Thongmee Watcharaporn, Narongkhananukul Chanomporn, Padungkiatsagul Tanyatuth, Jindahra Panitha, Vanikieti Kavin
Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Clin Ophthalmol. 2021 Feb 4;15:419-429. doi: 10.2147/OPTH.S295769. eCollection 2021.
To compare demographic data, clinical and radiological characteristics, treatments, and long-term visual outcomes between patients with late-onset neuromyelitis optica spectrum disorder-related optic neuritis (LO-NMOSD-ON) (age at onset ≥ 50 years) and patients with early-onset neuromyelitis optica spectrum disorder-related optic neuritis (EO-NMOSD-ON) (age at onset < 50 years).
This retrospective study included 47 patients (69 eyes) who were diagnosed with neuromyelitis optica spectrum disorder-related optic neuritis (NMOSD-ON) over a 12-year period. There were 14 patients (21 eyes) and 33 patients (48 eyes) in the LO-NMOSD-ON and EO-NMOSD-ON groups, respectively.
LO-NMOSD-ON-affected eyes exhibited significantly worse median nadir visual acuity (VA) at optic neuritis (ON) onset, compared with EO-NMOSD-ON-affected eyes (2.7 logMAR (range 2.6-2.9 logMAR) vs 1.95 logMAR (range 0.4-2.9 logMAR); 0.03). Similarly, 100% of LO-NMOSD-ON-affected eyes demonstrated a nadir VA of worse than or equal to 1.0 logMAR, compared with 62.5% of EO-NMOSD-ON-affected eyes ( = 0.03). LO-NMOSD-ON-affected eyes had a worse median final VA, compared with EO-NMOSD-ON-affected eyes (1.3 logMAR (range 0-2.9 logMAR) vs 0.3 logMAR (range 0-2.9 logMAR); adjusted = 0.037). LO-NMOSD-ON-affected eyes more frequently exhibited a final VA of worse than or equal to 1.0 logMAR, compared with EO-NMOSD-ON-affected eyes (57.1% vs 27.0%; adjusted = 0.039). A positive correlation was observed between age at ON onset of each eye and the final VA (logMAR) (Spearman 0.34, = 0.0075). The remaining parameters did not significantly differ between the two groups.
Patients with LO-NMOSD-ON had significantly worse nadir VA at ON onset and significantly worse final VA, relative to patients with EO-NMOSD-ON. Age at ON onset of each eye was positively correlated with final VA (logMAR). Despite the difference in common age at onset, NMOSD-ON should be included in the differential diagnosis of late-onset acute to subacute optic neuropathy, along with ischemic optic neuropathy.
比较迟发性视神经脊髓炎谱系障碍相关性视神经炎（LO-NMOSD-ON）（发病年龄≥50岁）与早发性视神经脊髓炎谱系障碍相关性视神经炎（EO-NMOSD-ON）（发病年龄<50岁）患者的人口统计学数据、临床和影像学特征、治疗方法及长期视力预后。
这项回顾性研究纳入了47例（69只眼）在12年期间被诊断为视神经脊髓炎谱系障碍相关性视神经炎（NMOSD-ON）的患者。LO-NMOSD-ON组有14例患者（21只眼），EO-NMOSD-ON组有33例患者（48只眼）。
与EO-NMOSD-ON累及的眼睛相比，LO-NMOSD-ON累及的眼睛在视神经炎（ON）发作时的最低视力中位数显著更差（2.7 logMAR（范围2.6 - 2.9 logMAR）对1.95 logMAR（范围0.4 - 2.9 logMAR）；P = 0.03）。同样，100%的LO-NMOSD-ON累及的眼睛最低视力≤1.0 logMAR，而EO-NMOSD-ON累及的眼睛为62.5%（P = 0.03）。与EO-NMOSD-ON累及的眼睛相比，LO-NMOSD-ON累及的眼睛最终视力中位数更差（1.3 logMAR（范围0 - 2.9 logMAR）对0.3 logMAR（范围0 - 2.9 logMAR）；校正后P = 0.037）。与EO-NMOSD-ON累及的眼睛相比，LO-NMOSD-ON累及的眼睛更频繁地出现最终视力≤1.0 logMAR（57.1%对27.0%；校正后P = 0.039）。每只眼睛ON发作时的年龄与最终视力（logMAR）之间存在正相关（Spearman秩相关系数r = 0.34，P = 0.0075）。两组之间的其余参数无显著差异。
相对于EO-NMOSD-ON患者，LO-NMOSD-ON患者在ON发作时的最低视力和最终视力显著更差。每只眼睛ON发作时的年龄与最终视力（logMAR）呈正相关。尽管发病年龄存在差异，但NMOSD-ON应与缺血性视神经病变一起纳入迟发性急性至亚急性视神经病变的鉴别诊断中。
