Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China.
Joint Shantou International Eye Center, Shantou University and Chinese University of Hong Kong, Shantou, China.
Br J Ophthalmol. 2019 Jun;103(6):831-836. doi: 10.1136/bjophthalmol-2018-312399. Epub 2018 Jul 26.
BACKGROUND/AIMS: To investigate clinical characteristics and prognosis of paediatric optic neuritis (PON) in patients seropositive for myelin oligodendrocyte glycoprotein antibody (MOG-Ab) in China.
Children displaying initial onset of optic neuritis (ON) were recruited from the Neuro-ophthalmology Department in the Chinese People's Liberation Army General Hospital from January 2016 to August 2017. They were assigned into three groups based on antibody status: MOG-Ab-seropositive ON (MOG-ON), aquaporin-4 antibody-seropositive ON (AQP4-ON) and double seronegative ON (seronegative-ON).
Totally 48 patients were assessed, including 25 MOG-ON (52.1%), 7 AQP4-ON (14.6%) and 16 seronegative-ON (33.3%). The MOG-ON and seronegative-ON cohorts had equal ratios of female/male, but the AQP4-ON cohort was predominantly females (100%). The patients with MOG-ON were significantly younger at onset compared with the AQP4-ON group. Of the MOG-ON eyes, 97.6% had good recovery of visual acuity (VA) (≥0.5) compared with33.3% of AQP4-ON eyes (p<0.001). However, there was no significant difference compared with the seronegative-ON eyes (82.6%, p0.052). Two children in the MOG-ON group ended up being diagnosed with acute disseminated encephalomyelitis, while only one patient in the AQP4-ON group developed neuromyelitis optica during follow-up. Patients with MOG-ON had thicker peripapillary retinal nerve fibre layers overall and in the superior and inferior quadrants than in patients with AQP4-ON (p0.005, p0.002 and p0.024, respectively). In addition, the macular ganglion cell-inner plexiform in MOG-ON eyes became significantly thicker than in AQP4-ON eyes (p=0.029). Orbital MRI revealed a larger proportion of patients with MOG-ON had intracranial optic nerve involvement than patients with seronegative-ON (51.2% vs 17.4%, p0.009).
MOG-ON was the most common PON subtype in China. MOG-ON had different clinical features including earlier age of onset, equal female/male ratio, better recovery of VA and thicker peripapillary retinal nerve fibre and macular ganglion cell-inner plexiform layers. MOG-Abs may be a potential biomarker for determining visual prognosis with PON.
背景/目的：研究中国髓鞘少突胶质细胞糖蛋白抗体（MOG-Ab）阳性的儿科视神经炎（PON）患儿的临床特征和预后。
2016 年 1 月至 2017 年 8 月，从中国人民解放军总医院神经眼科招募了首发视神经炎（ON）的患儿。根据抗体状态将其分为三组：MOG-Ab 阳性 ON（MOG-ON）、水通道蛋白 4 抗体阳性 ON（AQP4-ON）和双阴性 ON（阴性-ON）。
共评估了 48 例患者，其中 25 例为 MOG-ON（52.1%），7 例为 AQP4-ON（14.6%），16 例为阴性-ON（33.3%）。MOG-ON 和阴性-ON 两组的男女比例相等，但 AQP4-ON 组均为女性（100%）。MOG-ON 患者的发病年龄明显低于 AQP4-ON 组。MOG-ON 眼的视力（VA）恢复良好（≥0.5）的比例为 97.6%，而 AQP4-ON 眼为 33.3%（p<0.001）。然而，与阴性-ON 眼相比，差异无统计学意义（82.6%，p0.052）。MOG-ON 组有 2 例患儿最终被诊断为急性播散性脑脊髓炎，而 AQP4-ON 组只有 1 例患者在随访中发展为视神经脊髓炎。MOG-ON 患者的视盘周围视网膜神经纤维层（pRNFL）整体及上、下象限均明显厚于 AQP4-ON 患者（p0.005，p0.002 和 p0.024）。此外，MOG-ON 眼的黄斑神经节细胞-内丛状层厚度明显大于 AQP4-ON 眼（p=0.029）。眼眶 MRI 显示，MOG-ON 患者颅内视神经受累的比例明显高于阴性-ON 患者（51.2%比 17.4%，p0.009）。
MOG-ON 是中国最常见的 PON 亚型。MOG-ON 的临床特征不同，包括发病年龄更早、男女比例相等、VA 恢复更好、pRNFL 和黄斑神经节细胞-内丛状层更厚。MOG-Abs 可能是 PON 视功能预后的潜在标志物。
