_optic neuritis treatment trial ontt 视神经炎治疗试验课件

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1、TheOpticNeuritisTreatmentTrial(ONTT)R.R.BattuNarayanaNethralayaBangaloreClassicalDemyelinatingOpticNeuritisYoungadultsbetween20and45yearsF:M=3:1Monocularretroocularpainparticularlyoneyemovement(?Upward)Followedseveralhoursorafewdayslaterbyrapidvisuallossoccurringoverafew

2、daystoaweekClinicalexamination:Dyschromatopsia(mostlyred/green)andlossofcontrastoutofproportiontovisualacuityloss.Afferentpupillarydefect/RAPDFundusshowseithernormalfundusormild/moderatediscedemaAbout3weekslater,visualacuitystartsimprovingandcontinuestoimproveoverthenext

3、6months.TypicalDemyelinatingOpticNeuritisAcutetosubacuteonset–progressiveoverafewdaysto2weeksYoungadultpatient,typicallylessthan45yearsofage,butmaybeofanyagePeriocularpain(90%),especiallywitheyemovement–precedingorcoincidingwithvisuallossUnilaterallossofvisualacuity–vari

4、ableseverityReducedcontrastandcolourvision–outofproportiontolossofvisualacuityExacerbationofsymptomswithincreasedbodytemperature(Uhthoff’sphenomenon)Normal(65%)orswollen(35%)opticnerveheadMSTypicalDemyelinatingOpticNeuritisIpsilateralrelativeafferentpupillarydefectMildpe

5、riphlebitis(venoussheathing)Visualfielddefect–almostanytypeSpontaneousvisualimprovementin>90%startingwithin2–3weeksregardlessoftreatmentNodeteriorationinvisionwhencorticosteroidsarewithdrawnPalloroftheopticdiscisseenwithin4–6weeksfromonsetofvisuallossAncillaryinvestigati

6、onssuggestiveofMSAtypicalOpticNeuritisAge>50or<12yearsBilateralsimultaneousorrapidlysequentialONandchiasmitisSeverevisualloss–nolightperceptionProgressivevisuallossfor>2weeksfromonsetPainlessvisuallossPainfollowingonsetofvisuallossorpersistentpainfor>2weeksfromonsetSever

7、epainthatrestrictseyemovementsorwakespatientfromsleepUnusualocularfindings:Markedanteriorand/orposteriorsegmentinflammation/Markedperiphlebitis(venoussheathing)/Markedlyswollenopticnervehead/Markedopticdischaemorrhages/MacularstarLackofanyvisualrecoverywithin5weeksorcont

8、inueddeteriorationinvisualfunctionSymptomsorsignsofasystemicdisorderotherthanMSAfricanorAsianraceFamily