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Acute Idiopathic Blind Spot Enlargement Syndrome—New Perspectives in the OCT Era

Acute idiopathic blind spot enlargement syndrome (AIBSES) is characterized by unilateral visual field loss in the blind spot area, acute onset photopsia, and funduscopically few or no optic disc changes. AIBSES predominantly affects young adults and is often misdiagnosed as optic neuritis because of...

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Autores principales: Zimmermann, Julian A., Eter, Nicole, Biermann, Julia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9501978/
https://www.ncbi.nlm.nih.gov/pubmed/36142923
http://dx.doi.org/10.3390/jcm11185278
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author Zimmermann, Julian A.
Eter, Nicole
Biermann, Julia
author_facet Zimmermann, Julian A.
Eter, Nicole
Biermann, Julia
author_sort Zimmermann, Julian A.
collection PubMed
description Acute idiopathic blind spot enlargement syndrome (AIBSES) is characterized by unilateral visual field loss in the blind spot area, acute onset photopsia, and funduscopically few or no optic disc changes. AIBSES predominantly affects young adults and is often misdiagnosed as optic neuritis because of low awareness. Optical coherence tomography (OCT) has become the gold standard in diagnosing AIBSES as a disease of the outer retina. In our case series, we present three consecutive patients with AIBSES followed prospectively with and without steroid therapy. The patients, aged 25 to 27 years, presented in our neuroophthalmology department between 2020 and 2021. We report their disease course and management and discuss therapeutic options, as no well-established procedures exist. Common pitfalls and diagnostic errors are analysed. Two women and one man showed unilateral acute-onset photopsia and blind spot enlargement on perimetry without visual acuity reduction. Spectral domain OCT (Heidelberg Engineering, Heidelberg, Germany) revealed marked peripapillary changes in the ellipsoid zone and autofluorescence in all patients, corresponding to faint blurring of the optic disc margin. Characteristically, there was no P100 latency delay in the visual evoked potential in any of the patients. Two patients received weight-adapted oral prednisolone, which was gradually tapered over six to eight weeks. Two patients showed full recovery of their symptoms at six and seven months after onset, while mild defect healing was seen in one treated patient after 12 months. Follow-up OCT showed restoration of the outer retinal layers 6–12 months after disease onset. Careful history taking and an unprejudiced ophthalmological workup helps in diagnosing AIBSES in young adults with unilateral acute visual field defects. While its etiology is still unclear, accurate diagnosis of AIBSES can be made with peripapillary OCT. In our cases, the disease course of AIBSES was much better than its reputation. Early corticosteroid treatment may support outer retinal reorganisation, which can be followed with OCT in accordance with visual field restoration. This should be addressed in a prospective study.
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spelling pubmed-95019782022-09-24 Acute Idiopathic Blind Spot Enlargement Syndrome—New Perspectives in the OCT Era Zimmermann, Julian A. Eter, Nicole Biermann, Julia J Clin Med Article Acute idiopathic blind spot enlargement syndrome (AIBSES) is characterized by unilateral visual field loss in the blind spot area, acute onset photopsia, and funduscopically few or no optic disc changes. AIBSES predominantly affects young adults and is often misdiagnosed as optic neuritis because of low awareness. Optical coherence tomography (OCT) has become the gold standard in diagnosing AIBSES as a disease of the outer retina. In our case series, we present three consecutive patients with AIBSES followed prospectively with and without steroid therapy. The patients, aged 25 to 27 years, presented in our neuroophthalmology department between 2020 and 2021. We report their disease course and management and discuss therapeutic options, as no well-established procedures exist. Common pitfalls and diagnostic errors are analysed. Two women and one man showed unilateral acute-onset photopsia and blind spot enlargement on perimetry without visual acuity reduction. Spectral domain OCT (Heidelberg Engineering, Heidelberg, Germany) revealed marked peripapillary changes in the ellipsoid zone and autofluorescence in all patients, corresponding to faint blurring of the optic disc margin. Characteristically, there was no P100 latency delay in the visual evoked potential in any of the patients. Two patients received weight-adapted oral prednisolone, which was gradually tapered over six to eight weeks. Two patients showed full recovery of their symptoms at six and seven months after onset, while mild defect healing was seen in one treated patient after 12 months. Follow-up OCT showed restoration of the outer retinal layers 6–12 months after disease onset. Careful history taking and an unprejudiced ophthalmological workup helps in diagnosing AIBSES in young adults with unilateral acute visual field defects. While its etiology is still unclear, accurate diagnosis of AIBSES can be made with peripapillary OCT. In our cases, the disease course of AIBSES was much better than its reputation. Early corticosteroid treatment may support outer retinal reorganisation, which can be followed with OCT in accordance with visual field restoration. This should be addressed in a prospective study. MDPI 2022-09-07 /pmc/articles/PMC9501978/ /pubmed/36142923 http://dx.doi.org/10.3390/jcm11185278 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Zimmermann, Julian A.
Eter, Nicole
Biermann, Julia
Acute Idiopathic Blind Spot Enlargement Syndrome—New Perspectives in the OCT Era
title Acute Idiopathic Blind Spot Enlargement Syndrome—New Perspectives in the OCT Era
title_full Acute Idiopathic Blind Spot Enlargement Syndrome—New Perspectives in the OCT Era
title_fullStr Acute Idiopathic Blind Spot Enlargement Syndrome—New Perspectives in the OCT Era
title_full_unstemmed Acute Idiopathic Blind Spot Enlargement Syndrome—New Perspectives in the OCT Era
title_short Acute Idiopathic Blind Spot Enlargement Syndrome—New Perspectives in the OCT Era
title_sort acute idiopathic blind spot enlargement syndrome—new perspectives in the oct era
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9501978/
https://www.ncbi.nlm.nih.gov/pubmed/36142923
http://dx.doi.org/10.3390/jcm11185278
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