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Acute idiopathic optic neuritis: not always benign.

R Deschamps1, A Gueguen1, A Lecler2

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|July 14, 2018
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Summary

Idiopathic optic neuritis (ON) patients experienced poor visual acuity recovery, similar to aquaporin-4 (AQP4) antibody-related ON. Myelin oligodendrocyte glycoprotein (MOG) antibody-associated ON showed better outcomes.

Keywords:
anti-aquaporin-4idiopathicmyelin oligodendrocyte glycoproteinneuromyelitis opticaoptic neuritis

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Area of Science:

  • Ophthalmology
  • Neuroscience
  • Immunology

Background:

  • Recent data on idiopathic optic neuritis (ON) are scarce.
  • Idiopathic ON lacks specific biomarkers, differentiating it from antibody-associated forms.
  • Understanding idiopathic ON is crucial for accurate diagnosis and prognosis.

Purpose of the Study:

  • To characterize a large cohort of patients with idiopathic ON.
  • To compare the clinical course and visual outcomes of idiopathic ON with MOG-antibody and AQP4-antibody associated ON.
  • To identify potential differences in disease progression and visual recovery.

Main Methods:

  • A monocentric retrospective observational study was conducted.
  • Inclusion criteria for idiopathic ON: age ≥ 16 years, ≥ 2 years follow-up, negative MOG and AQP4 immunoglobulin G antibodies, and no suggestive MRI lesions.
  • Comparison with cohorts of MOG-antibody and AQP4-antibody associated ON patients.

Main Results:

  • 23 idiopathic ON patients (82.6% female, median age 36) showed recurrent ON in 56.5% of cases.
  • Final visual acuity in idiopathic ON was similar to AQP4-ON but worse than MOG-ON (p<0.019).
  • At last evaluation, 36.8% of idiopathic ON patients had visual acuity ≤0.5, compared to 0% in MOG-ON.

Conclusions:

  • Idiopathic optic neuritis exhibits poor visual acuity recovery.
  • Visual outcomes in idiopathic ON resemble those of AQP4-antibody associated ON.
  • MOG-antibody associated ON demonstrates significantly better visual recovery compared to idiopathic ON.