Clinical characteristics of myelin oligodendrocyte glycoprotein antibody-positive optic neuritis

Abstract

Objective: To investigate the clinical characteristics and prognosis of myelin oligodendrocyte glycoprotein(MOG) antibody-positive optic neuritis (MOG-ON). Methods: Retrospective case series study. A total of 65 patients diagnosed with MOG-ON at the Department of Ophthalmology of the Chinese People's Liberation Army General Hospital during January 2016 and October 2017 were selected. The patients underwent examinations including best corrected visual acuity (BCVA), fundus color photography, optical coherence tomography (OCT) and magnetic resonance imaging (MRI). The patients were tested for serum levels of antibodies for aquaporin 4 and MOG with a cell-based assay. The follow-up duration ranged from 14 to 217 months. Statistical analyses of patients' clinical features, neuroimaging features and prognosis were conducted. The independent-sample t test or Mann-Whitney U test for continuous variable data and the χ(2) test or Fisher exact test for classified variable data and rates were used. Results: There were 35 children (<18 years) and 30 adults (≥18 years) patients. Thirty-seven patients were female and 28 patients were male. The mean age of onset was (23±16) years (range of 3-61 years). There were 40 unilateral patients and 25 bilateral patients at the first onset. Fifty-five patients (84.6%) suffered from eye pain at the first onset and the incidence in children was significantly lower than that in adult [74.3% (26/35) and 96.7% (29/30), P=0.016]. Abnormal autoimmune antibodies were found in 13 patients (20.0%).And 47.8% (43/90) eyes had optic disc edema. Sixty percent (39/65) were recurrent optic neuritis and 73.8% (48/65) were bilateral diseases at final visit. Orbital MRI scans showed T(2) hyperintensity of optic nerve in 98.4% patients (62/63). Head MRI scans showed demyelinating lesions of the brain in 12/19 patients. Within 2 weeks of onset, 78.9%(71/90) of the affected eyes had BCVA ≤ 0.1. The visual impairment of the children and adult was serious, and there was no significant difference (P=0.650). After treatment with corticosteroid, visual acuity improved in all affect eyes. After the initial attack, 95.6%(86/90) of the affected eyes had BCVA ≥ 0.5. The children and adult had good visual recovery, and there was no significant difference (P=0.061). At the final visit, 86.7%(98/113) of the eyes had BCVA ≥ 0.5, the children had better visual recovery than adult [logarithm of the minimum angle of resolution, 0.10±0.35 vs. 0.32±0.53, t=-2.526, P=0.013].Three children (8.6%) were diagnosed with acute disseminated encephalomyelitis. The average thickness of peripapillary retinal nerve fiber layers (pRNFL) and macular ganglion cell-inner plexiform layers (mGCIPL) were (69.90±12.49) μm and (59.58±7.91) μm at least 6 months after optic neuritis attack. There were different degrees atrophy and not statistically different in pRNFL and mGCIPL between children and adult (P=0.606, 0.223). Conclusions: The clinical characteristics of MOG-ON are diverse. The children patients are more common and have better recovery of visual acuity. Additionally, some patients have demyelinating lesions in the brain. (Chin J Ophthalmol, 2019, 55: 174-179).