Plasma exchange is beneficial additive to optic neuritis treatment

Aug 8 2012

By Sarah Guy, MedWire Reporter

The addition of plasma exchange (PE) to pulsed intravenous corticosteroid treatment of acute optic neuritis associated with neuromyelitis optica (NMO) results in improved visual acuity, show study results.

Significantly fewer NMO patients treated with PE plus corticosteroids had poor visual acuity at 6 months after treatment than their corticosteroid-only treated peers, and PE was the only independent factor identified by the study authors that was associated with a visual acuity greater than 20/200.

Two attacks of optic neuritis are sufficient for definitive loss of vision, explain Harold Merle and colleagues from the Hôpital Pierre Zobda-Quitman, in Martinique, France, adding that few data exist on the short-term treatment of the inflammatory disease.

The team investigated the contribution of PE in treatment of acute optic neuritis after it "showed effectiveness in several neurologic diseases that share similar physiopathologic mechanisms."

A total of 52 optic neuritis patients formed the study cohort, with a mean Expanded Disability Status Scale of 4.8 (where 10 is the maximum), and 36 (69%) were treated with sequential corticosteroids alone (2 g of methylprednisolone per day for 3‑5 days), while 16 (31%) received additional PE.

While initial visual acuity (measured with the Snellen scale and converted to logMAR) did not differ significantly between the two treatment groups, the final measurement after 6 months was significantly better in the PE group than the corticosteroid-only group, at 20/400 versus 20/50.

Indeed, three-quarters of PE-treated patients had a final visual acuity superior to 20/40, whereas just over a third (39%) of corticosteroid-only patients did, report the researchers.

They observed poor visual acuity outcomes of 20/200 or less in over half (56%) of corticosteroid-only patients, and in just 13% of PE patients.

After adjustment for factors including age, gender, and disease duration, only receipt of PE was significantly associated with achieving a visual acuity of more than 20/200.

"Our study reveals that sequential treatment with corticosteroids and PE is more effective than intravenous corticosteroids alone in optic neuritis of NMO," conclude the authors in the Archives of Ophthalmology, adding that a randomized, multicenter study is needed for definitive validation of PE.

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