Efficacy of Plasma Exchange Therapy for Steroid-Unresponsive Neuromyelitis Optica

Seong Ho Jo; Jae Hwan Choi; Hee Yonng Choi; Jae Ho Jung

doi:10.3341/jkos.2014.55.3.465

Journal List > J Korean Ophthalmol Soc > v.55(3) > 1009925

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Jo, Choi, Choi, and Jung: Efficacy of Plasma Exchange Therapy for Steroid-Unresponsive Neuromyelitis Optica

Original Article

J Korean Ophthalmol Soc 2014;55(3):465-472.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.3.465

Efficacy of Plasma Exchange Therapy for Steroid-Unresponsive Neuromyelitis Optica

Seong Ho Jo, MD¹, Jae Hwan Choi, MD², Hee Yonng Choi, MD, PhD³, Jae Ho Jung, MD, PhD¹

¹Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Korea

²Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Korea

³Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea

Address reprint requests to Jae Ho Jung, MD, PhD Department of Ophthalmology, Pusan National University Yangsan Hospital #20 Geumo-ro, Mulgeum-eup, Yangsan 626-770, Korea, Tel: 82-55-360-2591, Fax: 82-55-360-2161, E-mail: jaeho0130@naver.com

Received 8 July 20131 September 2013 Accepted 28 January 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the therapeutic efficacy of plasma exchange therapy on steroid-unresponsive neuromyelitisoptica (NMO) patients.

Case summary

Three patients who had not achieved improvement of visual acuity and visual field after high steroid pulse therapy after optic neuritis visited our clinic with decreasing visual acuity combined with eye pain in the other eye. All patients were diagnosed as neuromyelitisoptica (NMO) based on the presence of NMO-IgG antibody and optic nerve en-hancing in contrast-enhanced orbital magnetic resonance imaging (MRI). Recurrent optic neuritis was observed. Steroid pulse retreatment was started but visual acuity was not improved in all patients. The patients received plasma exchange therapy, followed by immune suppression therapy. All patients showed improved visual acuity and restored visual field promptly without recurrence of neuromyelitisoptica.

Conclusions

In case of steroid-unresponsive neuromyelitisoptica, plasma exchange should be promptly considered as the treatment of choice.

Keywords: Neuromyelitisoptica, Plasma exchange, Steroid pulse therapy

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Figure 1.

(A) Visual field test shows right hemianopsia in the right eye. (B) Fundus photo shows optic atrophy in the left eye. (C) In orbit MRI enhanced by omniscan, both optic nerves are enhanced. (D) Visual field test shows improvement of visual field defects in the right eye after plasma exchange at last visit visit (1.5 years after onset time).

Figure 2.

(A) Visual field test shows diffuse visual field defects in the right eye. (B) Fundus photo shows optic atrophy in the left eye. (C) In orbit MRI enhanced by megaray, optic nerve of the right eye is enhanced. (D) Visual field test shows improvement of visual field defects in the right eye after plasma exchange at last visit (3 years after onset time).

Figure 3.

(A) Visual field test shows partial visual field defect in the left eye. (B) Fundus photo shows optic atrophy in the right eye. (C) In orbit MRI enhanced by megaray, optic nerve of the left eye is enhanced. (D) Visual field test shows improvement of visual field defect in the left eye after plasma exchange at last visit (6 months after onset time).

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