Merle Harold, Olindo Stéphane, Jeannin Séverine, Valentino Ruddy, Mehdaoui Hossein, Cabot Florence, Donnio Angélique, Hage Rabih, Richer Raymond, Smadja Didier, Cabre Philippe
Service d'Ophtalmologie, Centre Hospitalier Universitaire de Fort de France, Hôpital Pierre Zobda-Quitman, Martinique, France.
Arch Ophthalmol. 2012 Jul;130(7):858-62. doi: 10.1001/archophthalmol.2012.1126.
To assess the contribution of plasma exchange (PE) in association (add-on) with pulsed intravenous corticosteroids in acute optic neuritis of neuromyelitis optica (NMO) and limited forms of NMO.
Thirty-six patients with optic neuritis were treated from January 1, 1995, through December 31, 2010, with pulsed intravenous corticosteroids and 16 with pulsed intravenous corticosteroids plus PE. The ophthalmologic examination was performed at least 6 months after optic neuritis treatment. Visual acuity and visual field assessed with the Snellen scale and the logarithmic scale of the Early Treatment Diabetic Retinopathy Study were measured using standard automated perimetry and frequency doubling technology perimetry. Retinal peripapillary fiber thickness was measured using optical coherence tomography.
Final visual acuity was 20/400 in the corticosteroid group and 20/50 in the PE group (P=.04). The gain in visual acuity was 20/200 in the corticosteroid group and 20/30 in the PE group (P=.01). A poor final visual acuity outcome (≤20/200) was found in 19 of 36 patients (53%) in the corticosteroid group and 2 of 16 patients (13%) in the PE group (P=.008). Mean (SD) thickness of peripapillary retinal nervous fibers was 63.1 (20.4) μm in the corticosteroid group and 70.3 (20.3) μm in the PE group (P=.16). The mean (SD) thickness in the temporal quadrant was 38.5 (14.1) μm in the corticosteroid group and 44.5 (12.7) μm in the PE group (P=.02). In multivariate analysis, PE treatment was the only independent factor associated with a visual acuity greater than 20/200.
In optic neuritis associated with NMO, sequential treatment with pulsed intravenous corticosteroids and PE is more effective than standard monotherapy with corticosteroids on visual acuity outcome.
评估血浆置换（PE）联合脉冲式静脉注射皮质类固醇对视神经脊髓炎（NMO）及NMO局限型急性视神经炎的作用。
1995年1月1日至2010年12月31日期间，36例视神经炎患者接受脉冲式静脉注射皮质类固醇治疗，16例接受脉冲式静脉注射皮质类固醇联合PE治疗。视神经炎治疗至少6个月后进行眼科检查。使用标准自动视野计和频率加倍技术视野计，通过Snellen视力表和糖尿病视网膜病变早期治疗研究对数视力表评估视力和视野。使用光学相干断层扫描测量视网膜乳头周围纤维厚度。
皮质类固醇组最终视力为20/400，PE组为20/50（P = 0.04）。皮质类固醇组视力提高为20/200，PE组为20/30（P = 0.01）。皮质类固醇组36例患者中有19例（53%）最终视力差（≤20/200），PE组16例患者中有2例（13%）（P = 0.008）。皮质类固醇组视网膜乳头周围神经纤维平均（标准差）厚度为63.1（20.4）μm，PE组为70.3（20.3）μm（P = 0.16）。颞侧象限平均（标准差）厚度在皮质类固醇组为38.5（14.1）μm，PE组为44.5（12.7）μm（P = 0.02）。多因素分析中，PE治疗是与视力大于20/200相关的唯一独立因素。
在与NMO相关的视神经炎中，脉冲式静脉注射皮质类固醇与PE序贯治疗在视力改善方面比标准的皮质类固醇单一疗法更有效。
