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Short-term effect of additional apheresis on visual acuity changes in patients with steroid-resistant optic neuritis in neuromyelitis optica spectrum disorders

  • Clinical Investigation
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Abstract

Purpose

To evaluate temporal changes in visual acuity in patients with steroid-resistant optic neuritis (ON) in neuromyelitis optica spectrum disorders (NMOSD) after apheresis.

Design

Retrospective observational study, clinical case series

Subjects and methods

We reviewed the medical charts of 15 eyes of 9 consecutive patients with ON in NMOSD who underwent apheresis between March 2010 and September 2017. All patients were seropositive for anti-aquaporin 4 (AQP4) antibody and resistant to steroid pulse therapy. Apheresis was performed by either simple plasma exchange or/and immune adsorption therapy.

Results

Twelve eyes (80%) showed improvement with logMAR > 0.3 at 1 month after apheresis. Within 1 month after apheresis therapy, logMAR on average significantly decreased, the magnitude of change being greatest within the first week. Thereafter visual acuity became stable in 10 of the 11 eyes, until 12 months. However, two eyes (12%) showed recurrence of visual acuity reduction 3 months after the cessation of apheresis. There were a few serious complications during and after apheresis, but these were completely treatable.

Conclusions

Additional apheresis therapy rapidly improves the visual acuity of steroid-resistant seropositive AQP4 ON.

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References

  1. Lennon VA, Kryzer TJ, Pittock SJ, Verkman AS, Hinson SR. IgG marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel. J Exp Med. 2005;202:473–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Lennon VA, Wingerchuk DM, Kryzer TJ, Pittock SJ, Lucchinetti CF, Fujihara K, et al. A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet (London, England). 2004;364:2106–12.

    Article  CAS  Google Scholar 

  3. Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85:177–89.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Fernandes DB, Ramos Rde I, Falcochio C, Apostolos-Pereira S, Callegaro D, Monteiro ML. Comparison of visual acuity and automated perimetry findings in patients with neuromyelitis optica or multiple sclerosis after single or multiple attacks of optic neuritis. J Neuroophthalmol. 2012;32:102–6.

    Article  PubMed  Google Scholar 

  5. Nakajima H, Hosokawa T, Sugino M, Kimura F, Sugasawa J, Hanafusa T, et al. Visual field defects of optic neuritis in neuromyelitis optica compared with multiple sclerosis. BMC Neurol. 2010;10:45.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Deschamps R, Gueguen A, Parquet N, Saheb S, Driss F, Mesnil M, et al. Plasma exchange response in 34 patients with severe optic neuritis. J Neurol. 2016;263:883–7.

    Article  PubMed  Google Scholar 

  7. Abboud H, Petrak A, Mealy M, Sasidharan S, Siddique L, Levy M. Treatment of acute relapses in neuromyelitis optica: steroids alone versus steroids plus plasma exchange. Mult Scler. 2016;22:185–92.

    Article  PubMed  CAS  Google Scholar 

  8. Merle H, Olindo S, Jeannin S, Valentino R, Mehdaoui H, Cabot F, et al. Treatment of optic neuritis by plasma exchange (add-on) in neuromyelitis optica. Arch Ophthalmol. 2012;130:858–62.

    Article  PubMed  Google Scholar 

  9. Kleiter I, Gahlen A, Borisow N, Fischer K, Wernecke KD, Wegner B, et al. Neuromyelitis optica: evaluation of 871 attacks and 1,153 treatment courses. Ann Neurol. 2016;79:206–16.

    Article  PubMed  CAS  Google Scholar 

  10. Keegan M, Pineda AA, McClelland RL, Darby CH, Rodriguez M, Weinshenker BG. Plasma exchange for severe attacks of CNS demyelination: predictors of response. Neurology. 2002;58:143–6.

    Article  PubMed  CAS  Google Scholar 

  11. Kim SH, Kim W, Huh SY, Lee KY, Jung IJ, Kim HJ. Clinical efficacy of plasmapheresis in patients with neuromyelitis optica spectrum disorder and effects on circulating anti-aquaporin-4 antibody levels. J Clin Neurol (Seoul, Korea). 2013;9:36–42.

    Article  PubMed Central  Google Scholar 

  12. Grover S, Fishman GA, Anderson RJ, Tozatti MS, Heckenlively JR, Weleber RG, et al. Visual acuity impairment in patients with retinitis pigmentosa at age 45 years or older. Ophthalmology. 1999;106:1780–5.

    Article  PubMed  CAS  Google Scholar 

  13. Schulze-Bonsel K, Feltgen N, Burau H, Hansen L, Bach M. Visual acuities “hand motion” and “counting fingers” can be quantified with the Freiburg visual acuity test. Invest Ophthalmol Vis Sci. 2006;47:1236–40.

    Article  PubMed  Google Scholar 

  14. Sato T, Emi K. Analyses for visual prognosis in each edical treatment for the cases with diabetic retinopathy. JJOMT. 2012;60:264–8.

    Google Scholar 

  15. Weinshenker BG, O’Brien PC, Petterson TM, Noseworthy JH, Lucchinetti CF, Dodick DW, et al. A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease. Ann Neurol. 1999;46:878–86.

    Article  PubMed  CAS  Google Scholar 

  16. Bonnan M, Valentino R, Olindo S, Mehdaoui H, Smadja D, Cabre P. Plasma exchange in severe spinal attacks associated with neuromyelitis optica spectrum disorder. Mult Scler. 2009;15:487–92.

    Article  PubMed  CAS  Google Scholar 

  17. Kohler W, Bucka C, Klingel R. A randomized and controlled study comparing immunoadsorption and plasma exchange in myasthenic crisis. J Clin Apher. 2011;26:347–55.

    Article  PubMed  Google Scholar 

  18. Schneider-Gold C, Krenzer M, Klinker E, Mansouri-Thalegani B, Mullges W, Toyka KV, et al. Immunoadsorption versus plasma exchange versus combination for treatment of myasthenic deterioration. Ther Adv Neurol Disord. 2016;9:297–303.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kobayashi M, Nanri K, Taguchi T, Ishiko T, Yoshida M, Yoshikawa N, et al. Immunoadsorption therapy for neuromyelitis optica spectrum disorders long after the acute phase. J Clin Apher. 2015;30:43–5.

    Article  PubMed  Google Scholar 

  20. Bramlage CP, Schroder K, Bramlage P, Ahrens K, Zapf A, Muller GA, et al. Predictors of complications in therapeutic plasma exchange. J Clin Apher. 2009;24:225–31.

    Article  PubMed  Google Scholar 

  21. Heigl F, Hettich R, Arendt R, Durner J, Koehler J, Mauch E. Immunoadsorption in steroid-refractory multiple sclerosis: clinical experience in 60 patients. Atheroscler Suppl. 2013;14:167–73.

    Article  PubMed  CAS  Google Scholar 

  22. Llufriu S, Castillo J, Blanco Y, Ramio-Torrenta L, Rio J, Valles M, et al. Plasma exchange for acute attacks of CNS demyelination: predictors of improvement at 6 months. Neurology. 2009;73:949–53.

    Article  PubMed  CAS  Google Scholar 

  23. Magana SM, Keegan BM, Weinshenker BG, Erickson BJ, Pittock SJ, Lennon VA, et al. Beneficial plasma exchange response in central nervous system inflammatory demyelination. Arch Neurol. 2011;68:870–8.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We are grateful for the support of Grants-in-Aid 17K11449 (TK, MN) from the Japan Society of the Promotion of Science and to Norio Chihara for the plasma exchange treatment and to Enago (http://www.enago.jp) for the English language review.

Conflicts of interest

S. Mori, None; T. Kurimoto, None; K. Ueda, None; M. Nakamura, None.

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Authors and Affiliations

  1. Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Sotaro Mori, Takuji Kurimoto, Kaori Ueda & Makoto Nakamura

Authors
  1. Sotaro Mori
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  2. Takuji Kurimoto
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  3. Kaori Ueda
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  4. Makoto Nakamura
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Corresponding author

Correspondence to Takuji Kurimoto.

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Mori, S., Kurimoto, T., Ueda, K. et al. Short-term effect of additional apheresis on visual acuity changes in patients with steroid-resistant optic neuritis in neuromyelitis optica spectrum disorders. Jpn J Ophthalmol 62, 525–530 (2018). https://doi.org/10.1007/s10384-018-0602-9

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  • DOI: https://doi.org/10.1007/s10384-018-0602-9

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