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Neuroretinitis: review of the literature and new observations.
MedLine Citation:
PMID:  21317731     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Neuroretinitis (NR) is an inflammatory disorder characterized by optic disc edema and subsequent formation of a macular star figure. The underlying pathophysiology involves increased permeability of disc vasculature, but the etiology is not fully defined. In some cases, NR is probably due to an infectious process involving the disc; in others, a postviral or autoimmune mechanism is more likely. Cases can be divided into those in which a specific infectious agent has been identified, those considered idiopathic, and those with recurrent attacks. Some reports have not distinguished among these subgroups, and it is unclear if their clinical features vary. We reviewed the literature and our own patients looking particularly at features that might better distinguish these subtypes. Features common to all 3 groups included age, absence of pain, and fundus appearance. Preceding systemic symptoms were more common in patients with cat scratch disease (CSD) and uncommon in those with recurrence. The pattern and magnitude of visual field loss differed, more commonly confined to the central field in CSD cases and more severe in recurrent cases. Recovery of visual acuity and field was less substantial in recurrent cases even after the initial episode. MRI was usually normal in all 3 groups. Enhancement confined to the optic disc was found in all 3 groups, but enhancement of the retrobulbar optic nerve was seen only in recurrent cases. Findings that are strongly suggestive of CSD include very young age, preceding systemic symptoms, and poor visual acuity but with a small or absent relative afferent pupil defect (RAPD). In contrast, the following are suggestive of idiopathic NR with a high risk of recurrence: absence of systemic symptoms, visual field defect outside the central field, preserved visual acuity with a large RAPD, and poor recovery of vision. Decisions regarding evaluation and treatment should be made with these features in mind.
Authors:
Valerie Purvin; Seema Sundaram; Aki Kawasaki
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society     Volume:  31     ISSN:  1536-5166     ISO Abbreviation:  J Neuroophthalmol     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9431308     Medline TA:  J Neuroophthalmol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  58-68     Citation Subset:  IM    
Affiliation:
Midwest Eye Institute (VP, SS), Indianapolis, Indiana; Departments of Ophthalmology (VP, SS) and Neurology (VP), Indiana University, Indianapolis, Indiana; and l'Hôpital Jules Gonin (AK), Lausanne, Switzerland.
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