Clinical analysis of optic neuritis with chronic hepatitis B virus infection

Abstract

Objective To summarize the clinical features of optic neuritis (ON) complicated with chronic hepatitis B virus (HBV) infection, and evaluate the effectiveness of different treatment regimens, recurrence of ON, visual prognosis, HBV reactivation, liver function and liver structure changes. Methods and Results Total 19 patients (23 eyes) with acute ON complicated with chronic HBV infection admitted to Beijing Tongren Hospital, Capital Medical University from January 2015 to June 2021 were included. There were 13 females and 6 males, 15 cases with monocular onset, 17 cases with unidirectional course of disease, and 6 cases with optic disc edema. The time to the worst visual acuity (peak time) was 3 (2, 7) d after onset, and 16/23 eyes had severe visual impairment. Enhanced MRI showed abnormal intensity in orbital, intraductal or intracranial segments of optic nerve, even involving optic nerve sheath and optic chiasm. Anti⁃nuclear antibody (ANA) was positive in 5 cases and A type Sjögren's syndrome antibody (SSA) was weakly positive in one case. Cerebrospinal fluid (CBF) pressure decreased in 1/7 cases and white blood cell count increased in 2/7 cases. HBV DNA positive group (HBV DNA≥100 IU/ml, 10 cases and 11 eyes) had more severe visual impairment than negative group (HBV DNA＜100 IU/ml, 9 cases and 12 eyes), the difference was statistically significant (Fisher's exact probability: P=0.005, 0.003). HBV DNA positive group was treated with entecavir, and the recurrence of ON was ignored during follow⁃up. HBV DNA negative group didn't receive antiviral therapy, one case progressed to cirrhosis, 3 cases had abnormal liver function, and 2 cases had HBV reactivation. Conclusions The visual function of patients with ON complicated with chronic HBV infection was seriously impaired, and the response to glucocorticoid therapy was not good. The visual impairment of patients with positive HBV DNA was more serious than patients with negative HBV DNA. Patients with ON complicated with chronic HBV infection should be treated with antiviral drugs in combination with glucocorticoid therapy.

doi：10.3969/j.issn.1672⁃6731.2022.09.005