Short-term effect of additional apheresis on visual acuity changes in patients with steroid-resistant optic neuritis in neuromyelitis optica spectrum disorders

Purpose To evaluate temporal changes in visual acuity in patients with steroid-resistant optic neuritis (ON) in neuromyelitis optica spectrum disorders (NMOSD) after apheresis. Design Retrospective observational study, clinical case series Subjects and methods We reviewed the medical charts of 15 eyes of 9 consecutive patients with ON in NMOSD who underwent apheresis between March 2010 and September 2017. All patients were seropositive for anti-aquaporin 4 (AQP4) antibody and resistant to steroid pulse therapy. Apheresis was performed by either simple plasma exchange or/and immune adsorption therapy. Results Twelve eyes (80%) showed improvement with logMAR > 0.3 at 1 month after apheresis. Within 1 month after apheresis therapy, logMAR on average significantly decreased, the magnitude of change being greatest within the first week. Thereafter visual acuity became stable in 10 of the 11 eyes, until 12 months. However, two eyes (12%) showed recurrence of visual acuity reduction 3 months after the cessation of apheresis. There were a few serious complications during and after apheresis, but these were completely treatable. Conclusions Additional apheresis therapy rapidly improves the visual acuity of steroid-resistant seropositive AQP4 ON.