Bernardo Sanchez-dalmau | Universitat de Barcelona (original) (raw)
Papers by Bernardo Sanchez-dalmau
Journal of Neuro-Ophthalmology, 2011
We performed an in-depth study of the neuroophthalmologic signs and symptoms of a rare but fatal ... more We performed an in-depth study of the neuroophthalmologic signs and symptoms of a rare but fatal disease known as primary diffuse leptomeningeal gliomatosis (PDLG). Two new cases of PDLG are described, and 22 published cases reviewed. Papilledema and sixth nerve palsy are the most common neuro-ophthalmic findings. Other abnormalities include third and fourth nerve palsies, nystagmus, and vision loss. Involvement of the visual system may be part of the initial presentation of PDLG.
Journal of Neurology, 2014
It is currently believed that the incidence rate of optic neuritis (ON) ranges between 0.56 and 5... more It is currently believed that the incidence rate of optic neuritis (ON) ranges between 0.56 and 5.1 cases per 100,000 person-years. However, since these figures were generated, they have not been updated and there are suggestions that the incidence of ON is on the rise. When designing new therapies and clinical trials for ON, and to improve the management this disease, it is important to have accurate epidemiological data. Thus, we set out to obtain the prevalence and incidence rates of ON in Barcelona (Spain) from 2008 to 2012, by a retrospective evaluation of electronic hospital records at the Hospital Clinic of Barcelona (population of 300,000 in the catchment area) matching the following ICD-9-CM codes as search terms: 377.3-optic neuritis; 377.30-optic neuritis, unspecific; 377.31-optic papillitis; 377.32-retrobulbar neuritis, acute; 377.39-other optic neuritis and ''optic neuropathy''. Demographic and clinical data were collected from records with a confirmed diagnosis of ON, including cases of idiopathic ON, multiple sclerosis, neuromyelitis optica and CRION. The prevalence of acute ON on 31 December 2012 was 2.75 cases per 100,000 people. The mean annual prevalence of acute ON during the 2008-2012 period was 7.87 cases per 100,000 person-year and the mean annual incidence rate was 5.36 cases per 100,000 person-years. The incidence of ON in Barcelona during 2008-2012 was higher than previously reported. This increase may reflect the evolution of diagnostic criteria, the use of a referral-center approach instead of a population-based approach, increased awareness of demyelinating diseases, latitude-related factors and possibly a true increase in its incidence.
Background Most patients with multiple sclerosis without previous optic neuritis have thinner ret... more Background Most patients with multiple sclerosis without previous optic neuritis have thinner retinal layers than healthy controls. We assessed the role of peripapillary retinal nerve fi bre layer (pRNFL) thickness and macular volume in eyes with no history of optic neuritis as a biomarker of disability worsening in a cohort of patients with multiple sclerosis who had at least one eye without optic neuritis available.
The Lancet Neurology, 2016
Journal of Neurology, 2016
Monitoring disease burden is an unmeet need in multiple sclerosis (MS). Identifying patients at h... more Monitoring disease burden is an unmeet need in multiple sclerosis (MS). Identifying patients at high risk of disability progression will be useful for improving clinical-therapeutic decisions in clinical routine. To evaluate the role of visual field testing in non-optic neuritis eyes (non-ON eyes) as a biomarker of disability progression in MS. In 109 patients of the MS-VisualPath cohort, we evaluated the association between visual field abnormalities and global and cognitive disability markers and brain and retinal imaging markers of neuroaxonal injury using linear regression models adjusted for sex, age, disease duration and use of disease-modifying therapies. We evaluated the risk of disability progression associated to have baseline impaired visual field after 3 years of follow-up. Sixty-two percent of patients showed visual field defects in non-ON eyes. Visual field mean deviation was statistically associated with global disability; brain (normalized brain parenchymal, gray matter volume and lesion load) and retinal (peripapillary retinal nerve fiber layer thickness and macular ganglion cell complex thickness) markers of neuroaxonal damage. Patients with impaired visual field had statistically significative greater disability, lower normalized brain parenchymal volume and higher lesion volume than patients with normal visual field testing. MS patients with baseline impaired VF tripled the risk of disability progression during follow-up [OR = 3.35; 95 % CI (1.10-10.19); p = 0.033]. The association of visual field impairment with greater disability and neuroaxonal injury and higher risk of disability progression suggest that VF could be used to monitor MS disease burden.
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Archivos de la Sociedad Espanola de Oftalmologia
We present the case of a 54-year-old woman with papilledema associated to POEMS syndrome. The pre... more We present the case of a 54-year-old woman with papilledema associated to POEMS syndrome. The presence of intracranial hypertension was detected and treatment started with acetazolamide. The most common ophthalmological pathology in POEMS syndrome is papilledema, the etiology of which could be infiltrative, intracranial hypertension, inflammation or an increase of the vascular permeability. The correct diagnosis and treatment of papilledema, depending on its etiology, should permit an acceptable visual outcome to be achieved.
Archivos de la Sociedad Espanola de Oftalmologia
A 29-year-old woman presented with a subjective sensation of ocular asymmetry from several months... more A 29-year-old woman presented with a subjective sensation of ocular asymmetry from several months beforehand. Ophthalmological exam showed 3,5 mm right enophthalmos and light hypoglobus. CT (Computerized Tomography) scan showed a collapsed maxillar sinus, and a thinned inferior orbital wall. The diagnosis of silent sinus syndrome was made. An endoscopic maxillary antrostomy with uncinectomy was made with an excellent surgical outcome. Clinical features of silent sinus syndrome are described, including diagnosis, differential diagnosis and treatment.
PURPOSE: Evaluate the role of wide-field retinography to detect periphlebitis in patients with MS... more PURPOSE: Evaluate the role of wide-field retinography to detect periphlebitis in patients with MS, without ocular symptoms. BACKGROUND: Retinal periphlebitis (RP) is characterized by perivascular exudation, haemorrhage, and retinal venous sheathing. The relationship between RP and multiple sclerosis (MS) is known and has a variable incidence among series (5–39%), but relationship between the classical demyelinating lesions of white matter in MS and retinal vasculitis (non-myelinated neurons) remain unclear. If retinal inflammation parallels the inflammatory processes in the central nervous system, the presence of RP might favor the election of a more effective drug in patients with MS, even assuming a greater risk of side effects. METHODS: A prospective cohort including 118 patients with remittent-recurrent multiple sclerosis (aged 18–55 years), underwent a ophthalmic examination, between May/2013 to May/2014. We collected demographic and MSrelated variables, measured high and low-c...
Introduction: Retinal periphlebitis (RP) is characterized by perivascular exudation, hemorrhage, ... more Introduction: Retinal periphlebitis (RP) is characterized by perivascular exudation, hemorrhage, and retinal venous sheathing. The relationship between RP and multiple sclerosis (MS) is known and has a variable incidence among series (5-39%). RP has been related to a more active disease (1). Retinal inflammation parallels the inflamatory processes in the central nervous system and his presence of RP might favor the election of a more effective drug, even assuming a greater risk of side effects. The objetive of this study was evaluate the role of wide-field retinography to detect periphlebitis in patients without ocular symptoms. Methods: A prospective cohort including 118 patients with remittent-recurrent multiple sclerosis (aged 18–55 years), underwent a ophthalmic examination, between May/2013 to May/2014. We collected demographic and MS-related variables, measured high- and low-contrast monocular visual acuity using ETDRS (Early Treatment Diabetic Retinopathy Study), Color vision...
Introduction: Peripheral neuropathy secondary to drugs is a cause of severe disability. Usually I... more Introduction: Peripheral neuropathy secondary to drugs is a cause of severe disability. Usually Invasive techniques as cutaneous nerve biopsy are employed for diagnosis. Corneal confocal microscopy (CCM) is a noninvasive and rapid technique to assess in vivo all structures of the cornea, including the sub-basal nerve plexus. We designed a prospective study to evaluate the usefulness of CCM for determinate peripheral neuropathy. Methods: Ten patients with a high probability of developing peripheral neuropathy secondary to drug treatment were evaluated. Specifically, patients who started treatment with taxanes, cisplatin and / or oxaliplatin.No patients with prior use of chemotherapy, previous corneal surgery or infection and /or contact lenses were included in the study.The patients were visited before treatment and two, four months, at the end of chemotherapy and 3 months after treatment. These images were subsequently analyzed by CCmetrics Software (Manchester University) analyzing...
Graefe's Archive for Clinical and Experimental Ophthalmology, 2015
Purpose To characterise the changes of the retinal layers in patients with acute anterior ischaem... more Purpose To characterise the changes of the retinal layers in patients with acute anterior ischaemic optic neuropathy (AION), aiming to identify imaging markers for predicting the residual visual function. Methods This was a retrospective review of consecutive patients with unilateral AION from January 2010 to December 2013. We analysed affected eyes at baseline and 1 month later, compared to fellow healthy eyes. Utilising novel image analysis software, we conducted algorithmic segmentation in layers and division in early treatment of diabetic retinopathy study (ETDRS) quadrants of optical coherence tomography images of the macula. Pearson product moment regression analysis of retinal layer thickness and best corrected visual acuity (BCVA) in logMAR units and mean deviation of the SITA 24-2 visual field (VF) were carried out at the 1-month time point. Results Twenty eyes from 20 patients were included and compared to 20 healthy fellow eyes. At baseline, we found a significantly increased mean thickness of the retinal nerve fibre layer (RNFL) of 42.2 μm (±6.7SD) in AION eyes compared to 37.9 μm (±4.2 SD) in healthy eyes (p=0.002). The outer nuclear layer (ONL) was also significantly thickened at 96.6 μm (±7.2 SD) compared to 90.8 μm (±5.7 SD) in the fellow eye (p<0.001). After 1 month, the RNFL and the ganglion cell layer (GCL) were thinned 17.7 % [to 31.2 μm (±6.4 SD), p<0.001] and 19.3 % [to 66.5 μm (±7.0 SD), p<0.001] compared to the contralateral eye. Additionally, the ONL remained thickened at 96.7 μm (±7.0 SD, p<0.001). At baseline, we found a significant correlation between the ONL thickness and the VF (r=−0.482, p=0.005) and the BCVA at discharge (r=0.552, p<0.001), indicating that a thicker ONL correlates with poorer visual function. The GCL thickness also correlates with the BCVA at discharge (r=0.411, p= 0.02), where a thinner GCL predicts worse BCVA. At the 1month time point, the GCL thinning was correlated with both the VF (r=0.471, p=0.005) and the BCVA (r=−0.456, p= 0.007), indicating worse visual function. Conclusions Changes in the thickness of different layers of the retina occur early in the course of AION and evolve over time, resulting in the atrophy of the GCL and RNFL. ONL thickening at baseline is associated with visual dysfunction. Thinning of the GCL after 1 month correlates with poorer VF and BCVA at 1 month after acute AION.
Revista de neurologia
Pituitary adenomas are a frequently occurring pathology that require multidisciplinary management... more Pituitary adenomas are a frequently occurring pathology that require multidisciplinary management by several different specialists. Their neuro-ophthalmological manifestations vary widely and sometimes appear as the presenting symptom. To gather the main ophthalmological signs and symptoms of these tumours so that specialists who find themselves before any of them will suspect this pathology. This survey was based on the clinical experience of the neuro-ophthalmological unit at the Hospital Clinic de Barcelona, with over 350 patients who had suffered from pituitary tumours. A bibliographical search was also carried out on Medline for papers published on pituitary adenomas in the literature in both English and Spanish. We focused mainly on those that reported on the ophthalmological manifestations of such tumours. A number of articles were found dealing with isolated ophthalmological manifestations of these tumours, many of them as presenting symptoms. We also found review articles i...
BMC research notes, 2014
Multiple Sclerosis (MS) is an immune-mediated disease of the Central Nervous System with two majo... more Multiple Sclerosis (MS) is an immune-mediated disease of the Central Nervous System with two major underlying etiopathogenic processes: inflammation and neurodegeneration. The latter determines the prognosis of this disease. MS is the main cause of non-traumatic disability in middle-aged populations. The MS-VisualPath Cohort was set up to study the neurodegenerative component of MS using advanced imaging techniques by focusing on analysis of the visual pathway in a middle-aged MS population in Barcelona, Spain. We started the recruitment of patients in the early phase of MS in 2010 and it remains permanently open. All patients undergo a complete neurological and ophthalmological examination including measurements of physical and disability (Expanded Disability Status Scale; Multiple Sclerosis Functional Composite and neuropsychological tests), disease activity (relapses) and visual function testing (visual acuity, color vision and visual field). The MS-VisualPath protocol also asses...
Objective: Retrograde trans-synaptic degeneration of retinal ganglion cell layer (GCL) has been p... more Objective: Retrograde trans-synaptic degeneration of retinal ganglion cell layer (GCL) has been proposed as one of the mechanisms contributing to permanent disability after visual pathway damage. We set out to test this mechanism taking advantage of the new methods for imaging the macula with high resolution by optical coherence tomography (OCT) in patients with lesions in the posterior visual pathway. Additionally, we explored the association between thinning of GCL as an imaging marker of visual impairment such as visual field defects.
Current Treatment Options in Neurology, 2014
Multiple sclerosis is an autoimmune demyelinating disorder of the nervous system, in which almost... more Multiple sclerosis is an autoimmune demyelinating disorder of the nervous system, in which almost all patients develop some degree of visual impairment during the disease. Optic neuritis is the most common and known visual affection and may be the initial clinical disease manifestation, but visual complaints can have a wide variety of presentations and some of them can lead to clinical confusion. Most symptoms are the result of acute injury and subsequent axonal loss in the afferent and efferent visual pathway, but others may be consequences of treatments. Currently, we can tell the functional and anatomical damage caused by multiple sclerosis by visual function test, measurement of eye movements, electrophysiological testing, optical coherence tomography, and magnetic resonance imaging. The purpose of this review is to describe the afferent and efferent visual symptoms associated with multiple sclerosis or multiple sclerosis treatment, and review the current and future therapeutic options available for them.
Annals of Neurology, 2015
Objective: We set out to assess the dynamics of retinal injury after acute optic neuritis (ON) an... more Objective: We set out to assess the dynamics of retinal injury after acute optic neuritis (ON) and their association with clinical visual outcomes. Methods: Thirty-one consecutive patients with acute ON were prospectively analyzed over a 6-month follow-up period. Each month, we used optical coherence tomography (OCT) to assess the thickness of peripapillary retinal nerve fiber layer (pRNFL) and segmented macular layers, as well as high-contrast visual acuity, low-contrast visual acuity (LCVA), color visual acuity (CVA), and visual fields (VF). Results: In this prospective study, we found that 6 months after clinical onset, ON eyes suffered a reduction in pRNFL (245.3 lm) and macular thickness (217.3 lm). Macular atrophy was due to the decrease of macular RNFL thickness (27.8 lm) and that of the ganglion cell layer and inner plexiform layer (GCIP, 211.3 lm), whereas the thickness of the outer retinal layers increased slightly. The macular RNFL and GCIP thickness decreased in parallel, yet it always occurred more rapidly and more severely for the GCIP. The change in the GCIP thickness in the first month predicted the visual impairment by month 6; a decrease of 4.5 lm predicted poor LCVA (sensitivity of 93% and specificity of 88%), and a decrease of 7 lm predicted poor VF and CVA (sensitivity of 78% and 100% and specificity of 63% and 66%, respectively). Interpretation: Retinal axonal and neuronal damage develops quickly after ON onset. Assessment of ganglion cell layer thickness by OCT after ON onset can be used as an imaging marker of persistent visual disability.
Journal of Biophotonics, 2013
Journal of Neuro-Ophthalmology, 2011
We performed an in-depth study of the neuroophthalmologic signs and symptoms of a rare but fatal ... more We performed an in-depth study of the neuroophthalmologic signs and symptoms of a rare but fatal disease known as primary diffuse leptomeningeal gliomatosis (PDLG). Two new cases of PDLG are described, and 22 published cases reviewed. Papilledema and sixth nerve palsy are the most common neuro-ophthalmic findings. Other abnormalities include third and fourth nerve palsies, nystagmus, and vision loss. Involvement of the visual system may be part of the initial presentation of PDLG.
Journal of Neurology, 2014
It is currently believed that the incidence rate of optic neuritis (ON) ranges between 0.56 and 5... more It is currently believed that the incidence rate of optic neuritis (ON) ranges between 0.56 and 5.1 cases per 100,000 person-years. However, since these figures were generated, they have not been updated and there are suggestions that the incidence of ON is on the rise. When designing new therapies and clinical trials for ON, and to improve the management this disease, it is important to have accurate epidemiological data. Thus, we set out to obtain the prevalence and incidence rates of ON in Barcelona (Spain) from 2008 to 2012, by a retrospective evaluation of electronic hospital records at the Hospital Clinic of Barcelona (population of 300,000 in the catchment area) matching the following ICD-9-CM codes as search terms: 377.3-optic neuritis; 377.30-optic neuritis, unspecific; 377.31-optic papillitis; 377.32-retrobulbar neuritis, acute; 377.39-other optic neuritis and ''optic neuropathy''. Demographic and clinical data were collected from records with a confirmed diagnosis of ON, including cases of idiopathic ON, multiple sclerosis, neuromyelitis optica and CRION. The prevalence of acute ON on 31 December 2012 was 2.75 cases per 100,000 people. The mean annual prevalence of acute ON during the 2008-2012 period was 7.87 cases per 100,000 person-year and the mean annual incidence rate was 5.36 cases per 100,000 person-years. The incidence of ON in Barcelona during 2008-2012 was higher than previously reported. This increase may reflect the evolution of diagnostic criteria, the use of a referral-center approach instead of a population-based approach, increased awareness of demyelinating diseases, latitude-related factors and possibly a true increase in its incidence.
Background Most patients with multiple sclerosis without previous optic neuritis have thinner ret... more Background Most patients with multiple sclerosis without previous optic neuritis have thinner retinal layers than healthy controls. We assessed the role of peripapillary retinal nerve fi bre layer (pRNFL) thickness and macular volume in eyes with no history of optic neuritis as a biomarker of disability worsening in a cohort of patients with multiple sclerosis who had at least one eye without optic neuritis available.
The Lancet Neurology, 2016
Journal of Neurology, 2016
Monitoring disease burden is an unmeet need in multiple sclerosis (MS). Identifying patients at h... more Monitoring disease burden is an unmeet need in multiple sclerosis (MS). Identifying patients at high risk of disability progression will be useful for improving clinical-therapeutic decisions in clinical routine. To evaluate the role of visual field testing in non-optic neuritis eyes (non-ON eyes) as a biomarker of disability progression in MS. In 109 patients of the MS-VisualPath cohort, we evaluated the association between visual field abnormalities and global and cognitive disability markers and brain and retinal imaging markers of neuroaxonal injury using linear regression models adjusted for sex, age, disease duration and use of disease-modifying therapies. We evaluated the risk of disability progression associated to have baseline impaired visual field after 3 years of follow-up. Sixty-two percent of patients showed visual field defects in non-ON eyes. Visual field mean deviation was statistically associated with global disability; brain (normalized brain parenchymal, gray matter volume and lesion load) and retinal (peripapillary retinal nerve fiber layer thickness and macular ganglion cell complex thickness) markers of neuroaxonal damage. Patients with impaired visual field had statistically significative greater disability, lower normalized brain parenchymal volume and higher lesion volume than patients with normal visual field testing. MS patients with baseline impaired VF tripled the risk of disability progression during follow-up [OR = 3.35; 95 % CI (1.10-10.19); p = 0.033]. The association of visual field impairment with greater disability and neuroaxonal injury and higher risk of disability progression suggest that VF could be used to monitor MS disease burden.
[
Archivos de la Sociedad Espanola de Oftalmologia
We present the case of a 54-year-old woman with papilledema associated to POEMS syndrome. The pre... more We present the case of a 54-year-old woman with papilledema associated to POEMS syndrome. The presence of intracranial hypertension was detected and treatment started with acetazolamide. The most common ophthalmological pathology in POEMS syndrome is papilledema, the etiology of which could be infiltrative, intracranial hypertension, inflammation or an increase of the vascular permeability. The correct diagnosis and treatment of papilledema, depending on its etiology, should permit an acceptable visual outcome to be achieved.
Archivos de la Sociedad Espanola de Oftalmologia
A 29-year-old woman presented with a subjective sensation of ocular asymmetry from several months... more A 29-year-old woman presented with a subjective sensation of ocular asymmetry from several months beforehand. Ophthalmological exam showed 3,5 mm right enophthalmos and light hypoglobus. CT (Computerized Tomography) scan showed a collapsed maxillar sinus, and a thinned inferior orbital wall. The diagnosis of silent sinus syndrome was made. An endoscopic maxillary antrostomy with uncinectomy was made with an excellent surgical outcome. Clinical features of silent sinus syndrome are described, including diagnosis, differential diagnosis and treatment.
PURPOSE: Evaluate the role of wide-field retinography to detect periphlebitis in patients with MS... more PURPOSE: Evaluate the role of wide-field retinography to detect periphlebitis in patients with MS, without ocular symptoms. BACKGROUND: Retinal periphlebitis (RP) is characterized by perivascular exudation, haemorrhage, and retinal venous sheathing. The relationship between RP and multiple sclerosis (MS) is known and has a variable incidence among series (5–39%), but relationship between the classical demyelinating lesions of white matter in MS and retinal vasculitis (non-myelinated neurons) remain unclear. If retinal inflammation parallels the inflammatory processes in the central nervous system, the presence of RP might favor the election of a more effective drug in patients with MS, even assuming a greater risk of side effects. METHODS: A prospective cohort including 118 patients with remittent-recurrent multiple sclerosis (aged 18–55 years), underwent a ophthalmic examination, between May/2013 to May/2014. We collected demographic and MSrelated variables, measured high and low-c...
Introduction: Retinal periphlebitis (RP) is characterized by perivascular exudation, hemorrhage, ... more Introduction: Retinal periphlebitis (RP) is characterized by perivascular exudation, hemorrhage, and retinal venous sheathing. The relationship between RP and multiple sclerosis (MS) is known and has a variable incidence among series (5-39%). RP has been related to a more active disease (1). Retinal inflammation parallels the inflamatory processes in the central nervous system and his presence of RP might favor the election of a more effective drug, even assuming a greater risk of side effects. The objetive of this study was evaluate the role of wide-field retinography to detect periphlebitis in patients without ocular symptoms. Methods: A prospective cohort including 118 patients with remittent-recurrent multiple sclerosis (aged 18–55 years), underwent a ophthalmic examination, between May/2013 to May/2014. We collected demographic and MS-related variables, measured high- and low-contrast monocular visual acuity using ETDRS (Early Treatment Diabetic Retinopathy Study), Color vision...
Introduction: Peripheral neuropathy secondary to drugs is a cause of severe disability. Usually I... more Introduction: Peripheral neuropathy secondary to drugs is a cause of severe disability. Usually Invasive techniques as cutaneous nerve biopsy are employed for diagnosis. Corneal confocal microscopy (CCM) is a noninvasive and rapid technique to assess in vivo all structures of the cornea, including the sub-basal nerve plexus. We designed a prospective study to evaluate the usefulness of CCM for determinate peripheral neuropathy. Methods: Ten patients with a high probability of developing peripheral neuropathy secondary to drug treatment were evaluated. Specifically, patients who started treatment with taxanes, cisplatin and / or oxaliplatin.No patients with prior use of chemotherapy, previous corneal surgery or infection and /or contact lenses were included in the study.The patients were visited before treatment and two, four months, at the end of chemotherapy and 3 months after treatment. These images were subsequently analyzed by CCmetrics Software (Manchester University) analyzing...
Graefe's Archive for Clinical and Experimental Ophthalmology, 2015
Purpose To characterise the changes of the retinal layers in patients with acute anterior ischaem... more Purpose To characterise the changes of the retinal layers in patients with acute anterior ischaemic optic neuropathy (AION), aiming to identify imaging markers for predicting the residual visual function. Methods This was a retrospective review of consecutive patients with unilateral AION from January 2010 to December 2013. We analysed affected eyes at baseline and 1 month later, compared to fellow healthy eyes. Utilising novel image analysis software, we conducted algorithmic segmentation in layers and division in early treatment of diabetic retinopathy study (ETDRS) quadrants of optical coherence tomography images of the macula. Pearson product moment regression analysis of retinal layer thickness and best corrected visual acuity (BCVA) in logMAR units and mean deviation of the SITA 24-2 visual field (VF) were carried out at the 1-month time point. Results Twenty eyes from 20 patients were included and compared to 20 healthy fellow eyes. At baseline, we found a significantly increased mean thickness of the retinal nerve fibre layer (RNFL) of 42.2 μm (±6.7SD) in AION eyes compared to 37.9 μm (±4.2 SD) in healthy eyes (p=0.002). The outer nuclear layer (ONL) was also significantly thickened at 96.6 μm (±7.2 SD) compared to 90.8 μm (±5.7 SD) in the fellow eye (p<0.001). After 1 month, the RNFL and the ganglion cell layer (GCL) were thinned 17.7 % [to 31.2 μm (±6.4 SD), p<0.001] and 19.3 % [to 66.5 μm (±7.0 SD), p<0.001] compared to the contralateral eye. Additionally, the ONL remained thickened at 96.7 μm (±7.0 SD, p<0.001). At baseline, we found a significant correlation between the ONL thickness and the VF (r=−0.482, p=0.005) and the BCVA at discharge (r=0.552, p<0.001), indicating that a thicker ONL correlates with poorer visual function. The GCL thickness also correlates with the BCVA at discharge (r=0.411, p= 0.02), where a thinner GCL predicts worse BCVA. At the 1month time point, the GCL thinning was correlated with both the VF (r=0.471, p=0.005) and the BCVA (r=−0.456, p= 0.007), indicating worse visual function. Conclusions Changes in the thickness of different layers of the retina occur early in the course of AION and evolve over time, resulting in the atrophy of the GCL and RNFL. ONL thickening at baseline is associated with visual dysfunction. Thinning of the GCL after 1 month correlates with poorer VF and BCVA at 1 month after acute AION.
Revista de neurologia
Pituitary adenomas are a frequently occurring pathology that require multidisciplinary management... more Pituitary adenomas are a frequently occurring pathology that require multidisciplinary management by several different specialists. Their neuro-ophthalmological manifestations vary widely and sometimes appear as the presenting symptom. To gather the main ophthalmological signs and symptoms of these tumours so that specialists who find themselves before any of them will suspect this pathology. This survey was based on the clinical experience of the neuro-ophthalmological unit at the Hospital Clinic de Barcelona, with over 350 patients who had suffered from pituitary tumours. A bibliographical search was also carried out on Medline for papers published on pituitary adenomas in the literature in both English and Spanish. We focused mainly on those that reported on the ophthalmological manifestations of such tumours. A number of articles were found dealing with isolated ophthalmological manifestations of these tumours, many of them as presenting symptoms. We also found review articles i...
BMC research notes, 2014
Multiple Sclerosis (MS) is an immune-mediated disease of the Central Nervous System with two majo... more Multiple Sclerosis (MS) is an immune-mediated disease of the Central Nervous System with two major underlying etiopathogenic processes: inflammation and neurodegeneration. The latter determines the prognosis of this disease. MS is the main cause of non-traumatic disability in middle-aged populations. The MS-VisualPath Cohort was set up to study the neurodegenerative component of MS using advanced imaging techniques by focusing on analysis of the visual pathway in a middle-aged MS population in Barcelona, Spain. We started the recruitment of patients in the early phase of MS in 2010 and it remains permanently open. All patients undergo a complete neurological and ophthalmological examination including measurements of physical and disability (Expanded Disability Status Scale; Multiple Sclerosis Functional Composite and neuropsychological tests), disease activity (relapses) and visual function testing (visual acuity, color vision and visual field). The MS-VisualPath protocol also asses...
Objective: Retrograde trans-synaptic degeneration of retinal ganglion cell layer (GCL) has been p... more Objective: Retrograde trans-synaptic degeneration of retinal ganglion cell layer (GCL) has been proposed as one of the mechanisms contributing to permanent disability after visual pathway damage. We set out to test this mechanism taking advantage of the new methods for imaging the macula with high resolution by optical coherence tomography (OCT) in patients with lesions in the posterior visual pathway. Additionally, we explored the association between thinning of GCL as an imaging marker of visual impairment such as visual field defects.
Current Treatment Options in Neurology, 2014
Multiple sclerosis is an autoimmune demyelinating disorder of the nervous system, in which almost... more Multiple sclerosis is an autoimmune demyelinating disorder of the nervous system, in which almost all patients develop some degree of visual impairment during the disease. Optic neuritis is the most common and known visual affection and may be the initial clinical disease manifestation, but visual complaints can have a wide variety of presentations and some of them can lead to clinical confusion. Most symptoms are the result of acute injury and subsequent axonal loss in the afferent and efferent visual pathway, but others may be consequences of treatments. Currently, we can tell the functional and anatomical damage caused by multiple sclerosis by visual function test, measurement of eye movements, electrophysiological testing, optical coherence tomography, and magnetic resonance imaging. The purpose of this review is to describe the afferent and efferent visual symptoms associated with multiple sclerosis or multiple sclerosis treatment, and review the current and future therapeutic options available for them.
Annals of Neurology, 2015
Objective: We set out to assess the dynamics of retinal injury after acute optic neuritis (ON) an... more Objective: We set out to assess the dynamics of retinal injury after acute optic neuritis (ON) and their association with clinical visual outcomes. Methods: Thirty-one consecutive patients with acute ON were prospectively analyzed over a 6-month follow-up period. Each month, we used optical coherence tomography (OCT) to assess the thickness of peripapillary retinal nerve fiber layer (pRNFL) and segmented macular layers, as well as high-contrast visual acuity, low-contrast visual acuity (LCVA), color visual acuity (CVA), and visual fields (VF). Results: In this prospective study, we found that 6 months after clinical onset, ON eyes suffered a reduction in pRNFL (245.3 lm) and macular thickness (217.3 lm). Macular atrophy was due to the decrease of macular RNFL thickness (27.8 lm) and that of the ganglion cell layer and inner plexiform layer (GCIP, 211.3 lm), whereas the thickness of the outer retinal layers increased slightly. The macular RNFL and GCIP thickness decreased in parallel, yet it always occurred more rapidly and more severely for the GCIP. The change in the GCIP thickness in the first month predicted the visual impairment by month 6; a decrease of 4.5 lm predicted poor LCVA (sensitivity of 93% and specificity of 88%), and a decrease of 7 lm predicted poor VF and CVA (sensitivity of 78% and 100% and specificity of 63% and 66%, respectively). Interpretation: Retinal axonal and neuronal damage develops quickly after ON onset. Assessment of ganglion cell layer thickness by OCT after ON onset can be used as an imaging marker of persistent visual disability.
Journal of Biophotonics, 2013