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2010 ; 2
(ä): 83-94
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New developments in the treatment of optic neuritis
#MMPMID28539768
Jenkins TM
; Toosy AT
Eye Brain
2010[]; 2
(ä): 83-94
PMID28539768
show ga
Acute optic neuritis (ON) has various etiologies. The most common presentation is
inflammatory, demyelinating, idiopathic, or "typical" ON, which may be associated
with multiple sclerosis. This must be differentiated from "atypical" causes of
ON, which differ in their clinical presentation, natural history, management, and
prognosis. Clinical "red flags" for an atypical cause of ON include absent or
persistent pain, exudates and hemorrhages on fundoscopy, very severe, bilateral,
or progressive visual loss, and failure to recover. In typical ON, steroids
shorten the duration of the attack, but do not influence visual outcome. This is
in contrast to atypical ON associated with conditions such as sarcoidosis and
neuromyelitis optica, which require aggressive immunosuppression and sometimes
plasma exchange. The visual prognosis of typical ON is generally good. The
prognosis in atypical ON is more variable. New developments aimed at designing
better treatments for patients who fail to recover are discussed, focusing on
recent research elucidating mechanisms of damage and recovery in ON. Future
therapeutic directions may include enhancing repair processes, such as
remyelination or adaptive neuroplasticity, or alternative methods of
immunomodulation. Pilot studies investigating the safety and proof-of-principle
of stem cell treatment are currently underway.