Vision improvement in severe acute isolated optic neuritis after plasma exchange treatment in Chinese population: a prospective case series study

Abstract

Background: Plasma exchange (PE) is often considered as an effective treatment for neuromyelitis optica spectrum disorder (NMOSD) and several inflammatory demyelinating disorders of the central nervous system. This study aimed to evaluate the visual outcomes of Chinese patients with severe acute isolated optic neuritis (ON) who received PE therapy after high-dose intravenous methylprednisolone (IVMP) treatment. Methods: Thirty-seven acute isolated ON patients experiencing their first attack of severe visual impairment without neurological disability were recruited. All subjects received five cycles of double-filtration plasmapheresis. Visual acuity (VA) was documented at onset, 1 day before PE treatment, at each cycle of PE therapy and at the 1-month follow-up visit. Results: This study included 26 female (70.3%) and 11 male (29.7%) subjects, and 18 subjects (48.6%) had bilateral involvement. The time window between onset and PE treatment was 27.3 ± 12.7 days (range: 6–53 days). Mean VA (logMAR) of the studied eyes at onset, 1-day before PE treatment/after IVMP and after the fifth PE treatment were 3.41 ± 1.50, 2.61 ± 1.64 and 1.66 ± 1.52, respectively ( p < 0.001). Nineteen eyes (51.4%) showed no light perception at the onset, and 17 eyes (45.9%) improved to Snellen VA >20/800 after IVMP and PE treatments, among which five eyes (13.5%) recovered to Snellen VA 20/20 ( p < 0.001). Predictors of good visual outcome included body mass index [odds ratio (OR) = 0.734, p = 0.044], serum AQP4 antibody-positive status (OR = 0.004, p = 0.001), bilaterality (OR = 0.042, p = 0.008) and time window from onset to PE therapy per 1 day (OR = 0.79, p = 0.002). Conclusion: This study revealed that PE treatment effectively improves the visual outcomes of patients experiencing their first attack of severe acute isolated ON after high-dose IVMP treatment. Better visual outcomes can be achieved with early PE treatment.

Optic Neuritis in the Era of NMOSD and MOGAD: A Survey of Practice Patterns in Singapore

“…Again, there is no consensus for the timing at which plasmapheresis is performed. The mean duration between onset of symptoms and plasmapheresis reported by Deschamps et al 51 was 34.6 days (median 28 days, range 6–92 days) and Tan et al 52 was 27.2 ± 12.7 days (range 6–53 days). In addition, Tan et al 52 also found that the eyes with good visual outcomes (visual acuity ≥20/40) had a significantly shorter symptom onset to plasmapheresis with a mean time window of 22.4 ± 11.1 days.…”

Efficacy of Plasma Exchange Treatment for Demyelinating Optic Neuritis Associated with Various Serum Antibodies: A Prospective Cohort Study

“…The diagnosis of ON was based on the criteria described by the Optic Neuritis Treatment Trial [ 31 , 32 ]. The inclusion and exclusion criteria followed our previous study [ 30 ], but with no restriction on the times of attacks, initial visual acuity (VA), the disease duration, or the presentation of a related demyelinating disease of the CNS, such as transverse myelitis (TM), area postrema syndrome, acute disseminated encephalomyelitis, or MS.…”

“…Benefit-related factors, including the correlation between the benefit of PE and the timing of PE initiation are also somewhat controversial. Most studies concur that early initiation may increase the benefit to NMOSD patients [ 17 , 20 , 21 , 25 , 29 , 30 ], while some studies reported no strong correlation between the interval from relapse to PE treatment and 3-month functional scoring [ 14 ], and another study concluded that the time window from the onset of attack to PE initiation was not significantly associated with treatment outcome in children with acute inflammatory demyelinating central nervous system (CNS) syndromes [ 24 ]. Due to the scarcity of plasma resources, determining the optimal timing of treatment is valuable for clinical guidance.…”

“…One concern is whether different antibody subtypes are related to prognosis. While some studies have concluded that a positive AQP4 antibody result is associated with time to complete improvement [ 29 , 30 ], others have suggested that AQP4-Ab-seronegative patients are associated with a superior response to PE therapy [ 17 , 20 ]. There is limited evidence about the efficacy of PE for MOG-ON or D-ON patients.…”

Structural and Functional Alterations in Visual Pathway After Optic Neuritis in MOG Antibody Disease: A Comparative Study With AQP4 Seropositive NMOSD

“…Patients with severe visual impairment were defined as having a BCVA (ETDRS) poorer than 20/200 at the time of the acute phase. EDTRS VA of better than 20/40 at the remission phase is considered a good visual outcome ( 20 ).…”