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Correlation between peripapillary retinal thickness and serum level of vascular endothelial growth factor in patients with POEMS syndrome
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    How should we call POEMS syndrome associated optic neuropathy?
    • Julio González Martin-Moro, Ophthalmologist Hospital Universitario del Henares
    • Other Contributors:
      • Inés Contreras, Ophthalmologist
      • María Castro-Rebollo, Ophthalmologist
      • Belén Pilo-de-la-Fuente, Neurologíst

    We have read with great interest Yokouchi et al’s article on the correlation between vascular endothelial growth factor (VEGF) levels and peripapillary retinal thickness in patients with POEMS syndrome(1) and we would like to share some reflections onthis mysterious form of optic neuropathy.
    The acronym that gives name to the disorder does not include any ocular manifestation. However these patients frequently do develop ocular manifestations. Bilateral optic disc involvement appears in half of the patients and it has been considered an independent prognostic factor.(2)POEMS syndrome associated optic disc swelling constitutes a form of optic neuropathy that is not easy to classify. It is usually bilateral, but intracranial pressure is not elevated in most patients, so the term papilledema (although commonly used) is probably inaccurate. Most authors believe this optic neuropathy is related to increased VEGF levels, and Yokouchi et al’s work seems to support this theory.(1) From a pathogenic point of view optic disc swelling induced by cytokines should probably be considered a form of optic neuritis. However, inflammatory neuropathies often associate pain with eye movements and usually produce visual loss (reduced visual acuity and visual field damage) while POEMS patients present only minor visual disturbance and the visual prognosis is good.(3)
    We suggest that POEMS associated optic disc swelling should be considered a new form of optic neuropathy. This neuro...

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    Conflict of Interest:
    None declared.