The authors present a retrospective case review with the aim of describing the group of patients with myelin-oligodendrocyte glycoprotein-associated optic neuritis (MOG-ON) who had poor visual outcomes following their first attack despite rapid treatment. The study was conducted at a single tertiary neuro-ophthalmology centre. The medical records were reviewed for all cases of MOG-ON in at least one eye with a visual acuity of 6/60 or worse following their first attach after receiving treatment within one month of onset. The following data was extracted from the records: presentation, neuro-imaging and treatment. From 36 cases of MOG-ON, only two patients (5.5%) were identified to meet the inclusion criteria. Both were diagnosed and treated within one week. Treatment started with intravenous steroids for five days, escalating to plasma exchange within two weeks and intravenous immunoglobulin monthly infusions initiated within six weeks. Severe visual field constriction was seen in all eyes. Better seeing eyes visual acuities were 6/6 and 6/15 and visual acuities in the worse seeing eyes were 6/120 and perception of light. Details of both cases are described with retinal and magnetic resonance imaging. A detail the authors highlight is only mild enhancement of the worse affected optic nerve in the intracanalicular portion. They hypothesise this is due to inflammation resulting in a compartment syndrome within the canal causing the poor visual outcome through axonal loss. This hypothesis needs further testing. This study does however highlight that a small number of MOG-ON cases have poor visual outcome at their first attack despite prompt and exhaustive treatment, therefore counselling of this possibility should be applied.
Hypothesis for poor visual outcomes in myeline oligodendrocyte glycoprotein-related optic neuritis after first attack
Reviewed by Lauren Hepworth
Poor visual outcome after first attack in a cohort of patients with myelin oligodendrocyte glycoprotein-related optic neuritis.
CONTRIBUTOR
Lauren R Hepworth
University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.
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