2022 Volume 39 Issue 3 Pages 252-259
Introduction and Objective: This study aimed to compare the characteristics and treatment outcomes of neuromyelitis optica spectrum disorder（NMOSD）with those of typical and atypical optic neuritis（ON）at JEC Eye Hospitals in Kedoya and Menteng from 2017 to 2021.
Methods: This retrospective, descriptive study used the medical record date of patients treated with high-dose intravenous methylprednisolone at JEC Eye Hospitals. The diagnosis was made based on the Optic Neuritis Treatment Trial and International Consensus NMOSD diagnostic criteria（2015）and categorized as typical or atypical ON and NMOSD, respectively. Demographic, clinical, and radiological features and optical coherence tomography features were evaluated. The best-corrected visual acuity（BCVA）, Humphrey visual field examination, optic nerve head retinal nerve fiber layer（RNFL）thickness and macular ganglion cell complex（GCC）thickness were analyzed before and after treatment.
Result: In total, 64 patients（78 eyes）were included—43 patients（43 eyes）with typical ON, 14 patients（24 eyes）with atypical ON, and seven patients（11 eyes）with NMOSD. Most patients were women with a sudden onset of blurred vision and retrobulbar features. Older age, bilaterality, and recurrence were significantly associated with NMOSD compared to other conditions. The NMOSD and typical ON groups were more likely to present with retrobulbar ON than other groups. Long-segment optic nerve enhancement on neuroimaging was observed in all patients with NMOSD. Eyes with NMOSD had significantly lower nadir BCVA than those typical and atypical ON, with 81.78% showing nadir BCVA＜0.1. After treatment, all groups showed significant improvement in BCVA; however, the difference among the groups was not significant. Initially, the NMOSD group showed significantly lower inferior RNFL thickness than the other groups. However, the NMOSD group showed lesser thinning of the mean RNFL and GCC thickness than the other groups.
Conclusion: Bilateral involvement and recurrence of attack combined with distinctive neuroimaging features should raise awareness for NMOSD diagnosis. ON in NMOSD tended to have lower BCVA and lower inferior RNFL thickness than typical and atypical ON at initial presentation. There was no follow-up differences among the three groups in terms of BCVA and visual field improvement. The thinning of the RNFL and GCC at follow-up in the typical and atypical ON groups was more significant than that in the NMOSD group.
