Chan Fiona, Fraser Clare, Brilot Fabienne, Dale Russell C, Ramanathan Sudarshini
Translational Neuroimmunology Group, Kids Neuroscience Centre and ANZAC Research Institute, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Neurology, Concord Clinical School, Concord Hospital, Sydney, Australia.
Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
J Neuroimmunol. 2025 Nov 15;408:578715. doi: 10.1016/j.jneuroim.2025.578715. Epub 2025 Aug 6.
Myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) commonly manifests as optic neuritis (ON) in association with serum MOG immunoglobulin G (MOG-IgG). This review will evaluate the literature on visual dysfunction in MOG-IgG ON, with a focus on ophthalmic structural biomarkers and ancillary outcome measures.
PubMed was systematically searched using the terms "optic neuritis", "visual outcomes" and "myelin-oligodendrocyte glycoprotein" between 2007 to January 2025. High-contrast visual acuity (HCVA), low-contrast visual acuity (LCVA), contrast sensitivity, visual fields (VF), electrophysiology, optical coherence tomography (OCT)/angiography, magnetic resonance imaging (MRI) and quality of life (QoL) were evaluated.
35 studies and 2335 patients were included. 89 % of studies reported HCVA. OCT and MRI were reported in 63 % and 43 % of studies, respectively. MOG-IgG ON had moderate-severe HCVA loss at nadir but good HCVA recovery. MRI features characteristic to MOG-IgG ON include longitudinally extensive lesions +/- perineural enhancement. OCT in acute MOG-IgG ON revealed moderate-severe peripapillary retinal nerve fibre layer (p-RNFL) swelling. However severe axonal loss was noted in chronic outcomes, despite preservation of HCVA, highlighting a recognised structure-function discordance. Only 31 % reported on VFs, 17 % on LCVA, and 14 % on VEPs, all of which demonstrated abnormalities even in patients with normal HCVA. Only one study reported on contrast sensitivity or QoL.
Current clinical assessments may underestimate visual dysfunction in MOG-IgG ON. Prospective, longitudinal multimodal evaluation should be a key focus for future research, to identify the most sensitive biomarkers to be incorporated into routine clinical practice. This will better identify patients at risk of adverse visual outcomes in MOG-IgG ON, guide clinical management and improve QoL.
髓鞘少突胶质细胞糖蛋白抗体相关疾病（MOGAD）通常表现为视神经炎（ON），伴有血清MOG免疫球蛋白G（MOG-IgG）。本综述将评估关于MOG-IgG ON视觉功能障碍的文献，重点关注眼科结构生物标志物和辅助结局指标。
在2007年至2025年1月期间，使用“视神经炎”“视觉结局”和“髓鞘少突胶质细胞糖蛋白”等术语对PubMed进行系统检索。评估了高对比度视力（HCVA）、低对比度视力（LCVA）、对比敏感度、视野（VF）、电生理学、光学相干断层扫描（OCT）/血管造影、磁共振成像（MRI）和生活质量（QoL）。
纳入35项研究和2335例患者。89%的研究报告了HCVA。分别有63%和43%的研究报告了OCT和MRI。MOG-IgG ON在最低点时HCVA有中度至重度丧失，但HCVA恢复良好。MOG-IgG ON的MRI特征包括纵向广泛病变伴/不伴神经周围强化。急性MOG-IgG ON的OCT显示中度至重度视乳头周围视网膜神经纤维层（p-RNFL）肿胀。然而，尽管HCVA得以保留，但在慢性结局中发现了严重的轴突丢失，凸显了一种公认的结构-功能不一致。仅31%的研究报告了VF，17%报告了LCVA，14%报告了VEP，即使在HCVA正常的患者中，这些指标也均显示异常。只有一项研究报告了对比敏感度或QoL。
目前的临床评估可能低估了MOG-IgG ON中的视觉功能障碍。前瞻性、纵向多模态评估应成为未来研究的关键重点，以确定最敏感的生物标志物并纳入常规临床实践。这将更好地识别MOG-IgG ON中存在不良视觉结局风险的患者，指导临床管理并改善QoL。
