J Korean Ophthalmol Soc.  2014 Mar;55(3):465-472. 10.3341/jkos.2014.55.3.465.

Efficacy of Plasma Exchange Therapy for Steroid-Unresponsive Neuromyelitis Optica

• Jo SH
• Choi JH
• Choi HY
• Jung JH

• KMID: 2218281
• DOI: http://doi.org/10.3341/jkos.2014.55.3.465

Abstract

PURPOSE
To report the therapeutic efficacy of plasma exchange therapy on steroid-unresponsive neuromyelitisoptica (NMO) patients.
CASE SUMMARY
Three patients who had not achieved improvement of visual acuity and visual field after high steroid pulse therapy after optic neuritis visited our clinic with decreasing visual acuity combined with eye pain in the other eye. All patients were diagnosed as neuromyelitisoptica (NMO) based on the presence of NMO-IgG antibody and optic nerve enhancing in contrast-enhanced orbital magnetic resonance imaging (MRI). Recurrent optic neuritis was observed. Steroid pulse retreatment was started but visual acuity was not improved in all patients. The patients received plasma exchange therapy, followed by immune suppression therapy. All patients showed improved visual acuity and restored visual field promptly without recurrence of neuromyelitisoptica.
CONCLUSIONS
In case of steroid-unresponsive neuromyelitisoptica, plasma exchange should be promptly considered as the treatment of choice.

Keyword

Neuromyelitisoptica; Plasma exchange; Steroid pulse therapy

MeSH Terms

Eye Pain
Humans
Magnetic Resonance Imaging
Neuromyelitis Optica*
Optic Nerve
Optic Neuritis
Orbit
Plasma Exchange*
Plasma*
Recurrence
Retreatment
Visual Acuity
Visual Fields

Figure

• 

  Figure 1. (A) Visual field test shows right hemianopsia in the right eye. (B) Fundus photo shows optic atrophy in the left eye. (C) In orbit MRI enhanced by omniscan, both optic nerves are enhanced. (D) Visual field test shows improvement of visual field defects in the right eye after plasma exchange at last visit visit (1.5 years after onset time).

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  Figure 2. (A) Visual field test shows diffuse visual field defects in the right eye. (B) Fundus photo shows optic atrophy in the left eye. (C) In orbit MRI enhanced by megaray, optic nerve of the right eye is enhanced. (D) Visual field test shows improvement of visual field defects in the right eye after plasma exchange at last visit (3 years after onset time).

• 

  Figure 3. (A) Visual field test shows partial visual field defect in the left eye. (B) Fundus photo shows optic atrophy in the right eye. (C) In orbit MRI enhanced by megaray, optic nerve of the left eye is enhanced. (D) Visual field test shows improvement of visual field defect in the left eye after plasma exchange at last visit (6 months after onset time).

Reference

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