Sun Chuanbin, Liu Zhe
Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Department of Ophthalmology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.
Front Med (Lausanne). 2024 Dec 2;11:1514687. doi: 10.3389/fmed.2024.1514687. eCollection 2024.
The treatment of demyelinating optic neuritis (DON) in pregnant patients is challenging, especially when there is poor or no response to intravenous methylprednisolone pulse (IVMP) therapy or adjunctive treatments such as intravenous immunoglobulin (IVIG) therapy. We herein report a case of a 28-year-old pregnant woman who experienced sequential severe vision loss in both eyes. She presented to a local hospital with the main complaint of sudden, painless vision loss in the left eye and was diagnosed with DON in the left eye. However, she did not receive orbital MRI or IVMP therapy due to safety concerns. Upon admission to our hospital, her visual acuity was 20/30 in the right eye and there was no light perception in the left eye. Her right eye vision deteriorated rapidly, declining to 20/1,000 one day after the admission. The ophthalmic examination revealed a normal anterior segment and a swollen optic disk in the right eye and a dilated pupil with a relative afferent pupillary defect and a swollen optic disk in the left eye. The serological tests for common pathogens, including the aquaporin-4 antibody (AQP-4 Ab), myelin oligodendrocyte glycoprotein antibody (MOG-Ab), and other common autoantibodies, were all negative. The patient was clinically diagnosed with DON in both eyes and received 7 days of IVMP therapy and 4 days of IVIG therapy, but showed no visual improvement. A three-dose regimen of satralizumab 120 mg was then administered subcutaneously during the acute stage of DON, in combination with a slowly tapered oral methylprednisolone regimen. Moreover, 2 months after the first injection of satralizumab, the patient naturally gave birth to a healthy female infant weighing 2,305 g at 36 weeks and 1 day of gestation. Her visual acuity improved to 20/500 in both eyes and slightly increased to 20/320 in both eyes 2 months later. Her visual acuity remained stable during subsequent follow-up visits. The infant was fed formula milk powder and developed normally. No systemic or ocular side effects related to satralizumab therapy were observed in the patient or her fetus during the 9-month follow-up. Our findings in this case suggest that satralizumab may be a safe and efficient adjunctive therapy for pregnant patients with DON who poorly respond to IVMP and IVIG therapy, even in cases of dual-negative AQP-4 Ab and MOG-Ab.
孕妇脱髓鞘性视神经炎（DON）的治疗具有挑战性，尤其是在对静脉注射甲基强的松龙脉冲（IVMP）治疗或辅助治疗（如静脉注射免疫球蛋白（IVIG）治疗）反应不佳或无反应时。我们在此报告一例28岁孕妇，她双眼先后出现严重视力丧失。她因左眼突发无痛性视力丧失为主诉就诊于当地医院，被诊断为左眼DON。然而，出于安全考虑，她未接受眼眶MRI检查或IVMP治疗。入院时，她右眼视力为20/30，左眼无光感。入院一天后，她右眼视力迅速恶化，降至20/1000。眼科检查显示右眼眼前节正常，视盘肿胀，左眼瞳孔散大，伴有相对性传入瞳孔障碍，视盘肿胀。包括水通道蛋白4抗体（AQP-4 Ab）、髓鞘少突胶质细胞糖蛋白抗体（MOG-Ab）及其他常见自身抗体在内的常见病原体血清学检测均为阴性。该患者临床诊断为双眼DON，接受了7天的IVMP治疗和4天的IVIG治疗，但视力无改善。然后在DON急性期皮下注射三剂120 mg的萨特利珠单抗，并联合逐渐减量的口服甲基强的松龙方案。此外，在首次注射萨特利珠单抗2个月后，患者在妊娠36周1天时自然分娩一名体重2305 g的健康女婴。她双眼视力提高到20/500，2个月后双眼视力略有提高至20/320，并在随后的随访中保持稳定。婴儿喂配方奶粉，发育正常。在9个月的随访中，未观察到患者或其胎儿出现与萨特利珠单抗治疗相关的全身或眼部副作用。我们在此病例中的发现表明，对于对IVMP和IVIG治疗反应不佳的孕妇DON患者，即使是AQP-4 Ab和MOG-Ab双阴性的情况，萨特利珠单抗也可能是一种安全有效的辅助治疗药物。
