The Asia-Pacific Journal of Ophthalmology

Asia-Pacific Journal of Ophthalmology:

Articles in Press Original Study - Clinical

Clinical Course and Treatment Response of Neuromyelitis Optica Spectrum Disease: An 8-Year Experience

Lin, Chao-Wen; Lin, I-Hung; Chen, Ta-Ching; Jou, Jieh-Ren; Woung, Lin-Chung



Author Information


From the *Department of Ophthalmology, National Taiwan University Hospital, Taipei; †Department of Ophthalmology, Tri-Service General Hospital, Taipei; ‡Department of Ophthalmology, Changhua Christian Hospital, Changhua; and §Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan.


Reprints: Lin-Chung Woung, MD, PhD, Department of Ophthalmology, Taipei City Hospital, No. 145, Zhengzhou Road, Datong District, Taipei City 10341, Taiwan.
E-mail: wounglc@tpech.gov.tw.



Abstract


Purpose: To report the clinical course and treatment response in a cohort of neuromyelitis optica spectrum disorder (NMOSD) patients from a single referral center.


Design: Case series.


Methods: Ninety-six NMOSD patients who received treatment and follow-up checks at National Taiwan University Hospital for at least 2 years between 2008 and 2016 were recruited. Detailed characteristics of clinical course including acute episodes, maintenance therapies, and visual outcome were collected. Patients were examined every 6 months and during each episode of relapse. The study was approved by the institutional review board and informed consent was obtained.


Results: Among all patients, 68 (70.8%) had optic neuritis. Optic neuritis was the initial presentation of NMOSD in 44 patients. Among patients with optic neuritis, 32.4% had recurrent optic neuritis within 1 year from the first episode. Compared with the group without optic neuritis, the group with optic neuritis had a younger age of presentation (34.4 ± 15.9 versus 42.4 ± 14.7 years, P = 0.02) and a higher 1-year recurrence rate (64.7% versus 17.9%, P < 0.001). Among the patients with optic neuritis, 51.5% of patients had a final visual acuity of worse than 20/200. Multiple regression analysis showed that the presence of aquaporin-4-IgG antibodies and poor initial visual acuity were risk factors of worse visual outcome.


Conclusions: In this study, patients with optic neuritis were younger and had a higher 1-year recurrence rate. Despite using steroid therapy during the acute phase and immunosuppressive agents as long-term treatment, visual prognosis was poor. Aquaporin-4-IgG antibodies and initial visual acuity were associated with final visual outcome.




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