Jurnal Reading

Clinical Spectrum of
Neuritis Optic Patients
Receiving Intravenous
Corticosteroid Treatments
in Doctor Kariadi Hospital
Semarang

Disusun oleh : Inas Fakhira Assagaf (1102017108)

Pembimbing : dr. Atiek Indriawati, Sp.M
SPESIFIKASI

Judul : Clinical Spectrum of Neuritis Optic Patients

Receiving Intravenous Corticosteroid Treatments in
Doctor Kariadi Hospital Semarang

Tahun : 2021

Pengarang : Gadis Sativa dan Riski Prihatningtias

Kata Kunci : Optic neuritis; Corticosteroid; Visual

Outcome
01
ABSTRAK
03
METODE
05
HASIL

02
PENDAHULUAN
04
HASIL
06
DISKUSI
ABSTRAK

4
ABSTRAK

Pendahuluan dan Tujuan: Neuritis optik adalah peradangan saraf optik yang menyebabkan hilangnya penglihatan
secara tiba-tiba yang terjadi selama beberapa jam atau hari. Kortikosteroid telah banyak digunakan dalam pengobatan
neuritis optik karena efek anti-inflamasinya. Penelitian ini bertujuan untuk meninjau secara retrospektif kasus neuritis optik
yang telah diberikan pengobatan kortikosteroid intravena pada ketajaman penglihatan.
Metode: Penulis melakukan penelitian retrospektif terhadap pasien yang menjalani terapi kortikosteroid intravena selama
3 hari untuk neuritis optik dari Januari 2018 hingga Desember 2018 di RS Kariadi. Data yang dikumpulkan termasuk
demografi pasien, onset, pemeriksaan klinis, dan ketajaman visual.
Hasil: Penulis memasukkan 22 mata dari 16 pasien yang menerima pengobatan kortikosteroid intravena selama 3 hari
berturut-turut selama masa penelitian. Studi ini menemukan usia rata-rata 32,91±9,32 tahun (18-49 tahun). Onset rata-
rata adalah 2,36±3,07 bulan (0,1-12 bulan). Sepuluh mata (45,5%) memiliki RAPD positif dan lima mata (22,7%) memiliki
nyeri gerakan okular. Tiga belas pasien (59,1%) mengalami edema papil pada pemeriksaan funduskopi. Empat belas
mata (63,6%) memiliki ketajaman visual pada atau di bawah 6/60 pada saat presentasi. Ketajaman visual rata-rata pada
saat presentasi adalah 2,45±1,79 unit LogMar (Rentang 0,2-5,0 unit LogMar). Setelah tiga hari pengobatan kortikosteroid
intravena, ketajaman visual rata-rata adalah 1,81±1,42 unit LogMar (Kisaran 0,1-5,0 unit LogMar). Ketajaman penglihatan
sebelum dan sesudah perlakuan dianalisis menggunakan uji Wilcoxon dan memberikan hasil p=0,004.
Kesimpulan: Pengobatan kortikosteroid intravena umumnya memberikan ketajaman visual yang lebih baik pada pasien
neuritis optik. Tidak ada perbedaan yang signifikan dari onset dan pemeriksaan klinis dalam hasil visual pengobatan
kortikosteroid intravena.
Kata kunci: Neuritis optik; Kortikosteroid; Hasil Visual.
Singkatan: RAPD: Relative Afferent Pupillary Defect.
PENDAHULUAN
PENDAHULUAN

Neuritis optik adalah peradangan saraf optik yang menyebabkan hilangnya penglihatan secara
tiba-tiba yang terjadi selama beberapa jam atau hari. Dapat terjadi pada salah satu atau kedua saraf optik.
Neuritis optik sering menjadi penyebab cedera saraf optik akut. Neuritis optik juga sering dikaitkan dengan
multiple sklerosis (MS).

Insidensi neuritis optik antara usia 16 dan 55 tahun. Wanita > pria.

Terapi : Kortikosteroid dosis tinggi (≥1 g) yang diberikan secara intravena menjadi praktik standar
setelah Optic Neuritis Treatment Trial (ONTT), yang membandingkan 3 intervensi berbeda:
metilprednisolon intravena (IV) dosis tinggi (1 g setiap hari selama 3 hari), prednison oral dosis rendah (1
mg/kg setiap hari selama 14 hari), dan plasebo oral.

Berdasarkan hasil penelitian Morrow et al, menyatakan bahwa penggunaan kortikosteroid oral dosis
tinggi sama efektifnya dengan penggunaan kortikosteroid intravena dosis tinggi untuk pengobatan
neuritis optik akut.
METODE
 METODE

Penelitian ini adalah penelitian retrospektif yang dilakukan pada 16 pasien neuritis optik di RS
Kariadi yang menerima kortikosteroid intravena pengobatan selama 3 hari berturut-turut dari Januari
2018 - Desember 2018.

Diagnosis neuritis optik dibuat secara

klinis berdasarkan riwayat kehilangan
penglihatan akut atau subakut pada Kasus lain dikeluarkan dari
satu atau kedua mata dengan satu atau analisis karena data yang tidak
lebih dari temuan berikut : lengkap, kekambuhan neuritis
• Nyeri pada gerakan mata. optik dalam waktu satu tahun
• Pembengkakan saraf optik. dan berbagai jenis atau dosis
• Relative Afferent Pupillary Defect kortikosteroid yang diberikan
(RAPD). sebagai pengobatan.
• Diskromatopsia.
• Temuan MRI : adanya satu atau
lebih lesi hiperintens T2 pada MRI
otak.
 METODE

• Neuritis optik bilateral didefinisikan sebagai kedua mata terlibat secara bersamaan atau dalam waktu
4 minggu, dan neuritis optik berulang didiagnosis ketika serangan berulang mengenai satu atau
kedua mata setelah selang waktu > 4 minggu.

• Kortikosteroid yang dipilih sebagai pengobatan pasien neuritis optik dalam penelitian ini adalah
metilprednisolon 1000mg intravena per hari yang dibagi menjadi empat kali injeksi intravena sehari
selama tiga hari berturut-turut. Diikuti oleh oral metilprednisolon 1 mg/kg/hari setelah 3 hari.
Ketajaman visual pasca perawatan yang dianalisis dalam penelitian ini adalah setelah 3 hari
perawatan kortikosteroid intravena.

• Pasien dikelompokkan berdasarkan hasil visual yang lebih baik dan tidak dibandingkan untuk
berbagai parameter klinis.

• Analisis data menggunakan SPSS 15 dengan nilai p < 0,05 dianggap signifikan secara statistik.
HASIL
 HASIL

Penelitian ini melibatkan 16 pasien (22 mata) neuritis optik di RS Kariadi dan mendapatkan pengobatan
kortikosteroid intravena selama 3 hari berturut-turut. Penyebab infeksi sudah diperiksa dan disingkirkan
sebelum pengobatan intravena kortikosteroid diberikan.

Pasien dalam penelitian ini tidak ada penyakit mata yang signifikan, cedera, dan tidak ada riwayat
penyakit mata pada keluarga.

Beberapa pasien berada di bawah pengobatan lain untuk kondisi medis lainnya. Satu pasien dalam
pengobatan HIV, dua pasien SLE, tiga pasien MS, dan satu pasien hamil selama pengobatan. Peneliti
telah mengkonsultasikan kondisi medis ke bagian terkait seperti penyakit dalam, neurologi, dan obstetri
ginekologi, sebelum pemberian pengobatan kortikosteroid intravena.
 HASIL

Tabel 2. Ketajaman Penglihatan Pra dan Pasca Perawatan

Tabel 1. Gambaran Klinis Pasien dengan Neuritis Optik Gambar 1. Ketajaman Visual Sebelum dan Setelah Perawatan
 HASIL

Tabel 4. Analisis ketajaman visual

Tabel 3. Analisis Subkelompok Pasien Neuritis Optik (n=22 mata)

Gambar 2. Gambar Fundus dari Kasus Papilitis
DISKUSI
 DISKUSI

• Rasio perempuan dan laki-laki pada pasien penelitian ini adalah 4,33. Hal ini konsisten dengan
dominasi perempuan dalam studi neuritis optik dewasa.
• Studi ini menemukan usia rata-rata 18-49 tahun.Ini juga konsisten dengan studi neuritis optik yang
menemukan bahwa neuritis optik biasanya berkembang pada pasien antara usia 20 dan 40. Wilhelm
et al juga melaporkan usia rata-rata saat onset adalah 36 tahun; jarang terjadi pada orang di bawah
18 atau di atas 50.
• Wang et al melaporkan dalam periode tindak lanjut 26 dari 31 mata (83,9%) dengan neuritis optik
idiopatik mencapai ketajaman visual 6/12 atau lebih baik dengan (38,7%) pulih menjadi 6/6 atau
hanya satu mata yang berakhir dengan kurang dari ketajaman penglihatan 6/60.
• Saxena dkk memeriksa profil klinis dan hasil visual jangka pendek dari semua bentuk neuritis optik
yang menerima pengobatan 200mg deksametason dalam 150 ml larutan dekstrosa 5% yang
diberikan secara intravena selama 30 menit selama tiga hari berturut-turut.
 DISKUSI

• Para pasien diperiksa dan ditindaklanjuti untuk jangka waktu rata-rata 10 bulan. Ketajaman visual
logMAR median dari 99 mata meningkat secara signifikan dari 1,6 ± 0,8 menjadi 0,2 ± 0,6, meskipun
hanya 64% mata yang mencapai ketajaman visual akhir 20/40 atau lebih dibandingkan 94% dalam
ONTT.
• Keterlibatan bilateral terlihat pada 6 (37,5%) pasien dan dibandingkan dengan 16% -35% yang
dilaporkan dalam penelitian lain di Asia, sedangkan penelitian di Afrika telah melaporkannya setinggi
80%.
• Empat (66,67%) dari pasien ini dengan presentasi bilateral mengalami edema papil. Dalam penelitian
ini 59,1% dari mata memiliki papilitis. Saxena dkk melaporkan penyimpangan yang signifikan dari
laporan ONTT adalah peningkatan frekuensi papilitis, yaitu 53,5% dalam penelitian mereka
dibandingkan dengan 35,3% pada penelitian sebelumnya.
• MRI dari 5 pasien menunjukkan lesi sugestif MS dan sudah diobati bersama dengan penyakit dalam.
Menurut penelitian ONTT bahkan hingga 15 tahun setelah serangan neuritis optik awal, bahwa hasil
MRI awal, jika abnormal dengan kelainan materi putih, adalah satu-satunya prediktor terpenting dari
risiko MS di masa depan.
 DISKUSI

• Chuenkongkaew W et al secara retrospektif mengevaluasi 81 pasien di Thailand dan hasil visual

ditemukan lebih baik bagi mereka yang menerima terapi steroid lebih awal (dalam 8 hari setelah
onset neuritis). Studi mereka mendukung perlunya perawatan dini dan bertentangan dengan hasil
ONTT. Sementara penelitian sebelumnya menyebutkan bahwa tidak adanya nyeri retroorbital telah
terbukti menghasilkan hasil visual yang lebih buruk dibandingkan dengan pasien dengan nyeri
retroorbita.
• Menurut Du Y et al pembengkakan diskus merupakan parameter penting lainnya yang telah
dievaluasi sebagai penanda prognostik untuk hasil visual. Mereka mempelajari serangkaian kasus
neuritis optik bilateral dan menyimpulkan bahwa adanya pembengkakan diskus bilateral memprediksi
hasil visual yang negatif. Dalam studi ini, perbandingan median ketajaman visual pada presentasi dan
setelah 3 hari pengobatan kortikosteroid intravena dianalisis dan memberikan hasil yang signifikan
(P=0,004).
• Pengobatan oral dinilai mungkin lebih nyaman karena meminimalkan perjalanan ke pusat infus,
terutama bagi mereka yang tinggal di daerah pedesaan. Selain itu, penelitian sebelumnya telah
menunjukkan bahwa pemberian oral disukai oleh penderita MS. Penggunaan secara oral juga lebih
hemat biaya.
KESIMPULAN
KESIMPULAN

Pemberian kortikosteroid umumnya memberikan

ketajaman visual yang lebih baik pada neuritis optik.
Tidak ada perbedaan yang signifikan dari onset dan
pemeriksaan klinis dengan hasil visual pengobatan
kortikosteroid intravena.
REFERENSI

Sativa,G., and Prihatningtias, R. 2021. Clinical Spectrum of Neuritis

Optic Patients Receiving Intravenous Corticosteroid Treatments in
Doctor Kariadi Hospital Semarang. Ophthalmol Ina, 47 (2), pp: 52-57.
THANKS
 52 Clinical Spectrum of Neuritis Optic Patients Receiving Intravenous Corticosteroid Treatments in
Doctor Kariadi Hospital Semarang

ORIGINAL ARTICLE

Clinical Spectrum of Neuritis Optic

Patients Receiving Intravenous
Corticosteroid Treatments in Doctor
Kariadi Hospital Semarang
Gadis Sativa1, Riski Prihatningtias2
1
Resident of Ophthalmology Department, Faculty of Medicine, Diponegoro University, Doctor Kariadi Hospital
Semarang
2
Staff of Neuro Ophthalmology Subdivision, Department of Ophthalmology, Faculty of Medicine, Diponegoro
University, Doctor Kariadi Hospital, Semarang
E-mail: gadis.sativa@yahoo.com

ABSTRAK

Introduction and Objective: Optic neuritis is inflammation of the optic nerve leading to sudden loss
of vision that takes place over several hours or days. Corticosteroids have been widely used in the
treatment of optic neuritis due to their anti-inflammatory effects. This study aimed to retrospectively
review cases of optic neuritis that have been the administration of intravenous corticosteroid treatment
on visual acuity.
Methods: The authors conducted a retrospective study of patients who underwent 3 days of intravenous
corticosteroid therapy for neuritis optic from January 2018 to December 2018 in Kariadi Hospital. The
data collected included patient demographics, onset, clinical examinations, and visual acuity.
Result: The authors included 22 eyes from 16 patients who received intravenous corticosteroid
treatment for 3 consecutive days during the study period. The study found a mean age of 32,91±9,32
years (18-49 years). The mean onset was 2,36±3,07 months (0,1-12 months). Ten eyes (45,5%) had
positive RAPD and five eyes (22,7%) had ocular movement pain. Thirteen patients (59,1%) had papil
edema in funduscopy examination. Fourteen eyes (63,6%) had visual acuity at or below 6/60 at the time
of presentation. The mean visual acuity at the time of presentation was 2,45±1,79 LogMar units (Range
0,2-5,0 LogMar units). After three days of intravenous corticosteroid treatment, the mean visual acuity
was 1,81±1,42 LogMar units (Range 0,1-5,0 LogMar units). The visual acuity before and after treatment
were analyzed using the Wilcoxon test and gave p=0,004 as result.
Conclusion: Treatment of intravenous corticosteroid commonly gave a better visual acuity on neuritis
optic patients. There are no significant differences of onset and clinical examinations in intravenous
corticosteroid treatment visual outcome.

Keywords: Optic neuritis; Corticosteroid; Visual Outcome

Abbreviations: RAPD: Relative Afferent Pupillary Defect

Ophthalmol Ina 2021;47(2):52-57
INTRODUCTION
O ptic neuritis, or inflammation of
the optic nerve, is a frequent cause
of acute optic nerve injury in
children and adults. Optic neuritis is also
often associated with multiple sclerosis
(MS), the cause of optic neuritis is protean.
As a result, the prognosis and treatment of
optic neuritis will vary depending on the
etiology, duration, and severity of vision
loss, previous injury, and the success of
previous treatment. Optimal treatment for
patients with optic neuritis depends on
prompt recognition, appropriate diagnostic
studies, and early institution of effective
therapy.1
Optic neuritis (ON) is inflammation
of the optic nerve leading to sudden loss of
vision that takes place over the course of
several hours or days.2 It is an inflammation
of one or both optic nerves that often results
in temporary visual loss. It affects young to
middle-aged adults between 16 and 55
years of age.3 Optic neuritis typically
affects women more often than men. It is
second only to glaucoma as the most
common acquired optic nerve disorder in
persons younger than age 50.4
Inflammation of the optic nerve
causes loss of vision usually due to the
swelling and destruction of the myelin
sheath covering the optic nerve. Direct
axonal damage may also play a role in
nerve loss in many cases.5
High-dose (≥1 g) corticosteroids
given intravenously became standard
practice after the Optic Neuritis Treatment
Trial (ONTT), which compared 3 different
interventions: high-dose intravenous (IV)
methylprednisolone (1 g daily for 3 days),
oral prednisone low dose (1 mg / kg daily
for 14 days), and oral placebo; there was no
IV placebo group. Based on the results of
the study by Morrow et al., stated that the
use of high-dose oral corticosteroids is as
effective as high-dose intravenous
corticosteroids for the treatment of acute
optic neuritis.6
Corticosteroids have been used to
treat acute demyelinating events for many
years. Corticosteroids reduce blood-brain
53
barrier damage, as indicated by decreased
intensity, or complete resolution, of the
lesions that increase their gadolinium on
MRI scanning, leading to accelerated
recovery from acute relapse. 7
Administration of a high-dose IV
corticosteroid was not superior to the
administration of a bioequivalent oral dose
for the treatment of acute ON.6
MATERIAL AND METHODS
A retrospective study was
performed on all patients who presented
with optic neuritis at Kariadi Hospital that
received corticosteroid intravenous
treatment for 3 consecutive days from
January 2018 until December 2018. The
study has identified a total of 16 cases that
were eligible for inclusion. Other cases
were excluded from the analysis for
incomplete data, neuritis optic relapse
within a year and different types or dose of
corticosteroid given as treatment.
The diagnosis of optic neuritis was
made clinically based on acute or subacute
vision loss history in one or both eyes with
one or more of the following findings: pain
on eye movement, optic nerve swelling,
relative afferent pupillary defect (RAPD,
dyschromatopsia, magnetic resonance
imaging (MRI) supporting finding and no
other identifiable cause. Demographic and
clinical information collected for each
patient included age at onset, gender, onset
of vision loss, RAPD, pain on eye
movement and funduscopy examination.
Abnormal magnetic resonance imaging
(MRI) was defined by the presence of one
or more T2-hyperintense lesions on brain
MRI.
Bilateral optic neuritis was defined
as, both eyes involved simultaneously or
within 4 weeks of each other, and recurrent
optic neuritis was diagnosed when the
repeat attack affected one or both eyes after
an interval of more than 4 weeks. This is
similar to the criterion used for the
diagnosis of 2 demyelinating episodes or
attacks in MS patients.8
 54 Clinical Spectrum of Neuritis Optic Patients Receiving Intravenous Corticosteroid Treatments in
Doctor Kariadi Hospital Semarang

Corticosteroid that was chosen as

treatment for neuritis optic patient in this
study is methylprednisolone 1000mg
intravenous per day divided into four times
intravenous injections a day for three
consecutive days. The intravenous
treatment was followed by oral
methylprednisolone 1mg/kg/day after 3
days. The visual acuity post-treatment
analyzed in this study is after 3 days of
intravenous corticosteroid treatments.
Patients were grouped on the basis
of improved visual outcome and not then
compares for various clinical parameters.
An Excel spreadsheet was designed to
collect the data and statistical analysis was
performed using the SPSS 15. Qualitative A review of past medical conditions
data were expressed as percentage and revealed no significant ophthalmic
quantitative data were expressed as disorder, injuries, or illness and there is no
meanstandard deviation or median and family history of ophthalmic disease. Some
range. Data with parametric distribution patients were under other medication for
were analyzed with the Wilcoxon test and other medical conditions. One patient under
those non-parametric distribution were medication for Human Immunodeficiency
analyzed using the Chi-square or Fisher Virus (HIV), two patients with SLE, Three
exact test. A p-value of <0.05 was taken as patients with MS, and one patient
statistically significant. undergoing pregnancy during treatment.
We have consulted the medical condition to
RESULTS the related division such as internal
medicine, neurology, and obstetric
The study included 16 patients (22 gynaecology, before administering
eyes) who had been diagnosed with neuritis intravenous corticosteroid treatment.
optic in Kariadi Hospital and received
Tabel 2. Acuity Pre and Post Treatment
intravenous corticosteroid treatment for 3
consecutive days. The mean age of the
study patients was 32,919,32 years (18-49
years). There were 2 males (12,5%) and 14
(87,5%) females. The data of causes for
optic neuritis in this study were limited
because the only source was from a medical
record, for a few that were available such as
Multiple Sclerosis (MS) and Systemic
Lupus Erythematosus (SLE), and for other
cases were isolated idiopathic. Infection
cause was already being screened and ruled
out before corticosteroid intravenous
treatment administered.

Table 1. Clinical Features of Patients with

Optic Neuritis
Ophthalmol Ina 2021;47(2):52-57
Figure 1. Visual Acuity Pre and Post Treatment
The clinical features of the patients
are summarized in Table 1. The mean
visual acuity at the time of presentation was
2,451,79 LogMar units (Range 0,2-5,0
LogMar units). Thirteen patients (59,1%)
had papil oedema in funduscopy
examination. Fourteen eyes (63,6%) had
visual acuity at or below 6/60 of the Snellen
Chart at the time of initial presentation.
Five patients had no perception of light at
presentation. Overall, the visual acuity loss
was severe in majority of our patients. Papil
oedema was present in 13 patients. Six
patients had atrophy papil and the
remaining patients had normal fundi
(retrobulbar neuritis). The presentation is
bilateral in 6 (37,5%) patients. Four
(66,67%) of these patients with bilateral
presentation had papil oedema.
Table 3. Subgroup Analysis of Neuritis Optic
Patients (n=22 eyes)
All these patients were given
intravenous methylprednisolone
1000mg/day for three consecutive days
followed by oral metil prednisolone
(1mg/kg/day). This was according to the
treatment guidelines of Optic Neuritis
Treatment Trial where all neuritis patients
are given steroids after the baseline
investigations rule out an infective etiology.
55
After three days of intravenous
corticosteroid treatment the mean visual
acuity was 1,811,42 LogMar units (Range
0,1-5,0 LogMar units). The visual acuity
improved in 13 eyes. 2 patients from 16
patients had recurrence with the median
period of reccurence was 2 months (1-3
months).
MRI was done in 15 patients
(93,75%). MRI showed lesions suggestive
multiple sclerosis in 2 patients, and neuritis
optic in 5 patients.
Table 4. Analysis of visual acuity
* Significant (p < 0,05)
Figure 2. Fundus Image of a Case of Papilitis
DISCUSSION
In this series, we retrospectively
reviewed the medical records of optic
neuritis patients, and found 16 patients
fitting the eligibility criterion. The female
to male ratio in our study patients was 4.33.
This is consistent with the female
preponderance in adult optic neuritis
studies.9,10,11 The study found a mean age of
32,919,32 years (18-49 years). It also
consistent with neuritis optic studies that
found it typically develop in patients
between the ages of 20 and 40.11 Wilhelm
et al too reported the mean age at onset is
36 years; it is rare in persons under 18 or
over 50.10 The age of presentation and
female preponderance noted in the present
study was similar to that reported by the
ONTT and other studies.
Vision at presentation was poor in
most patients with fourteen eyes (63,6%)
having a visual acuity of 6/60 or lesser. The
 56 Clinical Spectrum of Neuritis Optic Patients Receiving Intravenous Corticosteroid Treatments in
vision loss as well as the recovery was
similar in males and females. Visual
recovery was good for 7 eyes (31,8%)
gaining a visual acuity more than 6/60, but
only 2 eyes (9.09%) gaining a visual acuity
more than 6/12. The mean LogMar visual
acuity improved significantly from was
2,451,79 LogMar units to 1,811,42
LogMar units after three days of
intravenous corticosteroid treatment
(p=0,004). Wang et al reported Within the
follow-up period 26 of 31 eyes (83.9%)
with idiopathic ON attained visual acuity of
6/12 or better with (38.7%) recovering to
6/6 or better and only one eye ending with
less than 6/60 visual acuity.12 Saxena et al
examined the clinical profile and short-term
visual outcome of all forms of optic neuritis
received treatment in the form of 200mg of
dexamethasone in 150 ml of 5% dextrose
solution given intravenously over 30 min
for three consecutive days. The patients
were examined and followed up for a mean
period of 10 months. The median logMAR
visual acuity of 99 eyes improved
significantly from 1.6 ± 0.8 to 0.2 ± 0.6,
though only 64% of eyes achieved a final
visual acuity of 20/40 or more as against
94% in the Optic Neuritis Treatment
Trial.13
Bilateral involvement was seen in in
6 (37,5%) patients and compares to
16%-35% reported in other studies in Asia,
whereas an African study has reported it to
be as high as 80%.12 Four (66,67%) of these
patients with bilateral presentation had
papil oedema. In our study 59,1% of the
eyes had Papilitis as the presenting feature
(Figure 2). Saxena et al reported a
significant deviation from the ONTT report
is the increased frequency of papillitis,
which was 53.5% in the their study as
compared with 35.3% in the former. The
above figures suggest that papillitis is as
common as retrobulbar neuritis, if not more
frequent, in the Asian population.13
Recurrence was noted in 3 eyes
within a year. None of those patient with
recurrence showed lesions suggestive of
Doctor Kariadi Hospital Semarang
MS. One of the patients has additional HIV
condition. MRI of 5 patients showed
lesions suggestive of MS and already
treated together with internal medicine.
According to ONTT study even as many as
15 years after the initial optic neuritis
attack, that the initial MRI result, if
abnormal with white matter abnormalities,
was the single most important predictor of
the future risk of MS.14 But the risk of MS
is difficult to predict in this study because
of a shorter follow-up. A Long-term study
needed to know the risk of MS.
Analysis of factors such as gender,
age, onset, RAPD, ocular movement pain
and oedema papil showed no correlation
with visual acuity outcome (Table 3).
Chuenkongkaew W et al retrospectively
evaluated 81 patients in Thailand and the
visual outcome was found to be better for
those who received the steroid therapy early
(within 8 days of onset of neuritis). Their
study supports the need for early treatment
and contradicts the results of the Optic
nerve treatment trial15. While previous
study mentioned that absence of retro-
orbital pain has been shown to result in a
poorer visual outcome as compared to
patients with retro-orbital pain16.
According to Du Y et al disc swelling is
another important parameter which has
been evaluated as a prognostic marker for
visual outcome. They studied a series of
bilateral optic neuritis cases and concluded
that the presence of bilateral disc swelling
predicted a negative visual outcome.17 All
of those study used more than 3 days visual
acuity post treatment to analysed various
clinical parameter. In this study,
comparison of median visual acuity at
presentation and after 3 days of
corticosteroid intravenous treatment was
analysed using Wilcoxon test and gave
significant p-value (p=0,004) (Table 4).
However, oral medication may be
more convenient, minimizing travel to the
infusion center, especially for those living
in rural areas. Additionally, other previous
studies have shown that oral administration
Ophthalmol Ina 2021;47(2):52-57 57

is preferred by people with MS. The use of 9. Wilhelm H, Schabet M. The Diagnosis and
oral administration is also more cost Treatment of Optic Neuritis. Deutsches
Aerzteblatt Online. 2015;.
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