Visual worsening despite resolution of subfoveal fluid in nonarteritic ischemic optic neuropathy

Abstract

anti-MOG antibodies. 6 Our patient showed neither antiaquaporin 4 nor anti-MOG antibodies.NMDA receptors are expressed in developing oligodendrocyte processes and may mediate regeneration of the retinal ganglion cell. However, the characteristics of optic neuritis associated with anti-NMDA receptor antibody have not been reported in detail. The 3 previous reports described that optic neuritis resolved only with corticosteroid pulse therapy (Table 1). Two of them showed recurrent optic neuritis, as in our case, but none had a simultaneous bilateral attack. 1,2 A pathogenic role of antibodies is suggested by the correlation between antibody titres and neurological outcome and by the decrease in number of postsynaptic NMDA receptors. 4 However, the direct role of antibodies in optic neuritis is unknown.This case provides the first detailed description of optic neuritis associated with anti-NMDA-receptor antibody, including pain on eye movements, precedent upper respiratory infection, decreased visual acuity and colour vision, disc swelling, central scotoma, and rapid response to corticosteroids. It also confirms that encephalitis associated with anti-NMDA receptor antibody can mimic neuromyelitis optica involving optic neuritis and transverse myelitis. 3 Anti-NMDA-receptor antibody should be sought in optic neuritis accompanied by encephalitis. Long-term steroids or other immunosuppressive therapies may be necessary to prevent relapses.