Abstract

MUCI MENDOZA, Rafael. Neuropatía óptica epidémica cubana: Parte II Aspectos neuro-oftalmológicos, neurológicos, nutricionales e históricos. Gac Méd Caracas [online]. 2002, vol.110, n.2, pp.188-193. ISSN 0367-4762.

In this study we shall define the clinical diagnostic elements of the so called "Cuban epidemic optic neuropathy" which affected over fifty thousand people from its beginning back in 1991 to the moment it was partially controlled in 1993 when it had become endemic. Attending an invitation from the Cuban Ministry of Health, the WHO/PHO and Orbis structured a group of experts that traveled to the island in May 1993. The prototype-case was defined after examining 20 patients from the ophthalmologic, neurological and neuroophthalmologic standpoints. Evaluation included visual fiels, optic nerve function tests, contrast sensitivity and exhaustive eye fundus examination. The basic elements of the disease clearly pointed towards a malnutrition-related optic neuropathy, e.g. sub acute loss of central visual acuity over one to two months period, red-green dyschro-matopsia, central scotomata, lowered contrast sensitivity, saccadic pursuit, and most striking of all, a profound attrition of the maculo-papilar bundle fibers of the retina. After the incorporation of this standardized casedefinition, cuban doctors were able to consistently lower their false-positive rate, which had been as high as 50%. Additional findings consisted of peripheral neuropathy with o without myelopathy, weight loss (mean 10 - 20 pounds) and various vitamin deficiencies. After implementing vitamin supplementation to all population we witnessed a dramatic drop in the incidence of new cases and significant visual improvement in previously affected patients. The cuban epidemic was characterized by multiple malnutrition-related syndromes, quite similar to those found in prisioners of war in the tropic World War II.

Keywords : Cuban epidemic optic neuropathy; Optic neuritis; Neurotoxicity; Peripheral nutritional polineuropathy.