Visual Outcomes Following Plasma Exchange for Optic Neuritis: An International Multicenter Retrospective Analysis of 395 Optic Neuritis Attacks

John J. Chen*, Eoin P. Flanagan, Sean J. Pittock, Nicole Caroline Stern, Nanthaya Tisavipat, M. Tariq Bhatti, Kevin D. Chodnicki, Deena A. Tajfirouz, Sepideh Jamali, Amy Kunchok, Eric R. Eggenberger, Marie A.Di Nome, Elias S. Sotirchos, Eleni S. Vasileiou, Amanda D. Henderson, Anthony C. Arnold, Laura Bonelli, Heather E. Moss, Sylvia Elizabeth Villarreal Navarro, Tanyatuth PadungkiatsagulHadas Stiebel-Kalish, Itay Lotan, Adi Wilf-Yarkoni, Helen Danesh-Meyer, Stefan Ivanov, Saif Huda, Mirasol Forcadela, David Hodge, Pascale Poullin, Julie Rode, Caroline Papeix, Samir Saheb, Marine Boudot de la Motte, Catherine Vignal, Yael Hacohen, Julie Pique, Elisabeth Maillart, Romain Deschamps, Bertrand Audoin, Romain Marignier

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


PURPOSE: To evaluate the effectiveness of plasma exchange (PLEX) for optic neuritis (ON). METHODS: We conducted an international multicenter retrospective study evaluating the outcomes of ON following PLEX. Outcomes were compared to raw data from the Optic Neuritis Treatment Trial (ONTT) using a matched subset. RESULTS: A total of 395 ON attack treated with PLEX from 317 patients were evaluated. The median age was 37 years (range 9-75), and 71% were female. Causes of ON included multiple sclerosis (108), myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD) (92), aquaporin-4-IgG–positive neuromyelitis optica spectrum disorder (AQP4+NMOSD) (75), seronegative-NMOSD (34), idiopathic (83), and other (3). Median time from onset of vision loss to PLEX was 2.6 weeks (interquartile range [IQR], 1.4-4.0). Median visual acuity (VA) at the time of PLEX was count fingers (IQR, 20/200-hand motion), and median final VA was 20/25 (IQR, 20/20-20/60) with no differences among etiologies except MOGAD-ON, which had better outcomes. In 81 (20.5%) ON attacks, the final VA was 20/200 or worse. Patients with poor outcomes were older (P = .002), had worse VA at the time of PLEX (P < .001), and longer delay to PLEX (P < .001). In comparison with the ONTT subset with severe corticosteroid-unresponsive ON, a final VA of worse than 20/40 occurred in 6 of 50 (12%) PLEX-treated ON vs 7 of 19 (37%) from the ONTT treated with intravenous methylprednisolone without PLEX (P = .04). CONCLUSION: Most ON attacks improved with PLEX, and outcomes were better than attacks with similar severity in the ONTT. The presence of severe vision loss at nadir, older age, and longer delay to PLEX predicted a worse outcome whereas MOGAD-ON had a more favorable prognosis.

Original languageEnglish
Pages (from-to)213-224
Number of pages12
JournalAmerican Journal of Ophthalmology
StatePublished - Aug 2023


FundersFunder number
Caring Friends NMO Research Fund
National Institutes of HealthP30 EY 026877
National Institutes of Health
National Institute of Neurological Disorders and StrokeK23NS117883, R01NS113828
National Institute of Neurological Disorders and Stroke
Mayo Clinic
Research to Prevent Blindness
Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine


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