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Purpose: to identify the intraretinal hyperreflective foci (HRF), their specific characteristics, localization features and correlations with the duration of the disease, type of course and previous episodes of optic neuritis (ON) in multiple sclerosis (MS) patients using a high-resolution OCT scanning protocol. Materials and methods. The study included 160 patients (318 eyes) divided into 8 groups, i.e. Group 1: 44 eyes (13.84 %) — MS onset without a history of ON; Group 2: 30 eyes (9.43 %) — debut of MS with ON; Group 3: 56 eyes (17.61 %) — relapsing-remitting MS (RRMS) lasting ≤ 10 years without ON; Group 4: 38 eyes (11.95 %) — RRMS lasting ≤ 10 years with ON; Group 5: 49 eyes (15.41 %) — RRMS lasting ˃ 10 years without ON; Group 6: 37 eyes (11.63 %) — RRMS lasting ˃ 10 years with ON; Group 7: 34 eyes (10.69 %) — secondary progressive MS (SPMS) without ON; Group 8: 30 eyes (9.43 %) — SPMS with ON. Results. HRF were identified in all groups, at the levels of both the outer nuclear layer (ONL) and the inner nuclear layer (INL). Their number increased depending on the duration, type of course, and the presence of ON history. The thickness of the inner layers of the retina corresponded to the average normative indicators in the group with the onset of MS without ON. In the SPMS group after ON, a decrease in the total thickness of ganglions retinal cells layer (GCL) and the inner plexiform layer (IPL) was noted, showing minimal values of both avGCL + IPL (65.83 ± 8.27 μm) and avRNFL (76.37 ± 6.94 μm). High inverse correlations were revealed between avGCL + IPL and the amount of GRF at the levels of ONL and INL (-0.82 and -0.85, respectively, p = 0.01). Conclusions. The presence and quantity of HRF can be considered as a prognostic non-invasive biomarker associated with the duration of MS and the history of ON, allowing one to visualize the penetration of microglia activated by immune cells into the unmyelinated part of the central nervous system, helpful in elucidating their role in the pathogenesis and progression of the disease.

A clinical case of bilateral descending optic neuritis in a 63-year-old patient is presented. The patient, whose age is beyond the normal limit for this pathology, was previously treated for neuritis of the right eye, which had no effect and led to a complete atrophy of the optic nerve (ON). A timely correct diagnostics of the left eye, which revealed structural disorders of the optic nerve accompanied by inflammatory viral changes of brain tissue, was a key factor in choosing an adequate treatment, which helped retain visual functions. The clinical observation illustrates the polyetiological nature of inflammation of the ON, the viral agent playing a leading role. Importantly, ophthalmic manifestations of the herpesvirus infection may remain the only sign of this pathology for a long time, so the ophthalmologist must always be on the alert regarding the viral genesis of the disease.

The discovery of antibodies against aquaporin-4 (AQP4) and against myelinoligodendrocyte glycoprotein (MOG) confirmed the existence of two disease entities distinct from multiple sclerosis (MS) — neuromyelitis optica spectrum disorders (NMOSD) and myelinoligodendrocyte glycoprotein-associated disease (MOGAD). Demyelinating optic neuritis (ON) can be either idiopathic (iDON) or a manifestation of MS, NMOSD (AQP4-ON) or MOGAD (MOG-ON).Objective: to determine the clinical features of ON and to evaluate the diagnostic value of optical coherence tomography (OCT) in demyelinating diseases of the central nervous system.Material and methods. The study included 43 patients with demyelinating ON who were divided into three groups according to the underlying disease (NMOSD, MOGAD and MS/iDON). We assessed visual acuity (VA) in the acute phase and analyzed VA and average values of retinal nerve fiber layer thickness (RNFL) and retinal ganglion cell complex (RGC) thickness using OCT data 6 months after the onset of ON.Results. ON was observed in the onset of the disease in 75% of NMOSD patients, 62% of MOGAD patients and 86% of MS/iDON patients. In the MOGAD and NMOSD groups, bilateral ON was predominantly observed. In 65% of patients with MOGAD (MOG-ONr), a recurrent course of ON was observed. VA was significantly lower in patients with AQP4-ON in acute phase and comparable to the MOG-ONr group in the long-term phase. VA in the onset of MOG-ON with a single episode was comparable to that of MS/iDON (p=0.2), but recovery was less pronounced (p=0.03). The most significant thinning of the RNFL and RGC complex was observed in the AQP4-ON and MOG-ONr groups. In AQP4-ON and MOG-ON groups, restoration of VA up to 0.5 and higher was observed significantly more frequently in the group of patients receiving pulse therapy with glucocorticoids (p=0.018).Conclusion. The study showed the most pronounced structural and functional disturbances in the long-term phase of AQP4-ON and MOG-ONr. MOG-ON was characterized by a high frequency of relapses with the influence of this factor on VA and thinning of the retinal layers in the long-term.

Purpose: to study significant functional and structural changes in the retina and the intraocular section of the optic nerve in multiple sclerosis (MS) patients and analyze how they are interrelated with electrophysiological changes in the visual analyzer.Materials and methods. The study included 44 patients (88 eyes): group 1 (26 eyes) with MS duration ≤ 5 years and no history of optic neuritis (ON); group 2 (30 eyes) with MS duration from 6 to15 years and no history of ON; and group 3 (32 eyes) with MS duration ≤ 15 years with a history of ON. All patients underwent a complete ophthalmological examination and optical coherence tomography and had visually evoked potentials (VEP) and static automated perimetry registered.Results. A decrease in functional and structural parameters progressing with the duration of MS was revealed. In particular, best corrected visual acuity (BCVA) fell to 0.860 ± 0.075, the photosensitivity index MD maximally fell to -3.78 ± 0.95 dB, the strength of the P100 wave amplitude dropped to 7.84 ± 2.98 μV, the latency index of VEP rose to 124.21 ± 1.36 ms, the thickness of GCL + IPL fell to 65.69 ± 7.85 μm, and RNFL thickness averagely fell a low as to 80.25 ± 8.81 μm. When analyzing the topography of GCL + IPL decrease by sectors, the maximum value was revealed in the upper temporal segment (67.63 ± 7.89 μm). Sectoral changes in RNFL arranged in descending order of thickness showed the following sequence: lower upper nasal temporal. As the disease progressed, structural and functional changes were accompanied by an increase in the depth and a decrease in the thickness of the lamina cribrosa, with a maximum value revealed in the group with prior ON (239.00 ± 11.93 μm). Strong correlations were found in all study groups between (1) ave. GCL + IPL and ave. RNFL (r = 0.69; 0.64; 0.88, p < 0.03), (2) ave. GCL+IPL and BCVA (r = 0.86; 0.75; 0.78, p < 0.05), (3) MD and ave GCL + IPL (r = 0.52; 0.69; 0.71, p < 0.03), and (4) MD and ave. RNFL (r = 0.67; 0.61; 0.66, p < 0.05), as well as between the parameters of the lamina cribrosa and the markers under study.Conclusion. Significant functional and structural changes in the retina and the optic nerve were detected, correlating with the duration of the disease and with the clinical features of the course of multiple sclerosis. The presence of ON in history was accompanied by more pronounced changes, which can be considered as an important additional aggravating factor of the disease.

Purpose: to study the prevalence of various chronic infections, the frequency of their reactivation and characteristic associations of microorganisms in patients with optic neuritis of various etiologies.Material and methods. 13 patients with optic neuritis (ON) and 12 patients with ON and multiple sclerosis were tested for a broad range of infectious agents in their blood serum.Results. All patients were shown to have mixed infections; 64 % of them had an association of 4 or more infectious agents. The patients of both groups were infected with Epstein-Barr virus (100 %), Cytomegalovirus (92 %) and Herpex simplex viruses (92 %) types 1 and/or 2 with serological signs of their reactivation. The combination of Herpes virus reactivation, Toxoplasma and urogenital infection was more often detected in patients with demyelinating ON. In patients with multiple sclerosis, a mutual correlation was detected: the higher the degree of infection (combination of 5 or more pathogens), the lower the visual acuity at the onset of the disease (p < 0.05) and the less favourable the vision prognosis.Conclusion. Possibly, mixed infection may play an important role in the pathogenesis of ON, including that of demyelinating etiology, as a trigger or an aggravating factor.

Neuromyelitis optica spectrum disorders (NMOSD) are a group of autoimmune inflammatory demyelinating diseases of the central nervous system. In 2015, International Expert Panel established diagnostic criteria for NMOSD. The majority of patients with NMOSD have aquaporin-4 autoantibody (AQP4-IgG). This case describes a 43-year-old woman who presented with weakness in her limbs followed by intractable vomiting. One year and 3 months later, she experienced acute visual impairment, which recurred several times. MRI of the spinal cord revealed a T2-hyperintense signal lesion at the cervical level extending over 4 vertebral segments. MRI of the brain showed involvement of the brainstem. AQP4-IgG was detected in her blood serum. It took 30 months from the onset of symptoms to establish the correct diagnosis. During this time, several incorrect diagnoses were made, including ischemic stroke, functional movement disorder and vertebrobasilar insufficiency. As a result of delayed diagnosis and treatment, the patient developed severe irreversible visual impairment. This case underscores the importance of early diagnosis and early treatment of NMOSD.

Optic neuritis (ON) can often occur at the onset of a demyelinating autoimmune CNS disease or as one of its clinical manifestations. The introduction of novel laboratory techniques, technical advances in magnetic resonance imaging (MRI), electrophysiologic studies, and ocular imaging have significantly expanded the spectrum of autoimmune optic neuropathies. Identification of different forms of ON based on clinical and instrumental data can lead to early diagnosis of the underlying neurologic disorder. According to current guidelines, one can distinguish between typical ON, which are mainly associated with multiple sclerosis (MS), and atypical ON, which are the main clinical manifestation of neuromyelitis optica spectrum disorders (NMOSD) and diseases associated with myelin oligodendrocyte glycoprotein antibodies (MOGAD). In this paper, we present four clinical cases of atypical ON at the onset of NMOSD and MOGAD and illustrate the high diagnostic value of a multidisciplinary approach.

The review summarizes the evidence of visual and neurological complications in the acute stage of COVID-19 and in post-COVID syndrome. Neurological symptom complexes, and cerebrovascular disorders are described. Ophthalmologic manifestations may be a typical sign of COVID-19 onset, but they may also develop several weeks after recovery. The spectrum of neuro-ophthalmological manifestations in most cases includes optic neuritis, optic disc edema, optic neuropathy, and venous thrombosis. Ophthalmologists should be aware of the possible associations of ocular diseases with COVID-19 in order to diagnose and initiate an early treatment for life and vision threatening complications.

Purpose: to determine objective echographic criteria for the differential diagnosis of anterior ischemic optic neuropathy (AION) and optic neuritis (ON).Material and methods. The research involved 60 patients aged 40 to 60 years, including 30 patients with suspected AION and 30 patients with suspected ON. The control group consisted of 40 healthy volunteers. In addition to the standard ophthalmological examination, all patients underwent ultrasound optic nerve s examination with measurement of the optic nerve thickness and acoustic density (AD) of the parenchyma and optic nerve sheets. Assessment of blood flow in retrobulbar vessels was carried out in the modes of Color Doppler Imaging and pulse dopplerography.Results. There were no statistically significant differences in average echographic parameters of the optic nerve s thickness between the groups of patients with AION and ON. In patients with ON there was a statistically significant decrease in the average AD index compared to that in patients with AION and in healthy volunteers (106.02 ± 5.40 y. e., 146.58 ± 9.70 y.e. and 135.3 ± 2.1 y. e., accordingly). The AD values in all patients with AION exceeded 133 y. e., in patients with ON this index was less than 132 y. e. Evaluation of hemodynamic parameters in the vessels of the eye demonstrated a statistically significant decrease in the peak systolic velocity (Vsyst) and end-diastolic velocity (Vdiast) blood flow in the central retinal artery and medial and lateral short posterior ciliary arteries in patients with AION (in 2-fold) compared with ON and normal indices (p < 0.001). There were no statistically significant differences between parameters of blood flow in patients with ON and in healthy volunteers. In addition, there were no significant intergroup differences of hemodynamic parameters of the ophthalmic artery (p > 0.05).Conclusions. AD of the optic nerve and parameters of blood flow velocities (Vsyst and Vdiast) in medial and lateral short posterior ciliary arteries can be attributed to the diagnostic criteria of the AION and ON.

An increase in the incidence of optic neuritis among the working-age population, as well as an unpromising prognosis for vision due to the development of optic nerve atrophy, determines the high social significance of this problem. The aim of the work is to analyze the effect of Imunofan at the parameters of cellular immunity and clinical symptoms of the disease in the complex treatment of optic neuritis associated with herpes virus infection. The study involved 37 people (37 eyes) with acute optic neuritis associated with herpes infection. The treatment regimen included the appointment of a dexamethasone solution according to a decreasing scheme, a 1% solution of the drug Emoxipin 0.5 mL and a 12.5% solution of the drug Dicynone 0.5 mL through an irrigation system implanted in the retrobulbar space, in combination with the neuroprotection drugs (Pikamilon and Semax) for 10 days. All patients were divided into 2 groups. The main group consisted of 20 patients who received Imunofan to the treatment regimen in addition. The comparison group included 17 patients who were treated only according to the method described above. The course of treatment lasted 10 days. The analysis of the data showed a more significant positive dynamics of cellular immunity parameters in those who received immunotherapy. Our studies showed the effectiveness of this drug in the complex treatment of optic neuritis associated with herpes infection, what is confirmed by the acceleration of inflammation relief, a more significant increase in visual functions of patients treated with Imunofan, and a lower percentage of optic nerve atrophy. In this group of patients, changes in the parameters of the cellular link of immunity occurred earlier and remained stable throughout the entire period of observation. According to our data, an intergroup assessment of the immunoregulatory index showed its faster increase in patients of the comparison group who received Imunofan, and reached normal values already 6 months after treatment. The clinical effectiveness of Imunofan in the complex therapy of optic neuritis associated with herpes infection was characterized by a reduction in the period of relief of signs of inflammation in the optic nerve by 2 times or more, by an increase in the maximum corrected visual acuity by 4.5 times, and by a decrease in the incidence of recurrence of optic neuritis by 2 times over a 12 months observation period.

Background. An increase in the incidence of optic neuritis (ON) among the workingage population, the complexity of etiological diagnosis and the choice of adequate etiotropic therapy, as well as a disappointing prognosis for vision due to the development of optic nerve atrophy determines the high social significance of this problem.The aim. Comprehensive clinical, functional, morphometric and laboratory-immunological evaluation of results of using the drug Imunofan® in combined treatment of ON associated with herpesvirus infection (HVI).Materials and methods. The study involved 39 people (39 eyes) with acute ON associated with HVI. The standard treatment regimen for the patients included the appointment of solutions: dexamethasone in a decreasing scheme, a 1 % Emoxypine® preparation 0.5 ml and 12.5 % Dicynone® preparation 0.5 ml through an irrigation system implanted into the retrobulbar space, with subsequent appointment of medicinal means of neuroprotection (Picamilon® and Semax®). All patients were divided into two groups. The main group – 22 patients, whose standard inpatient treatment was supplemented with intramuscular administration of the drug Imunofan®, 50 μg daily for 10 days. The control group consisted of 17 patients, who were treated only according to the standard method.Results. Analysis of obtained data showed that more significant positive dynamics was noted in patients of the main group.Conclusion. The clinical efficacy of the drug Imunofan® in the complex therapy of ON associated with HVI was characterized by relief of signs of inflammation in the optic nerve in the main group immediately after the end of the course of treatment, while in the control group – only after 3 months; an increase in the best corrected visual acuity by 1.3 times, a decrease in the incidence of postneuritic optic nerve atrophy at a follow-up period of 12 months.

Antibodies to myelin-oligodendrocyte glycoprotein (anti-MOG-IgG) is a specific biomarker that has been detected in peripheral blood from children with acute multiple encephalomyelitis (ADEM) as well as in adults with aquaporin-4 (AQP4), associated with seronegative opticoneuromyelitis spectrum disease (NMOSD), brainstem encephalitis, longitudinally disseminated transverse myelitis, and optic neuritis. Most experts now consider MOG-IgG-associated disorder (MOG-AD) an independent disease immunopathogenetically distinct from classical multiple sclerosis (MS) and aquaporin-4 (AQP4)-IgG-positive optomyelitis. Isolated, bilateral, and less frequently unilateral OH, with simultaneous or sequential involvement of the eyes, is the most frequent clinical manifestation of MOG-AD. Because of the significant overlap in the clinical and radiological picture, MOG-AD is often misdiagnosed as MS. Timely diagnosis is critical to ensure appropriate treatment. This article describes a clinical case of anti-MOG-IgG encephalomyelitis with late-onset ON initially diagnosed as MS.

Background. As the amount of knowledge about multiple sclerosis increases, there is an interest in other forms of demyelinating diseases, among which neuromyelitis optica spectrum disorder and MOG (myelin oligodendrocyte glycoprotein) antibody disease can be distinguished.Objective: to improve the efficiency of diagnosis and treatment, to assess the long-term outcome in patients with AQP-4-positive neuromyelitis optica and MOG antibody disease.Materials and methods. The study included 14 patients: children, adolescents, adults, and elderly (9 - female, 5 -male). The duration of catamnesis ranged from 1 year to 6 years.Results and discussion. Antibodies to AQP-4 were found in 5 patients, antibodies to MOG were found in 9 patients. 89 % of patients with MOG antibody disease had the number of antibodies to MOG less than 50 pg/ml, determined by the Sandwich-type ELISA method; therefore, multiple sclerosis cannot be excluded (considering the oligoclonal IgG type 2 in three patients). To clarify the diagnosis, antibodies to MOG must be tested by more specific method of live cell-based assay in these patients.Based on this group of patients, it can be assumed that the younger the patient was, the earlier the diagnosis was made and treatment started, the better was prognosis. The prognosis was more favorable in patients with AQP-4-positive neuromyelitis in whom the disease debuted with optic neuritis. Patients with MOG antibody disease had a more favorable prognosis if the disease debuted with a supratentorial brain lesion; less favorable - when oligoclonal IgG type 2 was detected. Gender had no influence on the outcome of the disease.Conclusion. Differential diagnosis of this diseases based on clinical data is practically impossible. The study was carried out in a small group, so it is difficult to translate the results to the population of patients with neuromyelitis optica spectrum disorders. During treatment, almost all patients show positive dynamics when using glucocorticosteroids, human immunoglobulin preparations. Plasmapheresis was ineffective in patients with AQP-4-positive neuromyelitis optica, in some patients with MOG antibody disease the positive effect was observed. Cytostatic therapy was effective in patients with AQP-4-positive neuromyelitis optica. B cell depletion therapy with rituximab was effective in patients with MOG antibody disease. Interferon preparations did not give a positive effect.

Crohn’s disease and ulcerative colitis are chronic inflammatory bowel diseases, which are often accompanied by inflammation of other organs. This article presents modern data on etiology, pathogenesis and clinical course of inflammatory bowel diseases, as well as information on extraintestinal eye manifestations of nonspecific ulcerative colitis and Crohn’s disease. The role of microbiota, genetic factors, immune system defects in pathogenesis of intestinal inflammation and extraintestinal eye manifestations is considered. The possibility the development of ophthalmopathology not only against the background of intestinal inflammation, but also as a consequence of therapeutic and surgical methods of treatment of ulcerative colitis and Crohn’s disease is noted. The peculiarities of the course of episcleritis/scleritis, keratitis, uveitis, chorioretinitis, optical neuritis for patients with inflammatory bowel diseases are considered. The presence of these complications may reflect the activity of the underlying disease, which in some cases requires correction of therapy. Anterior uveitis and episcleritis/scleritis are the most common extraintestinal manifestations of inflammatory bowel disease. Inflammation of tissues of the posterior segment of the eye and optic nerve against the background of ulcerative colitis and Crohn’s disease are less common, but are of clinical importance, as they can catastrophically damage the structures of the eye and, as a consequence, lead to complete blindness. Considering the possibility of mild clinical symptoms and asymptomatic course of inflammation in the eye envelopes, the importance of ophthalmological examination of all patients with ulcerative colitis and Crohn’s disease is emphasized. Aspects of modern therapy of ophthalmopathology and background intestinal inflammation are highlighted. Biological preparations — antagonists of pro-inflammatory cytokines — have been identified as the most promising in the treatment of inflammatory intestinal diseases and extraintestinal manifestations. The important role of proper nutrition and biologically active supplements containing omega-3 fatty acids, vitamin D, microelements, was noted as auxiliary therapy of both intestinal and extraintestinal inflammation.

The paper describes two cases of adolescent-onset anti-MOG (myelin oligodendrocyte glycoprotein) syndrome. One case had an onset of optic neuritis, followed by myelitis; a recurrence of the syndrome occurred during interferon-β therapy. In the other case the syndrome also began with optic neuritis; and after a long latent period it was manifested as unilateral encephalitis with contralateral hemiparesis and rare epileptic seizures. Detection of anti-MOG syndrome is of great importance, because its management tactics is different from that for multiple sclerosis; furthermore, the laboratory diagnosis of this syndrome can be made in our country now.

Purpose: to study the etiological structure and incidence rate of various genesis optical neuropathies (ON) according to the own observation data. Material and methods. The study is based on the data analysis from a survey of 658 patients (982 eyes) with ON. The results of routine physical examination of all patients were analyzed to determine the genesis of ON. Results. The most common cases of ON were ischemic ON (31.2 % of all cases), as well as optic neuritis (18.3 % of cases). The anterior optic pathway tumor or infiltrative lesions were detected in 9.9 %, dysthyroid ON was found in 7.2 %. Acute and chronic ON with the optic nerve drusen accounted for 12.4 % of all cases of ON, was found in 60.5 % of all patients with the optic nerve drusen. Hereditary ON was found in 10 % of all cases of ON, toxic - in 4,3 % as a result of acute and chronic alcohol intoxication, chronic narcotic poisoning, drug poisoning. Traumatic ON was found in 6.7 % of all cases of ON. Conclusions. The causes of ON are diverse, vary from innate changes to diseases of the optic nerve as a result of serious therapeutic and neurosurgical pathology, which threaten not only the ophthalmologic, but also the life prediction. The patient thorough clinical study is required to determine the disease genesis at the time of ON symptoms identifying.

Purpose: to develop an algorithm for testing patients with optic nerve atrophy due to MS using microperimetry with the different functional disorders.Patients and Methods. There were 20 patients (40 eyes) with the correct diagnosis of MS at the age of 33 ± 1.88 years in the study. The BCVA was from 0.1 to 1.0. Microperimetry was done on MP-1 (Nidek technologies, Vigonza, Italy) with the definition of mean sensitivity, stability and type of fixation. We chose the parameters of microperimetry: the research program, the size of the stimulus, the fixation mark and the test mode.Results. The best program for diagnosing central visual field defects was the program macula 12° 10 dB, for paracentral visual field defects – retina 40° 20 dB. The testing was conducted by using a standard stimulus Goldmann III, mark and survey mode is selected individually, according at the various types of functional disorders. The visual acuity was from 0.1 to 0.4 in 11 eyes with optic nerve atrophy. There were revealed absolute or relative defects of the central field of vision and the decreasing of mean sensitivity to 8.21 ± 2.3 dB, unstable central fixation — 71.18 ± 10, 3%. In 29 eyes with optic nerve atrophy and visual acuity 0.5–1.0 have been identified relative small central visual field defects and paracentral visual field defects in the inferior side with a decrease in sensitivity to 15,32 ± 0,84 dB in the area of 6° from the fixing point, stable central fixation 88,96 ± 2,9%.Conclusion. The authors developed an algorithm for testing patients with optic nerve atrophy due to MS. Using the algorithm identified the central and paracentral visual field defects with the decrease in the mean sensitivity.

Background. In case of a manifestation of multiple sclerosis (MS), visual disturbances in the form of monocular optic neuritis are most common. Diagnosis of central scotomas in case of optic neuritis due to MS using microperimetry in an unstable fixation or with very small or large sizes of central scotomas requires an individual selection of research parameters.Purpose. To develop an algorithm of microperimetry in patients with optic neuritis in case of multiple sclerosis in various manifestation degrees of functional disturbances. Material and methods. The study involved 22 patients (mean age 27.7±1.3 years) with acute monocular optic neuritis. The study was performed using the microperimeter MR-1 (Nidek technologies,Vigonza,Italy) in addition to the traditional examination. The microperimeter evaluated the average light sensitivity of retina and fixation stability. The selection of parameters for microperimetry was carried out in the course of the study.Results. The authors developed an examination algorithm for evaluation of patients with optic neuritis due to the MS in various manifestation degrees of functional disturbances, which includes a sequence selection of screening programs – macula 12° to 10 dB, the charge of the standard Goldmann III stimulus, the variant of fixation mark (central or circular) and the study mode (fully automatic or automatic with the additional use of manual operation). During the examination the central visual field defects of various sizes were revealed according to the proposed algorithm. Therewith, the size of detected defects was inversely proportional to the visual acuity.Conclusion. The algorithm first developed by the authors to test patients with optic neuritis in case of MS by the microperimetry method allowed to optimize the process of diagnosis for central scotomas and to obtain the reliable and more complete information about the status of fundus in various manifestation degrees of functional disorders. The indices of average light sensitivity was significantly different in groups of patients with visual acuity to 0.1 and higher than 0.1, that indicates the relationship between the size of the scotoma and the severity of lesion of the optic nerve in case of MS.

A benign course of multiple sclerosis is characterized by rare exacerbations of the disease, long-term remissions and the lack of severe disability within a few decades after the onset of symptoms. It is known that optic neuritis is the most common symptomatic manifestation of the disease where its relapses may be observed. Descriptions of clinical remission in multiple sclerosis longer than 30 years were not found in the literature.Purpose. To describe the dynamics of visual functions in a patient with a 36-year remission in case of benign multiple scler osis (BMS).Material and methods. At the S. Fyodorov Eye Microsurgery Federal State Institution (Moscow) the dynamics of visual functions in this female patient since the age from 22 years to 58 years. Following standard research methods were performed: computer perimetry using the Humphrey HFA II-750i device, optical coherence tomography (OCT) using the spectral optical coherence tomography Cirrus HD-OCT (Carl Zeiss Meditec Inc., USA), computer Microperimetry MR-1 (Nidek technologies, Vigonza, Italy), magnetic resonance imaging (MRI) of the brain and orbits (Siemens Magnetom AVANTO, 3 Tl) using the T1 and T2 FLAIR and T2 Fat Saturation programs.Results. This female patient with a clinic of multiple sclerosis nonmanifested within 36 years after the first episode of optic neuritis was examined and treated at the S. Fyodorov Eye Microsurgery Federal State Institution (Moscow, Russian Federation) the patient was with visual disabilities and the interval of benign MS course was 36 years. During this period the patient suffered optic neuritis (ON) of the right eye at the age of 22 years and ON in the contra-lateral eye aged 58 years. The diagnosis of multiple sclerosis was confirmed on the basis of sub-clinical neurological deficit (intention tremor when performing finger-nose test, increased knee reflexes, instability in Romberg), a repeated episode of optic neuritis in the fellow eye, the presence of multiple T2 lesions in a typical MS localization according the McDonald criteria. After the final confirmation of the diagnosis of MS in 58 years, the first episode of ON, which occurred 36 years ago, has been identified as a manifest disease. Diagnosis: OD – Atrophy of the optic nerve. OS – Optic neuritis. Benign Relaps-Remmiting Multiple Sclerosis (BRRMS), cerebral form, the acute stage. An early start of the disease with an isolated optic mono-symptom is typical for a benign MS course. Further research of these cases, it may be useful to optimize the management tactics all patients already diagnosed MS.Conclusion. The presented clinical case of a 36-year remission of MS is rare in the clinical practice. All patients with an episode of optic neuritis in history must be supervised by an ophthalmologist and a neur ologist.

Multiple sclerosis (MS) is a chronic autoimmune-inflammatory and neurodegenerative disease., Purpose: This study explores the main structural changes in patients with MS and their relationships with the activity and type of disease course., Material and Methods: This prospective study included 159 patients (318 eyes) with an established diagnosis of MS: group (44 eyes; 13.84%) - relapsing-remitting type MS (RRMS) lasting up to 1 year without a history of optic neuritis (ON); group 2 (30 eyes; 9.43%) - RRMS up to 1 year with ON; group 3 (56 eyes; 17.61%) - RRMS lasting from 1 to 10 years without ON; group 4 (38 eyes; 11.95%) - RRMS from 1 to 10 years with ON; group 5 (49 eyes; 15.41%) - RRMS >10 years without ON; group 6 (37 eyes; 11.63%) - RRMS >10 years with ON; group 7 (34 eyes; 10.69%) - secondary progressive multiple sclerosis (SPMS) without ON; group 8 (30 eyes; 9.43%) - SPMS with ON. Patients underwent standard ophthalmological examinations, including optical coherence tomography., Results: A decrease in structural parameters was diagnosed, progressing with the duration of the disease and the presence of ON: the minimum values of mGCL+IPL (65.83±9.14 μm) and mSNFL (76.37±14.77 μm) were detected in the group with SPMS with ON. High inverse correlations of EDSS with mGCL+IPL and mRNFL were demonstrated, with maximum in the group with the longest duration of MS without ON (-0.48 and -0.52 ( p =0.01), respectively)., Conclusion: Changes in the thickness of the structural parameters of the retina, measured by OCT, can be considered as a predictor of the course of MS.

Purpose: This study analyzes the main changes in retinal microcirculation in patients with multiple sclerosis (MS) and their relationship with the type of disease course., Material and Methods: 159 patients (318 eyes) were examined. The groups were formed according to the type of course and duration of MS: group 1 - 37 patients (74 eyes; 23.27%) with relapsing-remitting MS (RRMS) less than 1 year; group 2 - 47 patients (94 eyes; 29.56%) with RRMS from 1 year to 10 years; group 3 - 44 patients (86 eyes; 27.05%) with RRMS >10 years; group 4 - 32 patients (64 eyes; 20.12%) with secondary progressive MS (SPMS). Subgroups A and B were allocated within each group depending on the absence or presence of optic neuritis (ON). Patients underwent standard ophthalmological examination, including optical coherence tomography angiography (OCTA)., Results: A decrease in the vessel density (wiVD) and perfusion density (wiPD) in the macular and peripapillary regions was revealed, progressing with the duration of the disease and with its transition to the progressive type. The minimum values were observed in patients with SPMS (group 4), with the most pronounced in the subgroup with ON (wiVD = 16.06±3.65 mm/mm 2 , wiPD = 39.38±9.46%, ppwiPD = 44.06±3.09%, ppwiF = 0.41±0.05)., Conclusion: OCTA provides the ability to detect subclinical vascular changes and can be considered a comprehensive, reliable method for early diagnosis and monitoring of MS progression.

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Background: Multiple sclerosis is regarded as the most frequent cause of neurological disability. Visual disturbances are common and may be due to pathology of retina, optic nerve and cerebral conduction tracts (optic tract). Routine methods of assessment of visual function are insufficient in diagnosing some visual problems including color vision disturbances. Aim: To assess color vision in patients with multiple sclerosis. Materials and methods: We examined 110 patients (age > 18 years old) with previously diagnosed multiple sclerosis. Neurological status was assessed using functional scales; results of neuroimaging, medical records and history were taken into account. Color vision was examined using Farnsworth dichotomous test. Control group included 20 healthy volunteers (8 men, 12 women, mean age 29.1 ± 1.4 years old). Results: In patients with multiple sclerosis, color vision defects were significantly more prevalent compared to the control group (89.1% vs. 65%, p < 0.05). Deuteranopia was found in 18.6% of patients with multiple sclerosis, protanopia in 17.3%, tritanopia in 7.3% of patients. Significant color vision defects positively correlated with disability level of the Expanded Disability Status Scale (EDSS) and were independent of disease duration and history of retrobulbar neuritis. Conclusion: In patients with multiple sclerosis, color vision defects were associated with the activity of pathological process. Severity of neurological disability level estimated by EDSS positively correlated with visual disturbances. Thus, Farnsworth dichotomous test may be recommended for dynamic monitoring of multiple sclerosis.

Purpose. To study the efficacy of complex treatment for optic neuritis using neuroprotectors according to magnetic resonance (MR) tractography findings.Material and methods. The study included 23 patients (31 eyes) with optic neuritis. They were divided into two groups of patients depending on the type of treatment. The control group consisted of 11 patients (15 eyes), who received a standard conservative therapy: anti-inflammatory, decongestants, desensitizing therapy. The patients of the main group (12 patients, 16 eyes) in addition to the above complex, received Cerebrolysin intravenously 10.0ml in 10ml of saline solution during 10 days, then Gliatilin (choline alfoscerate) in tablets 0.4gr 3 times per day for 2 months. The standard ophthalmic methods and special investigation methods were performed in all patients. The MR tractography was carried out using the magnetic resonance imaging BRIVO-355/1.5 Tesla GE (USA).Results. On admission to the hospital the visual acuity of the patients in both groups averaged 0.23±0.14, the total limit of visual field (TLVF) was mean 324.0±6.8є. As a result of performed therapy the main group of patients showed an increase in visual acuity up to 0.59±0.05 (p

Aim. To assess prognostic value of neuron-specific enolase (NSE) in blood serum and tear fluid in optic neuritis (ON).Patients and methods. ON patients as well as healthy persons were examined. Group I included 27 patients (27 eyes) with acute ON. Group II included 23 patients (23 eyes) with ON and continuing optic nerve atrophy. Group III (controls) included 10 healthy persons (20 eyes). NSE levels in tear fluid and blood serum were measured using electrochemical luminescence immune analyzer Cobas-e-411.Results. In group I, NSE levels in tear fluid and blood serum averaged 0.81±0.15 and 13.67±1.44 ng/mL, respectively. In group II, NSE level in tear fluid was 24.86±3.84 ng/mL (on average) while its blood serum level was within normal limits. In controls, NSE levels in tear fluid and blood serum were within normal limits (15.7±0.2 and 16.8±0.12 ng/mL, respectively).Conclusions. In group I, NSE level in tear fluid was 19‑fold less than normal (р < 0.05). It appears to be due to the activation of hypoxia and anaerobic glycolysis in neurons. In group II, NSE level in tear fluid was 1.43‑fold higher than normal (р < 0.05). This may be due to neuronal degeneration and progressive death with NSE release from damaged neurons into the cellular matrix.

Purpose: Evaluate the diagnostic value of specific methods of investigation for the early diagnosis of patients with optic neuritis (ON).Methods: 75 patients with ON were included into the study. Everyone were examined using static perimetry, optical coherence tomography of the optic nerve and thickness of peripapillary nerve fiber layer, visual evoked potentials to flash and pattern types.Results. In the early stage of defining the method was static perimetry (sensitivity 94 %), followed in descending order VEP and OCT (sensitivity 87 % and 84 %) and MRI of the brain and orbits (sensitivity 82 %).Conclusion: VEP, static perimetry, MRI of the brain and orbits, as well as OCT allow establishing inflammation of the optic nerve at the early stages of the disease. Complex application of these methods revealed ON to 97 % of cases.

Optic neuritis (ON) is one of the most common neuro-ophthalmic causes of vision loss worldwide. Demyelinating ON can be idiopathic or be one of the symptoms of autoimmune demyelinating diseases of the central nervous system (CNS) such as multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Demographic, clinical and radiological signs of ON in these CNS diseases have differences. In this regard, typical and atypical ON are currently distinguished. Recognizing the clinical features that differentiate typical MS-associated ON from atypical ON in NMOSD and MOGAD is important for choosing the correct disease management and treatment strategy. This review summarizes the data from clinical, laboratory, instrumental methods of management used for the differential diagnosis of optic neuritis.

The coexistence of optic neuritis and Guillain-Barré syndrome is a rare combination of neurological diseases. The trigger of an autoimmune inflammatory process is often a respiratory mycoplasma infection. Ignorance of such combination can lead to diagnostic and therapy mistakes. This article describes the case of a rare combination of overlapping optic neuritis and Guillain-Barré syndrome, associated with Mycoplasma pneumoniae and provides the short literature review. Further studies are required to identify common pathogenetic mechanisms of combined inflammatory lesions of the optic nerves and peripheral nervous system.

Despite the wide range of clinical, instrumental and laboratory methods used in modern ophthalmology, the problem of diagnosing optic neuropathy and identifying its etiology remains relevant. A complex multidisciplinary approach involving various specialists is required in the differential diagnosis of immune-mediated optic neuritis, for example in multiple sclerosis, neuromyelitis optica spectrum disorder, and MOG-associated diseases. Of special interest is differential diagnosis of optic neuropathy in demyelinating diseases of the central nervous system, hereditary optic neuropathies and ischemic optic neuropathy. The article presents a summary of scientific and practical results of differential diagnosis of optic neuropathies with various etiologies. Timely diagnosis and early therapy start reduces the degree of disability in patients with optic neuropathies of different etiologies.

Neuromyelitis optica spectrum disorder (NMOSD) is a group of rare and mostly severe autoimmune demyelinating central nervous system disorders which prevalence is 0.7-1 per 100.000 population and incidence is 0.037-0.73 per 100.000 person-years. NMOSD may present as a combination of uni- or bilateral optic neuritis, transverse myelitis or lesions of brain stem and other brain regions. The symptoms are mostly relapsing (up to 97.5%) and progressive. Occurrence of relapses is associated with seropositivity for aquaporin-4 (up to 80% of NMOSD patients) and bears a less favorable prognosis (mortality up to 32%). Women seropositive for aquaporin 4 constitute 90% of NMOSD patients. Compared to other demyelinating disorders, NMOSD is characterized by late onset (mean age is about 39 years) and association with other autoimmune disorders, including systemic lupus erythematosus, myasthenia gravis and Sjogren's syndrome. A genetic predisposition was found among Blacks and Asians, with HLA-DRB1*03:01 gene associated with higher risk of NMOSD in Asians. The course of the disease tends to be more severe in Blacks. There are clusters of an increased incidence of NMOSD in the Carribeans and in the Far East. Continued increase of prevalence and incidence of NMOSD worldwide compels continued epidemiological research in order to provide early diagnosis and treatment for this disorder.

Autoimmune encephalitis with antibodies to NMDA receptors (anti-NMDAR encephalitis), is the most common form of autoimmune encephalitis. The disease is curable, however, the lack of timely therapy can lead to the disability of patients or to the death. Difficulties in the diagnosis of anti-NMDAR encephalitis are caused by the heterogeneity of its manifestations, a possible overlapping with other autoimmune diseases and insufficient awareness about this form of encephalitis. This article describes the case of anti-NMDAR encephalitis associated with recurrent optic neuritis which might be an atypical manifestation for this disease. Optic neuritis could not be explained by overlapping with multiple sclerosis or neuromyelitis optica spectrum disorders.

The authors present three clinical cases of demyelinating diseases associated with MOG-antibodies. In the first case of a young adult male patient, the disease first manifested with stem encephalitis and high titer of plasma MOG-antibodies. In the second case of a male adolescent, the disease proceeded as neuromyelitis optica, aquaporin-4 antibody titer was normal. In the third case, the female child the disease presented with unilateral multifocal encephalitis and focal epileptic seizures. The article emphasizes the relationship of MOG-antibody titers with the severity and prognosis of the disease.

Autoimmune encephalitis with antibodies to NMDA receptors, or anti-NMDAR encephalitis, is the most common form of autoimmune encephalitis. The disease is curable, however, the lack of timely therapy can lead to the disability of patients or to the death. Difficulties in the diagnosis of anti-NMDAR encephalitis are caused by the heterogeneity of its manifestations, a possible overlapping with other autoimmune diseases and insufficient awareness about this form of encephalitis. This article presents the literature review and describes the case of anti-NMDAR encephalitis associated with recurrent optic neuritis, which might be an atypical manifestation for this disease. Optic neuritis could not be explained by overlapping with multiple sclerosis or neuromyelitis optica spectrum disorders.

Purpose: To assess the etiological significance of herpesviral infection (HVI) in patients with acute idiopathic optic neuritis (ON) using clinical and laboratory monitoring., Material and Methods: Clinical and laboratory examinations were conducted for 10 years and were based on the results of etiological monitoring of 79 patients (85 eyes) with acute idiopathic ON in the period of 2005-2015., Results: During a complex examination of 79 patients with acute idiopathic ON, various infectious pathogens were diagnosed in 75 people (94.9±2.1%). HVI was clearly dominant (69 patients - 87.3±2.4%). These patients were divided into 3 etiological groups. The first group - 34 people with herpesviral monoinfection; the second group - 15 people with mixed viral-viral infections; the third group - 20 people with mixed viral-bacterial infections. In the general population of patients with acute idiopathic ON associated with HVI, herpes simplex virus-1 is the most frequent (by more than 2.5 times), the infections of Epstein-Barr virus and cytomegalovirus were detected less often (p<0.05). Active current HVI in the general group of patients was diagnosed in 58 patients (84%). At the same time, reactivation of chronic infection (79.7%) was noted to be prevalent, while primary acute HVI was diagnosed rarely (4.3%). The remaining 11 patients (16%) had chronic persistent HVI., Conclusion: Clinical and laboratory monitoring of HVI in patients with acute idiopathic ON has shown the etiological role of herpesviruses in its development. Based on a complex of serological markers in enzyme-linked immunoassay reactions of blood serum, it was found that in patients with acute idiopathic ON the frequency of herpesviral infection is 87.3±2.4%. The proportion of active (etiologically significant) herpesviral infection is 84% of the total group. The results of the clinical and laboratory studies are of great practical importance for verification of the etiologic diagnosis and selection of adequate etiopathogenetic therapy in patients with acute idiopathic ON associated with HVI.

New terminology used by neurologists with multiple sclerosis (MS). The current use of terms 'definite' MS, 'MS signs', 'retrobulbar neuritis' and 'optic neuritis', 'relapse and exacerbation, types of MS course, criteria of effectiveness of MS therapy, NEDA, NEP, NEPAD; the classification therapy methods - 'escalation', 'induction' and therapy of immune reconstitution (TIR), therapy of maintenance/escalation (TME) and discussed.