a lesion of the clivus.</p><p><strong>Methods: </strong>A retrospective case series of GS is described.</p><p><strong>Results: </strong>Three patients were included: 1) a 38-year-old woman with a clival breast cancer metastasis; 2) a 35-year-old woman with a clival chordoma; and 3) a 72-year-old woman with a partially embolized dural arteriovenous fistula involving the hypoglossal canal.</p><p><strong>Conclusions: </strong>GS is a combination of CN 6th and 12th palsies and most commonly is due to a lesion in the clivus. Clinicians should be aware of this uncommon combination of cranial nerve findings, the localizing significance, and the differential diagnosis of clival lesions.</p>","PeriodicalId":16485,"journal":{"name":"Journal of Neuro-Ophthalmology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Junctional Scotoma as the Presenting Sign of Multiple Sclerosis.","authors":"Nicole V Carrabba, Mallika M Tyagi, You Zhou, Lna Malkawi, Pamela Davila Siliezar, Noor Adnan Rashid Laylani, Andrew G Lee","doi":"10.1097/WNO.0000000000002273","DOIUrl":"https://doi.org/10.1097/WNO.0000000000002273","url":null,"abstract":"","PeriodicalId":16485,"journal":{"name":"Journal of Neuro-Ophthalmology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Poor Visual Outcomes at Idiopathic Intracranial Hypertension Diagnosis Using a Supervised Machine Learning Algorithm.","authors":"Jacqueline K Shaia, Taseen A Alam, Ilene P Trinh, Jenna R Rock, Jeffrey Y Chu, Nicholas K Schiltz, Rishi P Singh, Katherine E Talcott, Devon A Cohen","doi":"10.1097/WNO.0000000000002340","DOIUrl":"https://doi.org/10.1097/WNO.0000000000002340","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic intracranial hypertension (IIH) is a vision-threatening disorder mainly affecting women of a reproductive age. Prompt diagnosis and intervention are vital to prevent vision loss, but validated tools to predict visual outcomes are lacking. The purpose of this study was to create a machine learning algorithm predicting poor visual outcomes at the time that the diagnosis of IIH is established, and stratifying risk among those with and without poor visual acuity at presentation.</p><p><strong>Methods: </strong>Using electronic health records, a retrospective cohort study was conducted between June 1, 2012 and September 30, 2023. Any patient aged 0-70 years who was diagnosed with IIH and met the revised diagnostic criteria was included in the analysis. In total, 391 patients with IIH had final outcomes available and were included in this analysis. Final visual outcomes were reported between 3 months and 1 year after diagnosis. Poor visual outcomes served as the model outcome and was defined as a visual field mean deviation (VFMD) worse than -7 dB or a visual acuity of 20/80 or worse. Both logistic regression and decision trees were used to build predictive models. Models were evaluated using multiple parameters including accuracy, sensitivity, specificity, and area under the curve. The best performing models were validated using a k-fold cross-validation.</p><p><strong>Results: </strong>The decision tree models performed the best and 4 prognostic risk groups were created: critical, high, medium, and low. In the critical risk group, patients who had both high baseline VFMD (worse than -12.59 dB) and identified as non-White had a poor visual outcome risk of 92.6%. A baseline VFMD worse than -9.1 dB resulted in a critical risk of a poor visual outcome at 69.8%. Any patient with a baseline VFMD better than -3.39 dB had a risk of a poor visual outcome at 1.04%.</p><p><strong>Conclusions: </strong>Our study provides clinicians with valuable prognostic markers to assist in identifying patients who are at critical risk for significant vision loss. Patients with a VFMD worse than -9.1 dB have a critical risk of a poor visual outcome, and this further increased if they identified as a minority patient.</p>","PeriodicalId":16485,"journal":{"name":"Journal of Neuro-Ophthalmology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Risk of Ischemic Stroke in Patients With Nonarteritic Anterior Ischemic Optic Neuropathy: A Big Data Study.","authors":"Rachel Shemesh, Hadar N Rosenblatt, Ruth Huna-Baron, Ainat Klein, Ofira Zloto, Niv Levy","doi":"10.1097/WNO.0000000000002354","DOIUrl":"https://doi.org/10.1097/WNO.0000000000002354","url":null,"abstract":"<p><strong>Background: </strong>This study explored ischemic stroke occurrence in patients with nonarteritic anterior ischemic optic neuropathy (NAION) and assess the link between NAION and carotid artery stenosis (CAS) as an ischemic stroke risk factor.</p><p><strong>Methods: </strong>A retrospective (2009-2019) nationwide, population-based study was conducted using a cohort database from Clalit, the largest healthcare network in Israel. Among 1,200,000 insured individuals, 605 NAION patients without prior ischemic stroke diagnosis were included, matched with a 10-fold larger comparison group by age, sex, and cardiovascular risk factors.</p><p><strong>Results: </strong>Results indicated a higher incidence of large-vessel ischemic stroke (18.7% vs 14.7% in the comparison group) and small-vessel ischemic stroke (4.8% vs 3.1% in the comparison group) in patients with NAION. CAS prevalence was elevated in patients with NAION both during the study and during follow-up. Multivariable analysis showed hazard ratios of 1.5 (P = 0.002) for large-vessel ischemic strokes and 1.56 (P = 0.031) for small-vessel ischemic strokes in patients with NAION. The cumulative probability of ischemic strokes for patients with NAION without risk factors was higher than for the comparison group without risk factors (log rank test, P = 0.017).</p><p><strong>Conclusions: </strong>These population-based study results revealed a higher incidence of ischemic stroke after a NAION episode compared with the comparison group. This association was valid regardless of any additional vascular risk factors. There is a need to consider specific management for patients with NAION diagnosed with carotid artery stenosis because of the potential for a triadic relationship among the 3 conditions.</p>","PeriodicalId":16485,"journal":{"name":"Journal of Neuro-Ophthalmology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multivariable Prediction Model for Suspected Ocular Myasthenia Gravis: Development and Validation.","authors":"Armin Handzic, Marius P Furter, Brigitte C Messmer, Magdalena A Wirth, Yulia Valko, Fabienne C Fierz, Edward A Margolin, Konrad P Weber","doi":"10.1097/WNO.0000000000002346","DOIUrl":"https://doi.org/10.1097/WNO.0000000000002346","url":null,"abstract":"<p><strong>Objective: </strong>Diagnosing ocular myasthenia gravis (OMG) remains challenging despite recent diagnostic advances. We addressed this challenge by developing and validating a multivariable prediction model that estimates the OMG probability given the results of any partial selection of available diagnostic tests.</p><p><strong>Methods: </strong>The source data for our model were retrieved from our blinded prospective diagnostic accuracy study at the University Hospital Zurich (USZ). Patients with ptosis and/or diplopia whose presentation was suspicious for OMG underwent comprehensive diagnostic testing. An independent neuromuscular specialist made the final diagnosis. These data were used to fit and validate a Bayesian network model against additional retrospective USZ and the University of Toronto (UoT) patient data. The primary outcome was to predict the likelihood of a positive OMG diagnosis given the available diagnostic tests. For any set of tests, the model returns an OMG probability together with 95% credible intervals, indicating the prediction uncertainty.</p><p><strong>Results: </strong>Of 89 patients included in the development of the model, 39 were diagnosed with OMG. Based on our Bayesian network model, the following variables were the most useful predictors in descending order: edrophonium test, acetylcholine receptor (AChR) antibodies), single-fiber electromyogram (sfEMG), repetitive nerve stimulations (RNS) facial nerve, RNS accessory nerve, Besinger score, ice test, sustained upgaze test, dysarthria, dyspnea, dysphagia, diplopia, ptosis, age, and sex. The model was validated by determining the mean error rate and the area under the curve (AUC) by both 10-fold cross-validation and prediction on the retrospective USZ and UoT validation data consisting of 69 and 24 patients, respectively. Of all variables, edrophonium (sensitivity 94%, specificity 90%) and AChR antibody testing (sensitivity 85%, specificity 96%) showed the highest predictive value during validation with an AUC of 0.912 and 0.872, respectively. Incorporating more predictors reduced the predictive error in both validation data sets.</p><p><strong>Conclusions: </strong>Our prediction model serves as a basis to predict the OMG likelihood. It underwent successful internal and external validation and can be used to assist in clinical decision making.</p>","PeriodicalId":16485,"journal":{"name":"Journal of Neuro-Ophthalmology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myelin Oligodendrocyte Glycoprotein Antibody-Positive Optic Neuritis and Associated Retinal Ischemia.","authors":"Venkata S Jonnakuti, Noor Laylani, Saif A Alryalat, Osama Al Deyabat, John J Chen, Andrew G Lee","doi":"10.1097/WNO.0000000000002334","DOIUrl":"https://doi.org/10.1097/WNO.0000000000002334","url":null,"abstract":"","PeriodicalId":16485,"journal":{"name":"Journal of Neuro-Ophthalmology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Conference of Neuro-Ophthalmology in Chandigarh India February 7-9, 2025.","authors":"Deborah I Friedman, Fiona E Costello, Aki Kawasaki, Kathleen B Digre","doi":"10.1097/WNO.0000000000002356","DOIUrl":"https://doi.org/10.1097/WNO.0000000000002356","url":null,"abstract":"","PeriodicalId":16485,"journal":{"name":"Journal of Neuro-Ophthalmology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}