Visual improvement of therapeutic plasma exchange for refractory optic neuritis patients in acute phase_Chinese Journal of Ocular Fundus Diseases

Authors：

Tan Shaoying ¹ , Zhuang Yuan ² ,  Wei Shihui ¹ , Xu Quangang ¹ , Zhao Jie ¹ , Yang Mo ¹ , Teng Da ¹ , Xiong Shuai ¹

1. Department of Ophthalmology, The Chinese PLA General Hospital, Beijing 100853, China;
2. Department of Blood Transfusion, The Chinese PLA General Hospital, Beijing 100853, China Tan Shaoying is working on the the Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou 515000, China;

Corresponding author：

Wei Shihui, Email: weishihui706@hotmail.com

Keywords：

Optic neuritis/therapy; Plasma Exchange; Visual prognosis

DOI：

10.3760/cma.j.issn.1005-1015.2019.03.009

Video：

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Objective To evaluate the visual improvement of therapeutic plasma exchange (TPE) for refractory optic neuritis (ON) patients in acute phase.Methods Seventy-five affected eyes from 44 refractory ON patients with severe visual defect or resistance to high-dose intravenous methylprednisolone (IVMP) therapy, who were admitted to The Chinese PLA General Hospital between January 2015 and August 2016, were recruited and received TPE therapy. Among these patients, 11 were male and 33 were female; the average age was 39.1±13.9; 31 patients had two affected eyes, 13 patients had one affected eye. The course of the disease on the group of patients were more than 2 weeks, and the visual acuity worsened for more than 10 days and continued to deteriorate. TPE treatment was performed on all of the patients. BCVA was recorded before and 24 h after treatment, and the visual function was scored using visual outcome scale (VOS). At the same time, the adverse reactions of TPE treatment were observed. The paired t-test was used to compare the VOS before and after treatment. The correlation between VOS before and after treatment was analyzed by Linear-by-Linear correlation analysis.Results Among 75 affected eyes, the post-therapy VOS 3.89±2.13 was significantly improved from pre-therapy VOS 5.56±1.69 (t=6.77, P＜0.001). Forty-eight of 75 eyes were improved at lease 1 score of VOS, the overall rate of visual improvement was 64.0%. Especially among the eyes with initial vision of light perception, an improved rate of 82.4% was presented. 75.0% in those eyes with initial vision of count fingers and 67.7% in no light perception. Linear-by-Linear correlation analysis showed a significant linear correlation between the scores of VOS before and after TPE treatment (r=0.398, P=0.01). During the course of TPE treatment, 5 patients had mild adverse reactions such as low calcium reaction and allergic reaction and were well controlled after treatment.Conclusion Using TPE to treat refractory ON in acute phased can improve the visual function of patients.

Citation： Tan Shaoying, Zhuang Yuan, Wei Shihui, Xu Quangang, Zhao Jie, Yang Mo, Teng Da, Xiong Shuai. Visual improvement of therapeutic plasma exchange for refractory optic neuritis patients in acute phase. Chinese Journal of Ocular Fundus Diseases, 2019, 35(3): 255-258. doi: 10.3760/cma.j.issn.1005-1015.2019.03.009 Copy

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1. Wingerchuk DM. Neuromyelitis optica: new findings on pathogenesis[J]. Int Rev Neurobiol, 2007, 79: 665-688. DOI: 10.1016/S0074-7742(07)79029-3.
2. Lan YL, Fang DY, Zhao J, et al. A research update on the potential roles of aquaporin 4 in neuroinflammation[J]. Acta Neurol Belg, 2016, 116(2): 127-134. DOI: 10.1007/s13760-015-0520-2.
3. Shams PN, Plant GT. Optic neuritis: a review[J]. Int MS J, 2009, 16(3): 82-89.
4. Lai C, Tian G, Liu W, et al. Clinical characteristics, therapeutic outcomes of isolated atypical optic neuritis in China[J]. J Neurol Sci, 2011, 305(1-2): 38-40. DOI: 10.1016/j.jns.2011.03.021.
5. Reeves HM, Winters JL. The mechanisms of action of plasma exchange[J]. Br J Haematol, 2014, 164(3): 342-351. DOI: 10.1111/bjh.12629.
6. Zhou H, Xu Q, Zhao S, et al. Distinct clinical characteristics of atypical optic neuritis with seronegative aquaporin-4 antibody among Chinese patients[J]. Br J Ophthalmol, 2017, 101(12): 1720-1724. DOI: 10.1136/bjophthalmol-2017-310157.
7. Schwartz J, Padmanabhan A, Aqui N, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis: the seventh special issue[J]. J Clin Apher, 2016, 31(3): 149-162. DOI: 10.1002/jca.21470.
8. Petzold A, Plant GT. Diagnosis and classification of autoimmune optic neuropathy[J]. Autoimmun Rev, 2014, 13(4-5): 539-545. DOI: 10.1016/j.autrev.2014.01.009.
9. Lehmann HC, Hartung HP, Hetzel GR, et al. Plasma exchange in neuroimmunological disorders: part 1: rationale and treatment of inflammatory central nervous system disorders[J]. Arch Neurol, 2006, 63(7): 930-935. DOI: 10.1001/archneur.63.7.930.
10. Kim SH, Kim W, Huh SY, et al. Clinical efficacy of plasmapheresis in patients with neuromyelitis optica spectrum disorder and effects on circulating anti-aquaporin-4 antibody levels[J]. J Clin Neurol, 2013, 9(1): 36-42. DOI: 10.3988/jcn.2013.9.1.36.
11. Okafor C, Ward DM, Mokrzycki MH, et al. Introduction and overview of therapeutic apheresis[J]. J Clin Apher, 2010, 25(5): 240-249. DOI: 10.1002/jca.20247.

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