- •Five-year visual outcome in MOG-IgG-associated disorder (MOGAD) was evaluated.
- •Five-year visual acuity (VA) was better in MOGAD than in anti-AQP4-positive NMOSD.
- •VA swiftly recovered spontaneously or after IVMP in almost all cases with MOGAD.
- •VA may not fully recover in some MOGAD cases with extensive optic nerve lesions.
- •Visual outcome was irrelevant to the level of serum MOG-IgG titer at the onset.
Optic neuritis (ON) is a major phenotype of clinical attack related to demyelinating neurological diseases of the central nervous system, including multiple sclerosis (MS), anti-aquaporin-4 (AQP4) antibody-positive neuromyelitis optica spectrum disorder (NMOSD), and anti-myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). As the concept of MOGAD is relatively new, the long-term visual outcomes after ON in MOGAD remains unclear.
To elucidate the long-term visual prognosis after ON in MOGAD, patients with MOGAD whose visual acuity were regularly followed for more than 5 years from the onset of ON were enrolled. Best-corrected visual acuity (BCVA) at nadir in the acute phase and at 1 and 5 years from onset was evaluated. The data from patients with MOGAD were compared with those from patients with MS or anti-AQP4-positive NMOSD.
Twenty-three patients (31 ON-involved eyes) with MOGAD, 20 patients (24 ON-involved eyes) with MS, and 22 patients (24 ON-involved eyes) with anti-AQP4-positive NMOSD were evaluated. All BCVA at nadir, 1 year, and 5 years from the onset of ON were much worse in anti-AQP4-positive NMOSD than in MS (p = 0.0024) and MOGAD (p = 0.0014) patients. In MOGAD and anti-AQP4-positive NMOSD, the serum disease-specific antibody titer was not associated with the subsequent visual prognosis. Visual acuity had almost fully recovered spontaneously or shortly after initiating acute treatment in 22 of the 23 patients with MOGAD-ON. The administration of high-dose intravenous steroid therapy further facilitated early recovery of visual acuity. Meanwhile, a small fraction of patients with extensive optic nerve lesions involving the chiasma irreversibly experienced severe visual impairment despite appropriate acute treatment.
Although a small fraction of patients with MOGAD who presented with extensive optic nerve lesions experienced irreversible severe visual impairment, the long-term visual outcomes after 5 years from ON in patients with MOGAD were generally as good as that in patients with MS and much better than that in patients with anti-AQP4-positive NMOSD.
Abbreviation:BCVA (best-corrected visual acuity), IVMP (intravenous methylprednisolone pulse), MOGAD (anti-myelin oligodendrocyte glycoprotein antibody-associated disease), MOG-IgG (anti-myelin oligodendrocyte glycoprotein antibody), MS (multiple sclerosis), AQP4-IgG (anti-aquaporin-4 antibodies), NMOSD (neuromyelitis optica spectrum disorder), ON (optic neuritis), VA (visual acuity)
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Published online: August 23, 2021
Accepted: August 22, 2021
Received in revised form: August 4, 2021
Received: June 29, 2021
© 2021 Elsevier B.V. All rights reserved.