title: Plasma exchange response in 34 patients with severe optic neuritis.
abstract: Optic neuritis could lead to severe visual impairment despite corticosteroids. Our aim was to evaluate the rate of visual improvement in patients treated with plasma exchange (PLEX) for severe steroid unresponsive optic neuritis and to identify predictive factors of outcome. Thirty-four patients (41 optic nerves damaged) with remaining visual acuity of 0.1 or less despite steroid pulse therapy were treated with PLEX from September 2010 to May 2015. Demographic and clinical neuro-ophthalmic findings, and spectral domain-optical coherence tomography data before PLEX treatment were analyzed. The mean symptom duration before PLEX was 34.6 days (median 28 days; range 6-92 days). After PLEX, the median final visual acuity was 0.8 and in 56 % of cases, final acuity was 0.5 or better. Past history of ipsilateral optic neuritis was associated significantly with poor outcome defined as final acuity less than 0.5. No significant difference in the visual outcome after PLEX was found between multiple sclerosis and neuromyelitis optica. In conclusion, this observational study showed that PLEX as second-line therapy led to a functionally important visual recovery in more than half patients with severe optic neuritis.
authors.affiliation: Service de Neurologie, Fondation Ophtalmologique Adolphe de Rothschild, 25 Rue Manin, 75019, Paris, France. rdeschamps@fo-rothschild.fr.
authors.forename: Romain
authors.initials: R
authors.lastname: Deschamps
authors.affiliation: Service de Neurologie, Fondation Ophtalmologique Adolphe de Rothschild, 25 Rue Manin, 75019, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Gueguen
authors.affiliation: Unité d'hémaphérèse thérapeutique, Hôpital Saint-Louis, APHP, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Parquet
authors.affiliation: Service d'hématologie clinique et de Thérapie Cellulaire, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France.
authors.forename: Samir
authors.initials: S
authors.lastname: Saheb
authors.affiliation: Unité de thérapeutique transfusionnelle, Hôpital universitaire Bicêtre, AP-HP, Le Kremlin-Bicêtre, France.
authors.forename: Francoise
authors.initials: F
authors.lastname: Driss
authors.affiliation: Département d'anesthésie réanimation, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
authors.forename: Malcie
authors.initials: M
authors.lastname: Mesnil
authors.affiliation: Service d'ophtalmologie, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Vignal
authors.affiliation: Service de Neurologie, Fondation Ophtalmologique Adolphe de Rothschild, 25 Rue Manin, 75019, Paris, France.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Aboab
authors.affiliation: Service de Neurologie, Fondation Ophtalmologique Adolphe de Rothschild, 25 Rue Manin, 75019, Paris, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Depaz
authors.affiliation: Service de Neurologie, Fondation Ophtalmologique Adolphe de Rothschild, 25 Rue Manin, 75019, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Gout
mesh_terms: D000293:Adolescent; D000328:Adult; D004351:Drug Resistance; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009902:Optic Neuritis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D010951:Plasma Exchange; D011379:Prognosis; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D013256:Steroids
keywords: Corticosteroids; Multiple sclerosis; Myelin oligodendrocyte glycoprotein; Neuromyelitis optica; Optic neuritis; Plasmapheresis