Sequential treatment with pulsed intravenous corticosteroids and plasma exchange improved visual acuity more effectively than pulsed corticosteroids alone in the treatment of optic neuritis associated with neuromyelitis optica, a study found.
“Plasma exchange is an effective technique that has been used for several decades. Plasma exchange has become more reliable, and complication rates have decreased,” the study authors said.
The study included 52 patients with optic neuritis; 36 patients were treated with pulsed intravenous corticosteroids as monotherapy and 16 were treated with sequential intravenous corticosteroids and adjunctive plasma exchange.
Patients in the pulsed corticosteroid-plasma exchange group underwent five daily consecutive exchanges during which a volume of plasma was exchanged with an albumin solution at 5%. It is believed that five exchanges withdraw more than 90% of immunoglobulin. These patients also received systemic anticoagulants.
Snellen visual acuity, visual fields and retinal peripapillary fiber thickness were assessed at least 6 months after optic neuritis treatment.
Study results showed that final visual acuity was 20/400 in the corticosteroid group and 20/50 in the corticosteroid-plasma exchange group; the between-group difference was statistically significant (P < .04). Nineteen patients in the corticosteroid group and two patients in the combination treatment group had final visual acuity of 20/200 or worse (P = .008).
Mean peripapillary fiber thickness was 63.1 μm in the corticosteroid group and 70.3 μm in the corticosteroid-plasma exchange group; the difference was not statistically significant.
Longer disease duration and absence of plasma exchange were associated with poor a prognosis; plasma exchange was the only independent variable associated with visual acuity better than 20/200, the authors said.