Aquaporin-4 Antibody-Positive Optic Neuritis: A Comparison of Clinical Characteristics and Visual Prognosis Between...

The diagnosis and treatment of aquaporin-4 antibody-positive optic neuritis (AQP4-ON) have evolved significantly over the past 20 years. We analysed 39 patients with AQP4-ON (43 eyes) treated at Inouye Eye Hospital between 2004 and 2024, dividing them into two groups: early (April 2004-March 2014, n = 22) and late (April 2014-March 2024, n = 17). We examined the clinical courses and best-corrected visual acuity (BCVA) 6 months after treatment. The age at onset was 57 (15, 74) years in the early group and 43 (25, 75) years in the late group (p = .38). All episodes were treated with at least one course of intravenous methylprednisolone (IVMP). Plasmapheresis was implemented in 1 eye (3.8%) in the early group and seven eyes (41.1%) in the late group, indicating a significantly higher use in the late group (odds ratio 16.3, 95% CI 1.7-815, p = .004). The final BCVA was 0.70 (-0.08, 3.40) logMAR in the early group and 0.10 (-0.08, 2.90) logMAR in the late group, with the late group showing significantly better outcomes (p = .042). In the late group, visual prognosis improved, and the introduction of plasmapheresis increased. Advancements in diagnosis and treatment may have contributed to the introduction of plasmapheresis in severe cases.