Prognostic factors in Chinese patients with acute non-infectious optic neuritis treated with intravenous methylprednisolone and oral prednisolone

Authors

  • Chun Wah Lam Hong Kong Eye Hospital
  • Rachel Wing Yan Tsui Hong Kong Eye Hospital
  • Ka Hing Lok
  • Noel Ching Yan Chan Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital
  • Carmen Kar Mun Chan Hong Kong Eye Hospital

Keywords:

Methylprednisolone, Neuromyelitis optica, Optic neuritis, Prednisolone, Steroids

Abstract

Objectives: Non-infectious optic neuritis (ON) in Caucasians is typically associated with multiple sclerosis (MS), and steroid treatment is optional. In Chinese patients, however, ON is often atypical and more likely to be associated with neuromyelitis optica spectrum disorder (NMOSD), for which early initiation of pulse intravenous steroid treatment is recommended. We aimed to identify factors associated with visual acuity (VA) improvement after intravenous and oral steroid treatment.

Methods: We reviewed the medical records of 64 Chinese patients (64 eyes) who presented to Hong Kong Eye Hospital between 2000 and 2019 with their first episode of acute ON and received intravenous methylprednisolone and oral prednisolone.

Results: Among all cases, 45.3% were idiopathic and isolated, 25.0% were NMOSD-related, and 17.2% were MS-related. Patients with MS-related ON were younger than patients with idiopathic or NMOSD-related ON (p<0.01). Greater improvement in VA was associated with worse nadir VA, greater VA improvement on day 14 of steroid treatment, and NMOSD-related ON, whereas smaller improvement in VA was associated with older age and presentation before anti-aquaporin-4 testing became available.

Conclusion: Because non-infectious ON in Chinese patients is often atypical, intravenous steroid treatment is recommended (rather than optional). Treatment outcomes have improved over the past 20 years, owing to more widespread testing for anti-aquaporin-4 antibodies and more aggressive treatment of NMOSD.

Author Biographies

Chun Wah Lam, Hong Kong Eye Hospital

Associate Consultant

Noel Ching Yan Chan, Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital

Consultant

Carmen Kar Mun Chan, Hong Kong Eye Hospital

Chief of Service

References

Beck RW, Cleary PA, Anderson MM Jr, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. N Engl J Med 1992;326:581-8.

Lai C, Tian G, Liu W, Wei W, Takahashi T, Zhang X. Clinical characteristics, therapeutic outcomes of isolated atypical optic neuritis in China. J Neurol Sci 2011;305:38-40.

Chen JJ, Tobin WO, Majed M, et al. Prevalence of myelin oligodendrocyte glycoprotein and aquaporin-4-IgG in patients in the Optic Neuritis Treatment Trial. JAMA Ophthalmol 2018;136:419-22.

Hickman SJ, Petzold A. Update on optic neuritis: an international view. Neuroophthalmology 2022;46:1-18.

Schulze-Bonsel K, Feltgen N, Burau H, Hansen L, Bach M. Visual acuities "hand motion" and "counting fingers" can be quantified with the Freiburg visual acuity test. Invest Ophthalmol Vis Sci 2006;47:1236-40.

Morrow SA, Fraser JA, Day C, et al. Effect of treating acute optic neuritis with bioequivalent oral vs intravenous corticosteroids: a randomized clinical trial. JAMA Neurol 2018;75:690-6.

Choy BNK, Ng ALK, Lai JSM. Clinical characteristics of optic neuritis in Hong Kong population: 10-year review. Int Ophthalmol 2018;38:557-64.

Cheng AC, Chan NC, Chan CK. Acute and subacute inflammation of the optic nerve and its sheath: clinical features in Chinese patients. Hong Kong Med J 2012;18:115-22.

Gospe SM 3rd, Chen JJ, Bhatti MT. Neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein associated disorder-optic neuritis: a comprehensive review of diagnosis and treatment. Eye (Lond) 2021;35:753-68.

Stiebel-Kalish H, Hellmann MA, Mimouni M, et al. Does time equal vision in the acute treatment of a cohort of AQP4 and MOG optic neuritis? Neurol Neuroimmunol Neuroinflamm 2019;6:e572.

Bennett JL, Costello F, Chen JJ, et al. Optic neuritis and autoimmune optic neuropathies: advances in diagnosis and treatment. Lancet Neurol 2023;22:89-100.

Ramanathan S, Mohammad S, Tantsis E, et al. Clinical course, therapeutic responses and outcomes in relapsing MOG antibody-associated demyelination. J Neurol Neurosurg Psychiatry 2018;89:127-37.

Chen JJ, Flanagan EP, Jitprapaikulsan J, et al. Myelin oligodendrocyte glycoprotein antibody-positive optic neuritis: clinical characteristics, radiologic clues, and outcome. Am J Ophthalmol 2018;195:8-15.

Juryńczyk M, Jacob A, Fujihara K, Palace J. Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease: practical considerations. Pract Neurol 2019;19:187-95.

Sugimoto K, Mori M, Liu J, et al. The accuracy of flow cytometric cell-based assay to detect anti-myelin oligodendrocyte glycoprotein (MOG) antibodies determining the optimal method for positivity judgement. J Neuroimmunol 2019;336:577021.

Waters PJ, McKeon A, Leite MI, et al. Serologic diagnosis of NMO: a multicenter comparison of aquaporin-4-IgG assays. Neurology 2012;78:665-9.

Chen JJ, Pittock SJ, Flanagan EP, Lennon VA, Bhatti MT. Optic neuritis in the era of biomarkers. Surv Ophthalmol 2020;65:12-7.

Wang J, Zhou H, Qin L, et al. Optic neuritis in the older Chinese population: a 5-year follow-up study. J Ophthalmol 2017;2017:3458356.

Song W, Qu Y, Huang X. Plasma exchange: an effective add-on treatment of optic neuritis in neuromyelitis optica spectrum disorders. Int Ophthalmol 2019;39:2477-83.

Chen JJ, Flanagan EP, Bhatti MT, et al. Steroid-sparing maintenance immunotherapy for MOG-IgG associated disorder. Neurology 2020;95:e111-e120.

Holmøy T, Høglund RA, Illes Z, Myhr KM, Torkildsen Ø. Recent progress in maintenance treatment of neuromyelitis optica spectrum disorder. J Neurol 2021;268:4522-36.

Rensel M, Zabeti A, Mealy MA, et al. Long-term efficacy and safety of inebilizumab in neuromyelitis optica spectrum disorder: analysis of aquaporin-4-immunoglobulin G-seropositive participants taking inebilizumab for ≥4 years in the N-MOmentum trial. Mult Scler 2022;28:925-32.

Pittock SJ, Berthele A, Fujihara K, et al. Eculizumab in aquaporin-4-positive neuromyelitis optica spectrum disorder. N Engl J Med 2019;381:614-25.

Yamamura T, Kleiter I, Fujihara K, et al. Trial of satralizumab in neuromyelitis optica spectrum disorder. N Engl J Med 2019;381:2114-24.

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Published

2024-05-13

How to Cite

1.
Lam CW, Tsui RWY, Lok KH, Chan NCY, Chan CKM. Prognostic factors in Chinese patients with acute non-infectious optic neuritis treated with intravenous methylprednisolone and oral prednisolone. Hong Kong J Ophthalmol [Internet]. 2024May13 [cited 2024Jul.15];28(1). Available from: https://www.hkjo.hk/index.php/hkjo/article/view/377

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