Optic Perineuritis: Malaysia Experience

Ismail Shatriah, Gan Eng Hui, Chua Chui Yin, Wan Hazabbah Wan Hitam

Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Purpose: To evaluate the clinical manifestations and visual outcomes of optic perineuritis (OPN).

Methods: A retrospective review was performed involving 12 consecutive patients (14 eyes) with OPN attended Hospital Universiti Sains Malaysia from July 2005 till June 2010.

Results: Most patients were Malay (75.0 %), and the remaining were Chinese (25.0 %). Female-to-male ratio was 3:2. Their ages ranged from 24 to 80 years (mean, 55.8 years). Most patients had no systemic illness (83.0 %). Majority of cases presented after a week history of poor vision (75.0%) with presenting visual acuity less than hand movement (78.6%). The most common funduscopic findings were swollen and hyperaemic optic disc (64.0 %), followed by peripapillary splinter haemorrhage. Humphrey visual field examination was not performed in 11 eyes (78.6%) due to poor vision. There were 2 eyes displayed superior altitudinal and 1 eye with central scotoma. The aetiology was undetermined in almost all the patients, though they were investigated thoroughly. There was only one patient with positive VDRL/TPHA, and was treated with IM Benzathine Penicillin G. All the patients were commenced on corticosteroid treatment except for one patient who had fungal infection. Nine cases (81.8%) required prolonged corticosteroid regime. The 2 cases of orbital cellulitis were started on additional antibiotics. Following treatment, the final visual acuity remained no perception of light in 3 patients (21.4%), counting fingers in 2 patients (14.3%), while 9 patients (64.3%) showed improvement with minimum of 2 lines and 5 patients (35.7%) regained final visual acuity of 6/6.

Conclusions: OPN is more common in older age group (more than 50 years old) and mainly presented with poor vision for more than a week. The aetiology was predominantly idiopathic. However, thorough investigations are vital. Patients with OPN generally achieved good final visual outcome with longer period of treatment with corticosteroids.