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Visual outcome of aquaporin-4 antibody-positive optic neuritis with maintenance therapy



To assess the effect of maintenance therapy on visual outcomes in preventing recurrences one year after first onset in patients with aquaporin-4 antibody (AQP4Ab)-positive optic neuritis.

Study design

Retrospective study.


The medical charts of 56 patients with optic neuritis (22 with AQP4Ab-positive and 34 with AQP4Ab-negative) at Niigata University Medical and Dental Hospital were retrospectively analyzed. Clinical characteristics, including visual acuity and number of recurrences one year after first onset, were compared among patients who were AQP4Ab-positivie with and those without maintenance therapy such as oral prednisolone and azathioprine, as well as those who were AQP4Ab-negative.


The mean ages were 49.3 and 45.2 years in the AQP4Ab-positive and the AQP4Ab-negative groups. The female to male ratio was 21:1 and 18:16 in the two groups, respectively. Multiple between-group comparison showed a statistically significant difference in visual acuity one year after first onset between the AQP4Ab-positive without maintenance therapy group and the AQP4Ab-negative group (0.05 (median, same applies below) vs. 1.0, p < 0.01). There was also a statistically significant difference in the number of recurrences in the year after first onset between the AQP4Ab-positive with and without maintenance therapy groups (1 vs. 0, p < 0.01).


This study demonstrates that patients with AQP4Ab-positive optic neuritis without maintenance therapy had the poorest visual acuity and the most recurrences one year after first onset. These results indicate that reducing the number of recurrences with maintenance therapy could improve the visual outcomes in patients with AQP4Ab-positive optic neuritis.

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The authors were motivated to delineate the clinical characteristics of patients with AQP4Ab-positive optic neuritis after the case reports published by Takagi et al. [14] Although Dr. Takagi passed away in December 2012, his report contributed much to this study. We would like to thank Editage ( for English language editing.

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Correspondence to Satoshi Ueki.

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Conflicts of interest

S. Ueki, None; T. Hatase, None; M. Kiyokawa, None; I. Kawachi, None; E. Saji, None; O. Onodera, None; T. Fukuchi, None; H. Igarashi, None.

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Corresponding Author: Satoshi Ueki

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Ueki, S., Hatase, T., Kiyokawa, M. et al. Visual outcome of aquaporin-4 antibody-positive optic neuritis with maintenance therapy. Jpn J Ophthalmol 65, 699–703 (2021).

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  • Optic neuritis
  • Anti-aquaporin-4 antibody
  • Visual outcome
  • Recurrences
  • Maintenance therapy