Skip to main content
 
Notice: Users may be experiencing issues with displaying some pages on stanfordhealthcare.org. We are working closely with our technical teams to resolve the issue as quickly as possible. Thank you for your patience.
Stanford Health Care

Visual Outcomes Following Plasma Exchange for Optic Neuritis: An International Multicenter Retrospective Analysis of 395 Optic Neuritis Attacks. American journal of ophthalmology Chen, J. J., Flanagan, E. P., Pittock, S. J., Stern, N. C., Tisavipat, N., Bhatti, M. T., Chodnicki, K. D., Tajfirouz, D. A., Jamali, S., Kunchok, A., Eggenberger, E. R., Nome, M. A., Sotirchos, E. S., Vasileiou, E. S., Henderson, A. D., Arnold, A. C., Bonelli, L., Moss, H. E., Navarro, S. E., Padungkiatsagul, T., Stiebel-Kalish, H., Lotan, I., Wilf-Yarkoni, A., Danesh-Meyer, H., Ivanov, S., Huda, S., Forcadela, M., Hodge, D., Poullin, P., Rode, J., Papeix, C., Saheb, S., Boudot de la Motte, M., Vignal, C., Hacohen, Y., Pique, J., Maillart, E., Deschamps, R., Audoin, B., Marignier, R. 2023

Abstract

To evaluate the effectiveness of plasma exchange (PLEX) for optic neuritis (ON).We conducted an international multicenter retrospective study evaluating the outcomes of ON following PLEX. Outcomes were compared to raw data from the Optic Neuritis Treatment Trial (ONTT) using a matched subset.A total of 395 ON attack treated with PLEX from 317 patients were evaluated. The median age was 37 years (range 9 to 75) and 71% were female. Causes of ON included: multiple sclerosis (108), myelin-oligodendrocyte-glycoprotein-antibody-associated-disease (MOGAD) (92), aquaporin-4-IgG-positive-neuromyelitis-optica-spectrum-disorder (AQP4+NMOSD) (75), seronegative-NMOSD (34), idiopathic (83), and other (3). Median time from onset of vision loss to PLEX was 2.6 weeks (IQR, 1.4-4.0). Median visual acuity (VA) at time of PLEX was count fingers (IQR, 20/200-hand motion) and median final VA was 20/25 (IQR, 20/20-20/60) with no differences among etiologies except MOGAD-ON which had better outcomes. In 81 (20.5%) ON attacks, the final VA was 20/200 or worse. Patients with poor outcomes were older (p=0.002), had worse VA at time of PLEX (p<0.001), and longer delay to PLEX (p<0.001). In comparison with the ONTT subset with severe corticosteroid-unresponsive ON, a final VA of worse than 20/40 occurred in 6/50 (12%) PLEX-treated ON versus 6/18 (33%) from the ONTT treated with intravenous methylprednisolone without PLEX (p=0.04).Most ON attacks improved with PLEX, and outcomes were better than attacks with similar severity in the ONTT. The presence of severe vision loss at nadir, older age, and longer delay to PLEX predicted a worse outcome while MOGAD-ON had a more favorable prognosis.

View details for DOI 10.1016/j.ajo.2023.02.013

View details for PubMedID 36822570