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著者: Hitoshi Ishikawa, Takeshi Kezuka, Keigo Shikishima, Akiko Yamagami, Miki Hiraoka, Hideki Chuman, Makoto Nakamura, Keika Hoshi, Toshiaki Goseki, Kimiyo Mashimo, Osamu Mimura, Takeshi Yoshitomi, Keiko Tanaka, Working Group on Diagnostic Criteria for Refractory Optic Neuritis Based on Neuroimmunological Perspective
雑誌名: Ophthalmology. 2019 Oct;126(10):1385-1398. doi: 10.1016/j.ophtha.2019.04.042. Epub 2019 May 6.
Abstract/Text
PURPOSE: To elucidate the clinical and epidemiologic characteristics of optic neuritis in Japan.
DESIGN: Multicenter cross-sectional, observational cohort study.
PARTICIPANTS: A total of 531 cases of unilateral or bilateral noninfectious optic neuritis identified in 33 institutions nationwide in Japan.
METHODS: Serum samples from patients with optic neuritis were tested for anti-aquaporin-4 antibodies (AQP4-Abs) and anti-myelin oligodendrocyte glycoprotein antibodies (MOG-Abs) using a cell-based assay and were correlated with the clinical findings.
MAIN OUTCOME MEASURES: Antibody positivity, clinical and radiologic characteristics, and visual outcome.
RESULTS: Among 531 cases of optic neuritis, 12% were AQP4-Ab positive, 10% were MOG-Ab positive, 77% were negative for both antibodies (double-negative), and 1 case was positive for both antibodies. Pretreatment visual acuity (VA) worsened to more than a median 1.0 logarithm of the minimum angle of resolution (logMAR) in all groups. After steroid pulse therapy (combined with plasmapheresis in 32% of patients in AQP4-Ab-positive group), median VA improved to 0.4 logMAR in the AQP4-Ab-positive group, 0 logMAR in the MOG-Ab-positive group, and 0.1 logMAR in the double-negative group. The AQP4-Ab-positive group showed a high proportion of females, exhibited diverse visual field abnormalities, and demonstrated concurrent spinal cord lesions on magnetic resonance imaging (MRI) in 22% of the patients. In the MOG-Ab-positive group, although posttreatment visual outcome was good, the rates of optic disc swelling and pain with eye movement were significantly higher than those in the AQP4-Ab-positive and double-negative groups. However, most cases showed isolated optic neuritis lesions on MRI. In the double-negative group, 4% of the patients had multiple sclerosis. Multivariate logistic regression analysis of all participants identified age and presence of antibodies (MOG-Ab and AQP4-Ab) as significant factors affecting visual outcome.
CONCLUSIONS: The present large-scale cohort study revealed the clinicoepidemiologic features of noninfectious optic neuritis in Japan. Anti-aquaporin-4 antibody-positive optic neuritis has poor visual outcome. In contrast, MOG-Ab positive cases manifested severe clinical findings of optic neuritis before treatment, but few showed concurrent lesions in sites other than the optic nerve and generally showed good treatment response with favorable visual outcome. These findings indicate that autoantibody measurement is useful for prompt diagnosis and proper management of optic neuritis that tends to become refractory.
Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
PMID 31196727 Ophthalmology. 2019 Oct;126(10):1385-1398. doi: 10.1016/j.ophtha.2019.04.042. Epub 2019 May 6.
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