Chinese expert consensus on the diagnosis and treatment of infiltrative optic neuropathy (2022)_Chinese Journal of Ocular Fundus Diseases

Authors：

 Neuro-ophthalmology Group of Ophthalmology Branch of Chinese Medical Association

Corresponding author: Wei Shihui, Email: weishihui706@hotmail.com;

Corresponding author：

Keywords：

Infiltrative optic neuropathy; Optic perineuritis; Optic nerve diseases; Practice guidelines as topic; Consensus

DOI：

10.3760/cma.j.cn511434-20221107-00588

Video：

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Abstract Full text Figures/Tables Video References Cited by

Infiltrative optic neuropathy (ION) is characterized by the infiltration of tumor cells or inflammatory cells in the optic nerve and its sheath. ION is rare in clinic practice, and ION caused by direct infiltration or metastasis of malignant tumors is easily misdiagnosed as optic perineuritis or optic neuritis, which means delayed proper treatment and makes patients risking possible side effects of steroid therapy. Currently, ophthalmologists are lack of sufficient knowledge about ION, which contributes to the high rate of misdiagnosis and missed diagnosis of ION in clinical practice. The diagnosis and treatment of ION have not yet formed systematic standardized guidelines. Therefore, Neuro-ophthalmology Group of Ophthalmology Branch of Chinese Medical Association organized experts to propose consenus of opinions on definition, diagnosis and treatment of ION, which helps to guide clinical diagnosis and treatment of ION, as well as basic researches about ION.

Citation： Neuro-ophthalmology Group of Ophthalmology Branch of Chinese Medical Association. Chinese expert consensus on the diagnosis and treatment of infiltrative optic neuropathy (2022). Chinese Journal of Ocular Fundus Diseases, 2022, 38(12): 955-962. doi: 10.3760/cma.j.cn511434-20221107-00588 Copy

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1. 魏世辉, 邱怀雨, 徐全刚. 神经眼科疾病图解[M]. 北京: 人民卫生出版社, 2017: 108-132.Wei SH, Qiu HY, Xu QG. Altas of neuro-ophthalmology[M]. Beijing: People’s Medical Publishing House, 2017: 108-132.
2. Volpe NJ. Compressive and Infiltrative Optic Neuropathies[M]//Miller NR, Newman NJ, Biousse V, et al. Walsh and Hoyt's Clinical Neuro-Ophthalmology. 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2005: 396-412.
3. Chamberlain PD, Dermarkarian CR, Woodland MB, et al. Optic nerve biopsy in leukemic infiltrative optic neuropathy: a case report and review of the literature[J]. Orbit, 2022, 41(4): 480-484. DOI: 10.1080/01676830.2021.1880443.
4. Kim JL, Mendoza P, Rashid A, et al. Optic nerve lymphoma: report of two cases and review of the literature[J]. Surv Ophthalmol, 2015, 60(2): 153-165. DOI: 10.1016/j.survophthal.2014.11.004.
5. Myers KA, Nikolic A, Romanchuk K, et al. Optic neuropathy in the context of leukemia or lymphoma: diagnostic approach to a neuro-oncologic emergency[J]. Neurooncol Pract, 2017, 4(1): 60-66. DOI: 10.1093/nop/npw006.
6. Phuljhele S, Agarwal D, Ramteke PP, et al. Perineuritis or infiltration of optic nerve sheath? A presentation of diffuse large B cell gastric lymphoma[J]. Indian J Ophthalmol, 2020, 68(6): 1212-1214. DOI: 10.4103/ijo.IJO-711-19.
7. Toosy AT, Mason DF, Miller DH. Optic neuritis[J]. Lancet Neurol, 2014, 13(1): 83-99. DOI: 10.1016/S1474-4422(13)70259-X.
8. 中华医学会眼科学分会神经眼科学组. 视神经炎诊断和治疗专家共识(2014年)[J]. 中华眼科杂志, 2014, 50(6): 459-463. DOI: 10.3760/cma.j.issn.0412-4081.2014.06.013.Neuroophthalmology Group, Ophthalmology Society of Chinese Medical Association. Expert consensus on diagnosis and treatment of optic neuritis (2014)[J]. Chin J Ophthalmol, 2014, 50(6): 459-463. DOI: 10.3760/cma.j.issn.0412-4081.2014.06.013.
9. Yang M, Zhao J, Song H, et al. Orbital magnetic resonance imaging may contribute to the diagnosis of optic nerve lymphoma[J/OL]. Front Neurol, 2020, 11: 301[2020-04-28]. https://pubmed.ncbi.nlm.nih.gov/32411078/. DOI: 10.3389/fneur. 2020.00301.
10. Sharma RK, Mays K. Unilateral blurred vision as the sole presenting symptom of chronic lymphocytic leukemia[J]. J Ophthalmic Vis Res, 2020, 15(1): 109-112. DOI: 10.18502/jovr.v15i1.5958.
11. Takkar A, Naheed D, Dogra M, et al. Infiltrative optic neuropathies: opening doors to sinister pathologies[J]. Neuroophthalmology, 2017, 41(5): 279-283. DOI: 10.1080/01658107.2017.1308519.
12. Mbekeani JN, Abdel Fattah M, Al Nounou RM, et al. Chronic myelogenous leukemia relapse presenting with central nervous system blast crisis and bilateral optic nerve infiltration[J]. J Neuroophthalmol, 2016, 36(1): 73-77. DOI: 10.1097/WNO.0000000000000326.
13. MacDonell-Yilmaz RE, Statler B, Channa P, et al. Leukemic infiltration of the optic nerve[J]. JCO Oncol Pract, 2020, 16(3): 139-141. DOI: 10.1200/JOP.19.00311.
14. Pflugrath AE, Brar VS. Bilateral optic nerve and retinal infiltration as an initial site of relapse in a child with T-cell acute lymphoblastic leukemia[J/OL]. Am J Ophthalmol Case Rep, 2020, 18: 100695[2020-04-10]. https://pubmed.ncbi.nlm.nih.gov/32368688/. DOI: 10.1016/j.ajoc.2020.100695.
15. Bouladi M, Zerei N, Bouraoui R, et al. Unilateral infiltration of the optic nerve revealing relapse of an acute lymphoblastic leukemia[J]. Tunis Med, 2019, 97(3): 504-507.
16. Sun CB, Liu GH, Xiao Q, et al. Serum and cerebrospinal fluid testing in optic neuropathy patients with malignant tumors[J/OL]. Dis Markers, 2022, 2022: 7076385[2022-02-17]. https://pubmed.ncbi.nlm.nih.gov/35222744/. DOI: 10.1155/2022/ 7076385.
17. 李娟娟, 黎铧, 王双珠, 等. 白血病所致视神经浸润的临床观察[J]. 眼科新进展, 2015, 35(9): 870-892. DOI: 10.13389/j.cnki.rao.2015.0237.Li JJ, Li H, Wang SZ, et al. Leukemic infiltration of optic nerve[J]. Rec Adv Ophthalmol, 2015, 35(9): 870-892. DOI: 10.13389/j.cnki.rao.2015.0237.
18. 徐全刚. 与肿瘤相关的视神经病变[J]. 中国眼耳鼻喉科杂志, 2022, 22(1): 3-6. DOI: 10.14166/j.issn.1671-2420.2022.01.002.Xu QG. Tumor-associated optic neuropathy[J]. Chin J Ophthalmol and Otorhinolaryngol, 2022, 22(1): 3-6. DOI: 10.14166/j.issn.1671-2420.2022.01.002.
19. Aghdam KA, Zand A, Sanjari MS. Isolated unilateral infiltrative optic neuropathy in a patient with breast cancer[J]. Turk J Ophthalmol, 2019, 49(3): 171-174. DOI: 10.4274/tjo.galenos.2018.24478.
20. 陈金邦, 钱德方. 直肠癌脉络膜视神经转移一例[J]. 中华眼科杂志, 1996, 32(3): 189.Chen JB, Qian DF. Choroidal optic nerve metastasis in rectal cancer: case report[J]. Chin J Ophthalmol, 1996, 32(3): 189.
21. Oyeniran E, Katz D, Kodati S. Isolated optic disc granuloma as a presenting sign of sarcoidosis[J]. Ocul Immunol Inflamm, 2022, 12: 1-3. DOI: 10.1080/09273948.2022.2127783.
22. Hickman SJ, Quhill F, Pepper IM. The evolution of an optic nerve head granuloma due to sarcoidosis[J]. Neuroophthalmology, 2016, 40(2): 59-68. DOI: 10.3109/01658107.2015.1134587.
23. Chung IK, Lee J, Shin JY. Peripapillary granuloma with optic nerve head involvement associated with sarcoidosis[J]. Korean J Ophthalmol, 2019, 33(4): 389-391. DOI: 10.3341/kjo.2018.0112.
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