how does high dose metilprednisolone injection works in diabetic patient with ON

High-dose intravenous methylprednisolone (IVMP) therapy is a commonly used treatment

approach for optic neuritis (ON), including in diabetic patients. The mechanism of action and
potential benefits of high-dose IVMP in diabetic patients with ON are as follows:

1. Anti-inflammatory Effect: Methylprednisolone is a corticosteroid that has potent anti-

inflammatory properties. By suppressing the immune response, it helps reduce the
inflammation associated with optic neuritis. This can alleviate symptoms and promote faster
recovery of vision.

2. Immunosuppressive Action: In optic neuritis, the immune system mistakenly attacks the
myelin sheath surrounding the optic nerve, leading to nerve damage. High-dose IVMP helps
suppress this immune response, thereby limiting further damage to the optic nerve and
promoting its repair.

3. Neuroprotective Effects: Methylprednisolone has been shown to have neuroprotective

properties, which can be beneficial for preserving optic nerve function in patients with optic
neuritis, including those with diabetes. It may help prevent additional damage to the optic
nerve and support its recovery.

4. Modulation of Blood Vessel Permeability: In diabetic patients, there may be alterations in

the blood vessels due to underlying microvascular changes. Methylprednisolone can help
modulate blood vessel permeability and reduce leakage from blood vessels, potentially
benefiting the retinal vasculature in diabetic patients with optic neuritis.

5. Individual Response Variation: It's important to note that individual responses to high-
dose IVMP can vary, including among diabetic patients. While some individuals may
experience significant improvement in vision and symptom relief, others may have a more
limited response. Response to treatment can depend on factors such as the severity of optic
neuritis, extent of optic nerve damage, underlying diabetic complications, and individual
variations in drug metabolism.

Peningkatan kadar HbA1c yang disebabkan oleh metilprednisolon dosis tinggi biasanya
bersifat sementara dan akan kembali normal setelah dosis steroid dikurangi atau dihentikan.

red flags optic neuritis

When evaluating a case of optic neuritis, there are certain "red flags" or warning signs that
may indicate the need for further investigation or urgent medical attention. These red flags
suggest the presence of atypical features or potentially serious underlying causes. Here are
some red flags to be aware of in the context of optic neuritis:

1. Bilateral Involvement: Optic neuritis typically affects one eye, but if both eyes are involved
simultaneously or sequentially, it may indicate a more severe or atypical form of optic
neuritis or an underlying systemic condition.
2. Severe or Rapidly Progressive Visual Loss: While optic neuritis often causes temporary
vision loss that improves over time, a sudden and severe loss of vision or rapid deterioration
of vision may indicate the need for urgent evaluation to rule out other serious causes.

3. Neurologic Symptoms Outside the Visual System: Optic neuritis is associated with multiple
sclerosis (MS) in many cases, and the presence of other neurologic symptoms, such as
weakness, numbness, balance problems, or bladder dysfunction, may suggest an underlying
neurological disorder.

4. Older Age: Optic neuritis is more common in young adults, particularly those under the
age of 50. On the other hand, optic nerve inflammation in individuals over the age of 50 may
be associated with conditions like giant cell arteritis, which requires prompt evaluation and
treatment to prevent potential vision loss.

5. Unusual or Atypical Features: Unusual or atypical clinical features, such as severe pain,
lack of response to treatment, optic disc swelling extending beyond six weeks, or recurrent
episodes of optic neuritis, should raise concern for alternative diagnoses or underlying
systemic conditions.

optic neuritis on retinal vein changes

Optic neuritis primarily affects the optic nerve, which is responsible for transmitting visual
information from the eye to the brain. It is characterized by inflammation of the optic nerve,
typically occurring due to autoimmune disorders like multiple sclerosis (MS) or as an isolated
event. While optic neuritis primarily involves the optic nerve, it does not typically cause
significant changes in the retinal veins. Here's an explanation of the relationship between
optic neuritis and retinal vein changes:

1. Retinal Vein Changes in Optic Neuritis: In general, optic neuritis does not directly cause
significant retinal vein changes. The primary focus of optic neuritis is the inflammation and
damage to the optic nerve itself. As a result, retinal vein changes such as vein dilation,
tortuosity, or occlusion are not commonly observed in cases of optic neuritis.

2. Possible Indirect Effects: While optic neuritis does not directly cause retinal vein changes,
it's important to note that the underlying condition associated with optic neuritis, such as
multiple sclerosis, can have systemic effects that may impact blood vessels throughout the
body, including the retinal veins. In these cases, any retinal vein changes would be attributed
to the systemic condition rather than the optic neuritis itself.

3. Diagnostic Considerations: When diagnosing optic neuritis, ophthalmologists and

neurologists typically focus on clinical signs and symptoms related to the optic nerve, such as
decreased visual acuity, visual field defects, and optic disc swelling. Other diagnostic tests,
such as visual evoked potentials (VEPs) and magnetic resonance imaging (MRI), are used to
assess the extent of optic nerve involvement and to rule out other causes.
vascular changes in optic neuritis
In optic neuritis (ON), vascular changes can sometimes be observed, although they are
typically less prominent compared to conditions like Anterior Ischemic Optic Neuropathy
(AION). Here are some vascular changes that can occur in optic neuritis:

1. Peripapillary Telangiectasia: Peripapillary telangiectasia refers to the dilation and

tortuosity of small blood vessels around the optic disc. These vascular changes can
sometimes be observed in cases of optic neuritis, indicating mild inflammation in the
surrounding tissues.

2. Capillary Leakage: In some instances of optic neuritis, there may be mild leakage of fluid
or proteins from the blood vessels surrounding the optic disc. This leakage can result in
subtle edema or swelling in the peripapillary area.

3. Retinal Vein Distension: Optic neuritis can sometimes cause mild distension or dilation of
the retinal veins, which are the blood vessels responsible for carrying deoxygenated blood
away from the retina. This distension may be visible upon examination of the retina.

It's important to note that these vascular changes in optic neuritis are generally less severe
than those seen in conditions like AION, where significant ischemia and damage to the optic
nerve head occur. Vascular changes in optic neuritis are usually mild and transient, resolving
as the inflammation subsides and the optic nerve recovers.

Diagnosing optic neuritis involves a comprehensive evaluation that includes clinical

assessment, visual testing, and sometimes additional diagnostic tests such as visual evoked
potentials (VEPs) or magnetic resonance imaging (MRI) of the brain and optic nerves. These
tests help to confirm the diagnosis, assess the extent of inflammation, and rule out other
underlying causes.

please elaborate more on disc appearance in AION and ON

1. AION (Anterior Ischemic Optic Neuropathy):
- Optic Disc Swelling: In AION, the optic disc typically shows swelling, which is also known
as optic disc edema. This swelling is caused by the accumulation of fluid due to impaired
blood flow and ischemic damage to the optic nerve head.
- Blurred Disc Margins: The margins or edges of the optic disc in AION may appear blurred
or indistinct. This blurring is a result of the swelling and elevation of the optic disc tissue.
- Disc Hemorrhages: Hemorrhages, which are tiny dot-like or flame-shaped spots of
bleeding, may be seen on or around the optic disc in some cases of AION. These
hemorrhages occur due to the compromised blood supply and subsequent damage to the
small blood vessels in the optic nerve head.
- Cotton-Wool Spots: Cotton-wool spots, which are fluffy white or grayish patches, may
also be present on the retina near the optic disc. These spots are caused by infarctions or
areas of localized ischemia in the retinal nerve fiber layer.

2. ON (Optic Neuritis):
 - Normal or Mild Optic Disc Swelling: In ON, the optic disc may appear normal or show mild
swelling, which is referred to as optic disc edema. The degree of swelling is typically less
pronounced compared to AION.
- Sharp Disc Margins: Unlike AION, the margins of the optic disc in ON usually remain sharp
and well-defined.
- Retrobulbar Neuritis: ON is often described as a retrobulbar neuritis, meaning that the
inflammation primarily affects the optic nerve behind the optic disc. As a result, the direct
involvement of the optic disc itself may be minimal.
- Normal or Mild Vascular Changes: In ON, there may be normal or mild changes in the
blood vessels around the optic disc. These changes are generally not as prominent as in
AION.

saraf optik bagian intrakranial

Saraf optik adalah pasangan saraf kranial kedua yang terdiri dari serat saraf yang membawa
informasi visual dari mata ke otak. Saraf optik memiliki dua segmen utama, yaitu segmen
intraokular dan segmen intrakranial.

Segmen intraokular terletak di dalam bola mata. Saraf optik meninggalkan bola mata melalui
diskus optikus (papilla) di bagian belakang bola mata dan membentuk saraf optik yang
melintasi retina dan menuju ke otak.

Segmen intrakranial saraf optik dimulai setelah saraf optik keluar dari bola mata melalui
diskus optikus. Saraf optik ini kemudian berjalan menuju otak melalui saluran optik (canalis
opticus), yang terletak di tulang tengkorak.

Selama perjalanannya melalui saluran optik, serat-serat saraf optik dari mata saling
bersilangan secara parsial di area yang disebut chiasm optikus. Setelah bersilangan, serat-
serat saraf optik ini melanjutkan perjalanan ke bagian belakang otak ke area visual primer
yang disebut korteks visual di lobus oksipital. Di korteks visual, informasi visual diolah dan
diterjemahkan menjadi pengalaman visual.

what are the complications and prognosis of optic neuritis based on AAO
Complications of Optic Neuritis:
1. Visual Impairment: Optic neuritis can lead to temporary or permanent vision loss. The
severity of vision impairment can vary among individuals and may range from mild visual
disturbances to significant visual deficits.

2. Optic Nerve Atrophy: In some cases, optic neuritis can result in optic nerve atrophy, which
is the degeneration of the optic nerve tissue. This can lead to permanent vision loss or visual
field defects.

3. Recurrence or Multiple Episodes: Optic neuritis can recur in some individuals, with
episodes of inflammation and vision loss affecting one or both eyes. Recurrence may be
associated with an increased risk of developing multiple sclerosis (MS) in some cases.

Prognosis of Optic Neuritis:

1. Visual Recovery: Many individuals with optic neuritis experience partial or complete visual
recovery over time. The rate and extent of recovery can vary, with some individuals
experiencing rapid improvement while others may have a slower recovery process.

2. Risk of Multiple Sclerosis (MS): Optic neuritis is considered one of the clinical features
associated with an increased risk of developing MS. However, not all cases of optic neuritis
progress to MS. The presence of certain factors, such as the presence of brain lesions on MRI
or positive cerebrospinal fluid (CSF) findings, may increase the risk of MS development.

3. Long-Term Visual Outcomes: The long-term visual outcomes of optic neuritis can vary.
While some individuals may achieve near-normal vision, others may experience persistent
visual deficits, such as decreased visual acuity, color vision abnormalities, or visual field
defects.

do cholesterol affect optic neuritis

There is evidence to suggest that high cholesterol levels may play a role in the development
or progression of certain optic nerve disorders, including optic neuritis. However, the
relationship between cholesterol and optic neuritis is complex and not fully understood.
Here are some key points:

1. Atherosclerosis and Blood Supply: High cholesterol levels can contribute to the
development of atherosclerosis, a condition characterized by the buildup of fatty plaques in
the arteries. Atherosclerosis can affect blood vessels supplying the optic nerve, potentially
leading to reduced blood flow and oxygenation to the optic nerve, which may increase the
risk of optic nerve damage and inflammation, including optic neuritis.

2. Comorbidities: High cholesterol is often associated with other health conditions such as
hypertension, diabetes, and obesity, which are known risk factors for optic nerve disorders.
These comorbidities can also contribute to the development or worsening of optic neuritis.

3. Impact on Immune System: Cholesterol is involved in the regulation of immune responses.

High cholesterol levels may disrupt the immune system's function, potentially leading to
increased inflammation and autoimmune reactions, which are implicated in optic neuritis.

does smoking and alcohol consumption affect optic neuritis

Smoking and alcohol consumption may have an impact on the development and progression
of optic neuritis. Here are some key points regarding their potential effects:

1. Smoking: Smoking tobacco has been associated with an increased risk of developing optic
neuritis. Studies have suggested that smokers may have a higher likelihood of developing
optic neuritis compared to non-smokers. Smoking can affect the immune system and blood
vessels, leading to increased inflammation and decreased blood flow to the optic nerve,
which may contribute to the development or worsening of optic neuritis.

2. Alcohol Consumption: The relationship between alcohol consumption and optic neuritis is
less clear and requires further research. However, excessive alcohol consumption can have
negative effects on overall health, including the cardiovascular system. Alcohol abuse can
potentially contribute to vascular disorders and compromised blood flow, which might
increase the risk of optic nerve damage and inflammation.

uhthoff and pulfrich phenomenon

1. Uhthoff Phenomenon:
The Uhthoff phenomenon refers to the temporary worsening of neurological symptoms,
particularly visual symptoms, in individuals with optic neuritis or other demyelinating
conditions when they experience an increase in body temperature. This increase in body
temperature can occur due to various factors, such as exercise, hot weather, fever, or taking
hot showers.

In the case of optic neuritis, the Uhthoff phenomenon specifically affects visual function. The
increased body temperature can lead to a temporary conduction block or slowing of nerve
impulses along the demyelinated optic nerve fibers. This can result in transient vision
changes, such as blurred vision, decreased visual acuity, or an increase in existing visual
disturbances.

It's important to note that the Uhthoff phenomenon is considered a transient and reversible
phenomenon. Once the body temperature returns to normal, the visual symptoms typically
improve.

2. Pulfrich Phenomenon:
The Pulfrich phenomenon is a visual phenomenon that occurs when there is a significant
asymmetry in the processing of visual information between the two eyes. It is typically
observed in individuals who have a visual impairment in one eye, such as reduced visual
acuity or altered depth perception.

The Pulfrich phenomenon is characterized by a perception of a time delay in the visual

information received by one eye compared to the other. This time delay causes a perceived
displacement of moving objects in the visual field. Specifically, when a moving object is
viewed with the impaired eye, it appears shifted or displaced from its actual position.

The Pulfrich phenomenon is related to the difference in the speed of processing between
the two eyes. The impaired eye takes longer to process visual information, leading to the
perceived displacement of moving objects.

The Pulfrich phenomenon can be observed in various conditions that affect visual
processing, such as optic neuritis, cataracts, or certain types of retinal disorders.

It's important to note that the Pulfrich phenomenon is a perceptual illusion and does not
indicate an actual physical displacement of objects. It can be assessed and quantified
through specialized testing, such as the Pulfrich pendulum test, which measures the
perceived displacement of a swinging pendulum.

can you please differentiate between typical and atypical optic neuritis based on AAO
1. Typical Optic Neuritis:
- Presentation: Typical optic neuritis is usually characterized by acute or subacute unilateral
vision loss accompanied by pain, particularly with eye movements. The visual loss typically
peaks within 1-2 weeks.
- Age Distribution: Typical optic neuritis commonly occurs in young adults, with a peak
incidence between the ages of 20 and 40.
- Association with Multiple Sclerosis (MS): Typical optic neuritis is strongly associated with
MS, and approximately 50% of patients with typical optic neuritis will develop MS in the
future.
- Visual Recovery: Patients with typical optic neuritis often experience significant
spontaneous visual recovery over a period of weeks to months.

2. Atypical Optic Neuritis:

- Presentation: Atypical optic neuritis refers to cases that do not meet the typical clinical
criteria. It may present with unusual features or atypical characteristics.
- Age Distribution: Atypical optic neuritis can occur at any age, including children and older
adults.
- Association with Multiple Sclerosis (MS): Atypical optic neuritis has a weaker association
with MS compared to the typical form. The risk of developing MS may be lower in cases of
atypical optic neuritis.
- Visual Recovery: Visual recovery in atypical optic neuritis may vary, and it may not follow
the typical pattern seen in typical optic neuritis. The prognosis depends on the underlying
cause and clinical characteristics.

differences between AION and ON based on AAO

1. Location of Optic Nerve Involvement:
- AION: AION involves the anterior portion of the optic nerve, specifically the optic nerve
head or the area where the optic nerve enters the eye. It is further classified into two types:
arteritic AION (AAION) and non-arteritic AION (NAION).
- ON: ON involves inflammation of the optic nerve, which can occur at any point along the
nerve, from the globe (eye) to the optic chiasm (where the optic nerves partially cross).

2. Presentation and Symptoms:

- AION: The typical presentation of AION is sudden, painless vision loss, often affecting one
eye. It is commonly associated with risk factors such as older age, hypertension, and
systemic vascular diseases. The vision loss in AION is typically characterized by a sudden and
severe decrease in visual acuity, often with an altitudinal (partial) visual field defect.
- ON: ON is characterized by inflammation of the optic nerve, resulting in visual symptoms.
The most common symptoms of ON include sudden or rapidly progressive vision loss,
typically in one eye, along with pain with eye movement, changes in color vision, and visual
field defects.

3. Underlying Causes and Associations:

- AION: AAION is primarily associated with giant cell arteritis (GCA), which is an
inflammatory condition affecting the medium and large-sized arteries. It is considered an
ophthalmic emergency due to its association with systemic vasculitis. NAION, on the other
hand, is typically associated with systemic vascular risk factors such as hypertension,
diabetes, and sleep apnea.
- ON: ON can have various underlying causes, with multiple sclerosis (MS) being the most
common associated condition. Other possible causes include infections, autoimmune
diseases, medication side effects, and systemic inflammatory conditions.

4. Visual Prognosis:
- AION: The visual prognosis for AION is generally poor, especially for AAION. Vision loss due
to AAION is often severe and can progress rapidly if not treated promptly with high-dose
corticosteroids. NAION has a more variable visual prognosis, with some cases experiencing
spontaneous improvement.
- ON: The visual prognosis for ON is typically better than that of AION. Most cases of ON
experience partial or complete recovery of vision over time, although some individuals may
have residual visual deficits. Early treatment with high-dose corticosteroids can help improve
visual recovery and prevent future episodes.

pathogenesis optic neuritis based on AAO

The pathogenesis, or underlying mechanism, of optic neuritis involves inflammation and
damage to the optic nerve. The exact cause of optic neuritis is not fully understood, but it is
believed to be an autoimmune disorder in most cases.
1. Immune System Activation: Optic neuritis is thought to occur when the immune system
mistakenly identifies components of the myelin sheath, a protective covering around the
optic nerve fibers, as foreign or abnormal. This triggers an immune response and activates
immune cells, including T-cells and B-cells.

2. Inflammatory Response: The activated immune cells release various inflammatory

mediators, such as cytokines and antibodies, into the optic nerve. These inflammatory
substances cause swelling, damage, and disruption of the myelin sheath, affecting the
normal transmission of nerve signals along the optic nerve.

3. Disrupted Nerve Signal Transmission: The inflammation and damage to the optic nerve
lead to a disturbance in the transmission of visual signals from the retina to the brain. This
results in visual symptoms, such as vision loss, blurred vision, altered color vision, and pain
with eye movement, which are characteristic of optic neuritis.

4. Possible Triggers: The specific trigger or inciting event that initiates the immune response
in optic neuritis is not well-defined. However, it is thought that viral infections, such as the
Epstein-Barr virus or the human herpesvirus-6, may play a role in some cases by triggering
an immune response that targets the optic nerve.

how does RAPD resolve on optic neuritis

In the context of optic neuritis, RAPD is caused by the asymmetrical damage or inflammation
of the optic nerve, resulting in impaired transmission of visual signals from the affected eye
to the brain. The RAPD reflects this imbalance in the pupillary response.
The resolution of RAPD in optic neuritis depends on the underlying cause and the extent of
optic nerve damage. In many cases, with appropriate treatment and the resolution of
inflammation, the optic nerve can recover, leading to a reduction or resolution of RAPD over
time. As the optic nerve heals, the pupillary responses in both eyes become more
symmetrical, and the RAPD diminishes or disappears.