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Taiwan Journal of Ophthalmology 2 (2012) 112–113

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Letter to the Editor

Bilateral papillitis associated with chiasmal optic neuritis

Dear Editor and May-Yung Yen.1 The authors have described the clinical
presentations and the visual outcome of three cases of chiasmal
We read with great interest the article entitled “Chiasmal optic optic neuritis. All three cases are female, with long term multiple
neuritis: A report of three cases” by Shih-Yun Lee, An-Guor Wang, sclerosis and previous episodes of unilateral or bilateral optic

Fig. 1. Fundus examination showed right (A) and left (B) papilledema before the initiation of methylprednisolone treatment. MRI showed abnormal high signal change of optic
chiasm on coronal (D) FLAIR imaging; and abnormal enhancement of bilateral posterior intraorbital optic nerves (C). Visual field examination (Octopus static perimetry) with
30 degree low vision program five days after methylprednisolone treatment (E and F).

2211-5056/$ – see front matter Copyright Ó 2012, The Ophthalmologic Society of Taiwan. Published by Elsevier Taiwan LLC. All rights reserved.

College of Medicine. neuritis–typical of post-Epstein-Barr virus infection? Acta Ophthalmol Scand nance imaging (MRI) showed an abnormal high signal change in 2000. bilateral involvement may comprise up to 16. disc swelling and hemorrhage subsided gradually. Tze-Yi Chan more on the left (Figs. 1A and 1B). our patient bilateral optic nerves. examination. The patient’s initial complaint was mild pain during 1. Case report chiasmal optic neuritis must be taken into consideration. We believe that the presenta. Yen MY. Beiran et al also identified a chiasmal involvement in the MRI including multiple sclerosis. for 2 to 3 days. Taiwan mild leukocytosis was noted. yet no clinical evidence of infection was found. Optic neuritis in Singapore. Shin Kong Wu Ho-Su Memorial days after the initiation of corticosteroid treatment revealed Hospital. as suggested by the authors. lesion. Magnetic reso. Lin YC. Serologic tests for syphilis (rapid plasma reagin) College of Medicine. Visual disturbance first took place in his right eye. then in his left eye in 1 week. 6 February 2012 tion of MRI in a patient with idiopathic bilateral optic neuritis. Lee HC. Zimhoni-Eibsitz M. Fundus examination showed bilateral Singapore Med J 2008. 3. he denied any systemic disease or trauma event prior to References this episode. without apparent inflammatory bilateral optic nerve and tract involvement. rheumatic arthritis (RA). the subsequent visual field and MRI exam. impression of bilateral optic neuritis. Fu Jen Catholic Hsu WM. et al. A case report.4 They hypothesized changes in the optic disc on fundus examination. was a young male. National Taiwan University. the patient was treated with 4. erythrocyte sedimenta. loss in 2 weeks. and folate were checked and were within Hospital. * Corresponding author. but with good recovery after tion of our case may supplement the above cases and help to intravenous corticosteroid pulse therapy. detailed MRI examination of the optic A 25-year-old male was seen after progressive. Wong TY. eye. the optic chiasm on coronal FLAIR imaging and abnormal enhance- ment of bilateral posterior intraorbital optic nerves and sheath. Only New Taipei City. the bilateral optic neuritis may originate from encountered a case with bilateral optic neuritis associated with the chiasmal portion. 2. Chiasmal optic neuritis: a report of three cases. Department of Ophthalmology. optic neuritis was presented as Soltau and Hart found a chiasmal inflammation with asymmetric retrobulbar optic neuritis. Paediatric chiasmal followed by oral prednisolone for another 2 weeks. Although Wu Ho-Su Memorial Hospital. Taiwan visual acuity improved to 6/12 in his right eye and 6/30 in his left College of Medicine. Cheng-Kuo Cheng* tion rate (ESR). Shin Kong inations revealed the existence of chiasmal optic neuritis. Krasnitz I. Taipei. Yen MY. Taiwan the normal range. J Neuroophthalmol 1996. Hart Jr WM. in all of these cases. Under the 170–5. In conclusion. Jpn J Ophthalmol 2006. we that in these cases. Lim SA. Shin Kong Wu Ho-Su Memorial C3. Taipei. the E-mail address: chengkuocheng. After a full course of corticosteroid Department of Ophthalmology. Taiwan a near total scotoma. anti-cardiolipin IgG. and a temporal hemianopsia with less nasal involvement Yu-Chi Lin in the left eye (Figs.4% (Singapore)2 and Shih-Lin District. Fu E. Soltau JB. There were no signif. Shin Kong Wu Ho-Su Memorial treatment. Taiwan also noted. However.9% (Taiwan)3 in idiopathic optic neuritis of Asian patients.49:667–71. Goh KY. Taiwan. Recently. Letter to the Editor / Taiwan Journal of Ophthalmology 2 (2012) 112–113 113 association of chiasmal optic neuritis with bilateral optic neuritis has rarely been reported in the literature. initial profound visual impairment. Bilateral optic neuritis originating in a single chiasmal intravenous methylprednisolone 250 mg every 6 hours for 3 days.5 Like our case. it was his first episode of attack. 5. 1C and 1D). Taipei. A significant improvement in visual field examination was New Taipei City. both of those patients also suffered tis. In contrast to the above cases. Lee SY. Fu Jen Catholic University. vitamin-B12.78:226–7. Wang AG. that in patients with sequential or simultaneous bilateral optic neuritis. followed by oral elucidate the variable clinical characteristics of chiasmal optic prednisolone.16:9–13. Taiwan The initial diagnosis of our patient was thought to be bilateral optic neuritis. anti-ds DNA. Wang AG. Taipei. Seah A. with extension of inflammation along the chiasmal involvement. Also. such as anti-nuclear antibody (ANA). 1E and 1F). who presented with bilateral papilli. Visual field examination 5 Department of Ophthalmology. with slight sparing of the nasal field in the right eye.2:68–72. 95. The Hospital. Department of Ophthalmology. Low conversion rate to multiple scle- rosis in idiopathic optic neuritis patients in Taiwan. 34. and human immunodeficiency virus (HIV) were negative. In an 8-year-old girl with bilateral papillitis. Available online 17 July 2012 . neuritis. By a sequential examina. He had light perception in his right eye and doubt- ful light perception in his left eye. Wen-Chang Road. disc edema and hemorrhage (Figs. the addition of this case further supports. C4. Miller B. Apart from mild cough with fever for 1 day. Laboratory examination. Taipei 11101. Taiwan eye movement and periocular fullness sensation in the morning J Ophthalmol 2012. Gelfand YA. bilateral visual chiasma is mandatory for an accurate diagnosis. without any history of systemic disease. Beiran I. C-reactive protein (CRP).50: icant findings on physical or neurological examination. Tow S.