Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Ophthalmology, Mettapracharak (Wat Rai Khing) Hospital, Nakhon Pathom, Thailand.
Ann Med. 2023 Dec;55(1):2227422. doi: 10.1080/07853890.2023.2227422.
To appraise whether plasma exchange (PLEX) effectively improves visual function for acute optic neuritis (ON) in neuromyelitis optica (NMO) or neuromyelitis optica spectrum disorder (NMOSD).
We searched Medline, Embase, Cochrane Library, ProQuest Central, and Web of Science to identify relevant articles published between 2006 and 2020.Eligible studies were in English and evaluated visual outcomes for people with acute ON in NMO or NMOSD treated with PLEX. They also had adequate pre- and posttreatment data. Excluded were studies with 1 or 2 case reports, or incomplete data.
Twelve studies were qualitatively synthesized (1 RCT; 1 controlled NRSI; 10 observational studies). Five before-and-after observational studies were used for quantitative synthesis. The PLEX in the 5 studies (3 to 7 cycles over 2 to 3 weeks) was performed as second-line or adjunctive therapy for acute ON in NMO/NMOSD.The qualitative synthesis revealed that visual-acuity recovery occurred between one day and 6 months after the first PLEX cycle completion. Thirty-two of 48 participants in the 5 quantitative-synthesis studies received PLEX. Relative to pre-PLEX values, visual-acuity improvements were nonsignificant at these post-PLEX time points: 1 day (SMD 0.611; 95% CI -0.620 to 1.842); 2 weeks (SMD 0.0214; 95% CI -1.250 to 1.293); 3 months (SMD 1.014; 95% CI -0.954 to 2.982); and 6 months (SMD 0.450; 95% CI -2.643 to 3.543).
There were inadequate data to determine whether PLEX effectively treats acute ON in NMO/NMOSD.
评价血浆置换（PLEX）是否能有效改善视神经脊髓炎（NMO）或视神经脊髓炎谱系障碍（NMOSD）患者的急性视神经炎（ON）的视力功能。
我们检索了 Medline、Embase、Cochrane 图书馆、ProQuest 中心和 Web of Science，以确定 2006 年至 2020 年期间发表的相关文章。符合条件的研究为英文，评估了接受 PLEX 治疗的 NMO 或 NMOSD 急性 ON 患者的视觉结局。这些研究还具有足够的治疗前后数据。排除了仅包含 1 或 2 例病例报告或数据不完整的研究。
12 项研究进行了定性综合分析（1 项 RCT；1 项对照 NRSI；10 项观察性研究）。5 项前后对照观察性研究用于定量综合分析。这 5 项研究中的 PLEX（在 2 至 3 周内进行 3 至 7 个周期）是 NMO/NMOSD 急性 ON 的二线或辅助治疗。定性综合分析显示，视力恢复发生在第一个 PLEX 周期完成后 1 天至 6 个月之间。在 5 项定量综合研究中的 48 名参与者中有 32 名接受了 PLEX。与 PLEX 前值相比，这些 PLEX 后时间点的视力改善无显著性意义：1 天（SMD 0.611；95%CI-0.620 至 1.842）；2 周（SMD 0.0214；95%CI-1.250 至 1.293）；3 个月（SMD 1.014；95%CI-0.954 至 2.982）；和 6 个月（SMD 0.450；95%CI-2.643 至 3.543）。
目前尚无足够的数据确定 PLEX 是否能有效治疗 NMO/NMOSD 的急性 ON。
