Clinical Spectrum of Pediatric Optic Neuritis in Indian Children

Abstract

Purpose: To study the clinical spectrum of pediatric optic neuritis in Indian children at a tertiary care centre. Methods: A retrospective study of patients diagnosed with optic neuritis below 20 years of age at a tertiary care centre in India over a 3 year period were reviewed. The ophthalmological examination findings, Goldmann perimetry, electrophysiological tests and magnetic resonance imaging (MRI) were reviewed. Results: The study reviewed 28 patients (44 eyes) and found a mean age of 12.6±4.9 years (2-20 years) having a follow-up record for a mean period of 6.3±4.9 months (0.3-38 months). 32.1% were females (F: M-0.47). Six patients (20.7%) had a viral prodrome and 12 (42.9%) complained of painful ocular movements. The mean baseline visual acuity (VA) was 1.80±0.6 logMAR units (Range=0.2-3.0 logMAR units) and the last best visual acuity was 0.43±0.4 log MAR units (Range=0-1.79 logMAR units). Thirty six eyes (81.8%) had a visual acuity at or below 3/60 and 40 eyes (90.9%) of 6/60 or lower of the snellen chart at the time of presentation. The mean contrast sensitivity at presentation was 1.02±0.46 (range=0-1.65). 16 pts (57.1%) had a bilateral presentation and 20 patients (71.4%) had either unilateral or bilateral papillitis. All the patients were given pulse dexamethasone (3-5 mg/kg/d) for three consecutive days followed by oral prednisolone (1-1.5 mgKg/day) for 11 days. At 1 week, 21 out of 44 eyes (47.7%) had a visual acuity ≥6/18 of the snellen chart. Three patients showed demyelination suggestive of multiple sclerosis (MS) on MRI brain and were diagnosed as probable MS. A total of 9 eyes (20.5%) of 6 patients (20.7%) had a recurrence. Those below 10 years of age presented more commonly with papillitis compared to teenagers (p value=0.01). All the parameters were similar in males and females. Conclusion: Pediatric optic neuritis patients are associated with a good visual outcome and a faster recovery. There are no gender differences in either the presentation or the visual recovery. Papillitis was more often seen in the children below 10 years of age. None of the patients developed clinically definite multiple sclerosis.

Clinical features and visual outcomes of pediatric optic neuritis in the Indian population: A prospective study

“…The mean age of presentation in the present study was 10.6 years, which correlates with the general mean age of presentation of PON in the studies conducted in other populations and in the Indian population. [ 16 - 18 ] Unilateral involvement (58%) was more common, which contrasts with the predominant laterality observed in other studies,[ 21 ] including those which are done in Indian population. [ 16 - 18 ] Similar to adult ON,[ 2 , 3 ] PON also showed a female predominance.…”

“…[ 16 - 18 ] Unilateral involvement (58%) was more common, which contrasts with the predominant laterality observed in other studies,[ 21 ] including those which are done in Indian population. [ 16 - 18 ] Similar to adult ON,[ 2 , 3 ] PON also showed a female predominance. [ 22 ] A similar observation was made in our study as well, with 58% of the patients being female.…”

“…[ 5 - 7 ] However, to the best of our knowledge, only three retrospective studies evaluated the clinical profile of PON in the Indian population. [ 16 - 18 ] In this study, our aim was to evaluate the same prospectively with 3 months follow-up.…”

“…Table 5 compares the various features of PON in our study with those reported in previous studies conducted in the Indian population. [ 16 - 18 ]…”

“…[ 17 ] reported generalized field suppression to be the most common defect followed by central scotoma, whereas Singh et al . [ 18 ] reported centrocecal scotoma to be the most common.…”