Jugnet Marie, David Thomas, Pierre Mitta, Valentino Ruddy, Mehdaoui Hossein, Merle Harold
Department of Ophthalmology, University Hospital of Martinique, Hôpital Pierre Zobda Quitman, Martinique, French West Indies, BP 632, 97261, Fort de France Cedex, France.
Department of Neurology, University Hospital of Martinique, Martinique, French West Indies, BP 632, 97261, Fort de France Cedex, France.
Ophthalmol Ther. 2025 Aug 9. doi: 10.1007/s40123-025-01216-w.
The treatment of severe optic neuritis (ON) is an emergency, and the role of therapeutic plasma exchange (PLEX) is still debated. The objective of this study was to evaluate the efficacy of the initial combination of parenteral corticosteroid therapy with therapeutic PLEX for the treatment of severe ON. This was a retrospective cohort study conducted between January 1998 and January 2023.
Therapeutic PLEX was initiated concomitantly with intravenous corticosteroid therapy. The etiological diagnosis of ON was specified as follows: neuromyelitis optica, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and multiple sclerosis. Sixty-five eyes (74.7%) underwent therapeutic PLEX, and 22 eyes (25.3%) received corticosteroid therapy alone.
The mean time to treatment was 7.9 ± 11 days. At 1 year, the mean visual acuity of plasmapheresis patients was 5/10, and that of non-plasmapheresis patients was 1.5/10 (p = 0.008). Five (8.1%) eyes in the PLEX group and 7 (31.8%) eyes in the group treated with corticosteroids alone remained completely blind (p = 0.005). The retinal nerve fiber layer and ganglion cell layer thickness were greater in the PLEX group than in the group treated with corticosteroids alone, 74 ± 23.1 μm versus 59.7 ± 19.3 μm and 24.7 ± 4.3 μm versus 23.3 ± 5.4 μm, respectively. MOGAD and multiple sclerosis patients had the best final visual acuity, 6/10 and 10/10, respectively (p = 0.01). No serious incidents were observed.
This is the largest series of severe ON observed in an Afro-descendant population and treated concomitantly with therapeutic PLEX and systemic corticosteroid therapy at the acute phase. Our study confirms the efficacy of therapeutic PLEX in treating severe ON.
重症视神经炎（ON）的治疗是一项紧急情况，治疗性血浆置换（PLEX）的作用仍存在争议。本研究的目的是评估肠外皮质类固醇疗法与治疗性PLEX联合初始治疗重症ON的疗效。这是一项于1998年1月至2023年1月期间进行的回顾性队列研究。
治疗性PLEX与静脉注射皮质类固醇疗法同时启动。ON的病因诊断如下：视神经脊髓炎、髓鞘少突胶质细胞糖蛋白抗体相关疾病（MOGAD）和多发性硬化症。65只眼（74.7%）接受了治疗性PLEX，22只眼（25.3%）仅接受了皮质类固醇治疗。
平均治疗时间为7.9±11天。1年后，血浆置换患者的平均视力为5/10，非血浆置换患者的平均视力为1.5/10（p=0.008）。PLEX组中有5只眼（8.1%）和仅接受皮质类固醇治疗组中有7只眼（31.8%）仍完全失明（p=0.005）。PLEX组的视网膜神经纤维层和神经节细胞层厚度大于仅接受皮质类固醇治疗组，分别为74±23.1μm对59.7±19.3μm和24.7±4.3μm对23.3±5.4μm。MOGAD和多发性硬化症患者的最终视力最佳，分别为6/10和10/10（p=0.01）。未观察到严重事件。
这是在非洲裔人群中观察到的最大系列的重症ON，并在急性期同时接受治疗性PLEX和全身皮质类固醇治疗。我们的研究证实了治疗性PLEX治疗重症ON的疗效。
