Optic neuritis (ON) is a condition that causes loss of vision. Most frequently, ON affects one eye, but occasionally, simultaneous bilateral loss of vision occurs. Typically, a variable degree of spontaneous recovery takes place within about 3 months and can continue for up to 1 year. There are a number of triggers for ON, ranging from postvaccination episodes to any type of inflammation and specific autoimmune conditions such as multiple sclerosis (MS), neuromyelitis optica (NMO), and myelin oligodendrocyte glycoprotein (MOG) ON among1 2 others. In about 5% of patients, there is risk of severe permanent loss of vision and blindness. A major challenge is that it is not possible to know the subtype of ON at presentation. While certain demographic features, symptoms and clinical signs are suggestive, more definitive results from blood tests and neuroimaging can take days or weeks to obtain. Furthermore, negative findings in the blood tests do not rule out non-multiple sclerosis-associated optic neuritis (MSON). The clinical management of patients who suffer from MSON has been profoundly influenced by the 1992 US Optic Neuritis Treatment Trial (ONTT).3 This trial recommended intravenous corticosteroids, not to improve the final outcome but to speed up visual recovery.4 There were, however, limitations to the ONTT protocol, which may have influenced the findings.5 First, the ONTT used a vague definition of ‘symptom onset’. This is relevant because loss of vision (used in the ONTT) is frequently preceded by several days of pain from inflammation.6 Second, there was delayed treatment initiation, at a mean of 5.0±1.6 days, which was timed from the visual loss but not from the onset of pain. Third, by contemporary standards, the trial primary outcome measure of high-contrast visual acuity (HCVA) was relatively crude. Fourth, the ONTT recruited a heterogeneous cohort of ON types, including a …

中文翻译：

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视神经炎新皮质类固醇治疗试验的案例：更新证据的审查。

视神经炎（ON）是一种导致视力丧失的疾病。最常见的是，ON影响一只眼睛，但偶尔会同时发生双侧视力丧失。通常，自发恢复的程度在大约3个月内发生，并且可以持续长达1年。ON的触发因素很多，从疫苗接种后发作到任何类型的炎症和特定的自身免疫性疾病，例如多发性硬化症（MS），视神经脊髓炎（NMO）和髓磷脂少突胶质糖蛋白（MOG）开启，还有其他1至2个。在约5％的患者中，存在严重永久性视力和失明的风险。一个主要的挑战是在演示时不可能知道ON的子类型。虽然某些人口统计特征，症状和临床体征具有暗示性，血液测试和神经成像的更确切的结果可能需要数天或数周的时间才能获得。此外，血液测试中的阴性结果并不排除非多发性硬化症相关性视神经炎（MSON）。1992年美国视神经炎治疗试验（ONTT）深刻影响了患有MSON的患者的临床管理。3该试验推荐静脉使用糖皮质激素，不是改善最终结局，而是要加快视力恢复。4 ，对ONTT协议的局限性可能会影响研究结果。5首先，ONTT使用了“症状发作”的模糊定义。这是相关的，因为视力丧失（在ONTT中使用）通常是炎症引起的几天疼痛。6其次，治疗开始时间延迟，平均为5.0±1.6天，这是从视力丧失开始的时间，而不是从疼痛发作开始的时间。第三，按照当代标准，高对比度视敏度（HCVA）的试验主要结局指标相对较粗糙。第四，ONTT招募了不同类型的ON类型，包括……