한빛사논문
서울대학교병원
Young Gi Min1,2, Yeji Moon3, Young Nam Kwon4, Byung Joo Lee3, Kyung-Ah Park5, Jae Yong Han6, Jinu Han6, Haeng-Jin Lee7, Seol-Hee Baek8, Byung-Jo Kim8, Jun-Soon Kim9, Kyung Seok Park9, Nam-Hee Kim10, Martha Kim11, Tai-Seung Nam12, Seong-Il Oh13,14, Jae Ho Jung15, Jung-Joon Sung1,2, Myoung-Jin Jang16, Seong-Joon Kim15, Sung-Min Kim1,2
1Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of).
2Department of Neurology, Seoul National University Hospital, Seoul, Korea (the Republic of).
3Department of Ophthalmology, University of Ulsan College of Medicine, Seoul, Korea (the Republic of).
4Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of).
5Department of Ophthalmology, Samsung Medical Center, Seoul, Korea (the Republic of).
6Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of).
7Department of Ophthalmology, Jeonbuk National University Hospital, Jeonju, Korea (the Republic of).
8Department of Neurology, Korea University Anam Hospital, Seoul, Korea (the Republic of).
9Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of).
10Department of Neurology, Dongguk University Ilsan Hospital, Ilsan, Korea (the Republic of).
11Department of Ophthalmology, Dongguk University Ilsan Hospital, Ilsan, Korea (the Republic of).
12Department of Neurology, Chonnam University Hospital, Hwasun, Korea (the Republic of).
13Department of Neurology, Kyung Hee University Hospital, Seoul, Korea (the Republic of).
14Department of Neurology, Busan Paik Hospital, Busan, Korea (the Republic of).
15Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (the Republic of).
16Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea (the Republic of).
YGM and YM are joint first authors.
S-JK and S-MK contributed equally.
Correspondence to Professor Sung-Min Kim; Professor Seong-Joon Kim
Abstract
Background: Optic neuritis (ON) prognosis is influenced by various factors including attack severity, underlying aetiologies, treatments and consequences of previous episodes. This study, conducted on a large cohort of first ON episodes, aimed to identify unique prognostic factors for each ON subtype, while excluding any potential influence from pre-existing sequelae.
Methods: Patients experiencing their first ON episodes, with complete aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibody testing, and clinical data for applying multiple sclerosis (MS) diagnostic criteria, were enrolled. 427 eyes from 355 patients from 10 hospitals were categorised into four subgroups: neuromyelitis optica with AQP4 IgG (NMOSD-ON), MOG antibody-associated disease (MOGAD-ON), ON in MS (MS-ON) or idiopathic ON (ION). Prognostic factors linked to complete recovery (regaining 20/20 visual acuity (VA)) or moderate recovery (regaining 20/40 VA) were assessed through multivariable Cox regression analysis.
Results: VA at nadir emerged as a robust prognostic factor for both complete and moderate recovery, spanning all ON subtypes. Early intravenous methylprednisolone (IVMP) was associated with enhanced complete recovery in NMOSD-ON and MOGAD-ON, but not in MS-ON or ION. Interestingly, in NMOSD-ON, even a slight IVMP delay in IVMP by >3 days had a significant negative impact, whereas a moderate delay up to 7-9 days was permissible in MOGAD-ON. Female sex predicted poor recovery in MOGAD-ON, while older age hindered moderate recovery in NMOSD-ON and ION.
Conclusion: This comprehensive multicentre analysis on first-onset ON unveils subtype-specific prognostic factors. These insights will assist tailored treatment strategies and patient counselling for ON.
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