Highlights
- •Distinct etiologies of optic neuritis significantly affect its clinical manifestation.
- •Myelin oligodendrocyte glycoprotein antibody-positive group involved long optic nerve.
- •Aquaporin-4 antibody-positive group had higher relapse rate and worse visual outcome.
- •Initial visual acuity and nerve fiber layer thickness are factors affecting vision.
- •Antibody-based classification facilitates treatment and prognosis in optic neuritis.
Abstract
Background
Optic neuritis (ON) is an inflammatory disease of optic nerve. The distinct etiologies
of ON significantly influence its clinical manifestation, neuroimaging findings, and
visual outcomes. However, the clinical characteristics might be influenced by the
racial differences. The purpose of this study is to investigate the clinical characteristics
of various types of ON at a Taiwanese tertiary center.
Methods
This cohort study analyzed 163 patients who received treatment and continued following-up
for ON between 2015 and 2022. We selected patients who had been tested for anti-aquaporin-4
antibody (AQP4-Ab) and anti-myelin oligodendrocyte glycoprotein antibody (MOG-Ab).
The participants were classified into four groups on the basis of their etiologies,
specifically (1) multiple sclerosis (MS)-related, (2) AQP4-Ab-positive, (3) MOG-Ab-positive,
or (4) idiopathic ON. The researchers recorded the patients’ clinical characteristics,
treatment course, magnetic resonance imaging and optical coherence tomography (OCT)
findings, and visual outcomes.
Results
MOG-Ab-positive group had higher percentages of disk swelling and pain with eye movement.
Long optic nerve and perineural enhancement are the hallmarks of MOG-Ab-related ON.
The ON relapse rate was higher in AQP4-Ab-positive group. Although members of AQP4-Ab-positive
group received immediate steroid pulse therapy, these patients experienced the worst
visual outcomes. Moreover, a thinner retinal nerve fiber layer (RNFL) was noted in
AQP4-Ab-positive group. MS group had a higher incidence of extra–optic nerve lesions.
Multivariate regression identified pretreatment visual acuity and RNFL thickness as
the important factors affecting visual outcomes.
Conclusions
This cohort study identified the clinical features of different types of ON. Patients
with AQP4-Ab-positive ON had poorer visual outcomes, which may be attributed to multiple
relapses and profound nerve damage, as revealed by OCT findings. Patients with MOG-Ab-positive
ON displayed long optic nerve enhancement but had more favorable prognoses. Thus,
antibody-based classification facilitates treatment and prognosis in ON.
Keywords
Abbreviations:
ADEM (acute disseminated encephalomyelitis), AQP4-Ab (anti-aquaporin-4 antibodies), CRION (chronic relapsing inflammatory optic neuropathy), CT (computer tomography), GCIPL (ganglion cell–inner plexiform layer), logMAR (logarithm of the minimum angle of resolution), MOG-AB (anti-myelin oligodendrocyte glycoprotein antibodies), MOGAD (myelin-oligodendrocyte glycoprotein antibody-associated disease), MRI (magnetic resonance imaging), MS (multiple sclerosis), NMO (neuromyelitis optica), NMOSD (neuromyelitis optica spectrum disorder), OCT (optical coherence tomography), ON (optic neuritis), RNFL (retinal nerve fiber layer), STIR (short tau inversion recovery), VA (visual acuity), VF (visual field)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 28, 2023
Accepted:
April 28,
2023
Received in revised form:
April 27,
2023
Received:
January 12,
2023
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
