Prognostic factors in Chinese patients with acute non-infectious optic neuritis treated with intravenous methylprednisolone and oral prednisolone
Keywords:
Methylprednisolone, Neuromyelitis optica, Optic neuritis, Prednisolone, SteroidsAbstract
Objectives: Non-infectious optic neuritis (ON) in Caucasians is typically associated with multiple sclerosis (MS), and steroid treatment is optional. In Chinese patients, however, ON is often atypical and more likely to be associated with neuromyelitis optica spectrum disorder (NMOSD), for which early initiation of pulse intravenous steroid treatment is recommended. We aimed to identify factors associated with visual acuity (VA) improvement after intravenous and oral steroid treatment.
Methods: We reviewed the medical records of 64 Chinese patients (64 eyes) who presented to Hong Kong Eye Hospital between 2000 and 2019 with their first episode of acute ON and received intravenous methylprednisolone and oral prednisolone.
Results: Among all cases, 45.3% were idiopathic and isolated, 25.0% were NMOSD-related, and 17.2% were MS-related. Patients with MS-related ON were younger than patients with idiopathic or NMOSD-related ON (p<0.01). Greater improvement in VA was associated with worse nadir VA, greater VA improvement on day 14 of steroid treatment, and NMOSD-related ON, whereas smaller improvement in VA was associated with older age and presentation before anti-aquaporin-4 testing became available.
Conclusion: Because non-infectious ON in Chinese patients is often atypical, intravenous steroid treatment is recommended (rather than optional). Treatment outcomes have improved over the past 20 years, owing to more widespread testing for anti-aquaporin-4 antibodies and more aggressive treatment of NMOSD.
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