Pulsed intravenous corticosteroids and plasma exchange (PE) is more effective than standard monotherapy for treating acute optic neuritis of neuromyelitis optica (NMO).

Dr Harold Merle and his team, Centre Hospitalier Universitaire de Fort de France, Hôpital Pierre Zobda-Quitman, Martinique, France, devised an investigation on 52 optic neuritis patients who were treated from 1 January 1995 to 31 December 31 2010.

Pulsed intravenous corticosteroids were used to treat 36 patients and pulsed intravenous corticosteroids plus PE was used to treat 16 patients. Ophthalmic examinations were performed at least six months after optic neuritis treatment. The Snellen scale and the logarithmic scale of Early Treatment Diabetic Retinopathy Study were used to measure visual acuity and visual field. Optical coherence tomography was used to measure retinal peripapillary fibre thickness.

The final visual acuity was 20/400 and 20/50 in the corticosteroid group and the PE group, respectively. The gain in visual acuity was 20/200 and 20/30 in the corticosteroids and PE groups, respectively.

Out of the corticosteroid group, 19 patients had a poor visual outcome, compared to just two patients in the PE group. According to the multivariate analysis, PE treatment was the sole independent factor linked to a visual acuity greater than 20/200 and it is more effective than standard monotherapy with corticosteroids.

The study is featured in the Archives of Ophthalmology and the abstract can be found here.