Long-Term Visual Prognosis for Suprasellar (Tuberculum Sellae) Meningiomas

To determine the long-term (>10 years) visual and neurologic outcome in patients with suprasellar meningiomas

Comparing EPI-743 treatment in siblings with Leber's Hereditary Optic Neuropathy mt14484 mutation

Univ So Calif, Keck Sch Med, Dept Ophthalmol, Doheny Eye Inst, Los Angeles, CA 90033 USAUniversidade Federal de São Paulo, São Paulo, BrazilEdison Pharmaceut, Mountain View, CA USAMaryland Neuroophthalmol, Pikesville, MD USAUniversidade Federal de São Paulo, EPM, São Paulo, BrazilWeb of Scienc

Natural History of Conversion of Leber's Hereditary Optic Neuropathy. A Prospective Case Series

Purpose: To illustrate the natural history of Leber's hereditary optic neuropathy (LHON). Design: Prospective observational case series. Participants: The Soave-Brazil pedigree of m.11778G>A/ND4 mitochondrial DNA LHON mutation. Methods: A prospectively acquired database of the Soave-Brazil pedigree was reviewed. Data from 285 individuals were included in the database over a 15-year period. The pedigree was reviewed for unaffected mutation carriers who converted to affected status, 6 patients with LHON were identified. The medical records were reviewed 1 year preconversion to 1 year postconversion for visual acuity (logarithm of the minimum angle of resolution [logMAR]), Humphrey Visual Field (HVF) mean deviation (MD), and retinal nerve fiber layer (RNFL) thickness, as measured by Cirrus (Carl Zeiss, Oberkochen, Germany) optic coherence tomography (OCT). The RNFL thickness values were normalized for age. Visual acuity, HVF, and processed RNFL data from each of the 12 eyes were then sorted into 2-month time periods relative to the date of conversion, within which they were averaged. Main Outcome Measures: The main outcome measures were visual acuity, HVF MD, and RNFL thickness. Results: Decreased visual acuity preceded conversion by up to 2 months and then declined up to 8 months postconversion. Decrease in HVF MD occurred at least 4 months preceding conversion, after which values decreased until plateau at 6 to 8 months. Average RNFL thickness was above normal baseline thickness in all 4 quadrants as measured by OCT at the time of conversion. Increase in RNFL thickness preceded conversion as early as 4 to 6 months, peaked at conversion, and decreased until individual plateaus. The temporal quadrant was first to be involved, then the inferior and superior quadrants, and the nasal quadrant showed the latest and least changes. Conclusions: Subclinical changes preceded the date of conversion and may reflect the complicated nature of identifying the date of conversion in LHON. Early increases in RNFL preceding conversion suggest that structural changes precede clinically significant vision loss. Asynchronous quadrant involvement supports a previously published mathematical model. The natural history of LHON is not a subacute process, as previously believed, but progresses more slowly, taking up to 8 months to plateau