关键词: 脱髓鞘性视神经炎, 水通道蛋白4抗体, 髓鞘少突胶质细胞糖蛋白抗体

Abstract:  Objective To compare and analyze the clinical characteristics and treatment efficacy between patients with neuromyelitis optica spectrum disorders associated optic neuritis (NMOSD-ON) and myelin oligodendrocyte glycoprotein antibody disease associated optic neuritis (MOGAD-ON). Design Retrospective case series. Participants Forty patients （53 eyes） diagnosed with NMOSD-ON and MOGAD-ON at the Ophthalmology Center of Affiliated Hospital of Shandong Second Medical University from December 2021 to December 2024. Methods Patients were divided into NMOSD-ON group (18 patients, 22 eyes) and MOGAD-ON group (22 patients, 31 eyes) based on serum antibody results. The two groups were compared in terms of demographic characteristics, clinical manifestations (including visual acuity, ocular pain, optic disc edema), peripapillary retinal nerve fiber layer (RNFL) thickness, cranial/orbital magnetic resonance imaging (MRI) findings, treatment outcomes, and recurrence. Main Outcome Measures Demographic characteristics, clinical manifestations, best corrected visual acuity (BCVA) before and after treatment, RNFL thickness, treatment response rate, and recurrence rate. Results The proportion of females in the NMOSD-ON group was significantly higher than that in the MOGAD-ON group (88.9% vs. 50.0%, P=0.009). The age at first onset in the NMOSD-ON group was significantly older than that in the MOGAD-ON group (55.00±14.41 years vs. 24.05±16.40 years, P<0.001). The incidence of optic disc edema was significantly higher in the MOGAD-ON group than in the NMOSD-ON group (74.2% vs. 13.7%, P<0.001). The proportion of eyes with pretreatment BCVA≤0.1 was 81.8% in the NMOSD-ON group and 54.8% in the MOGAD-ON group (P=0.041). At initial presentation, both superior and temporal RNFL thicknesses in the NMOSD-ON group were lower than those in the MOGAD-ON group (both P<0.05). At the early follow-up visit (1-3 months after treatment), the rate of visual improvement (including both complete recovery and partial improvement) in the NMOSD-ON group was 36.3%, significantly inferior to the 90.4% observed in the MOGAD-ON group (P<0.001). The 1-year recurrence rates were 44.4% and 36.4% for the NMOSD-ON and MOGAD-ON groups, respectively, with no significant difference (P=0.604). Conclusions NMOSD-ON predominantly affects middle-aged and elderly individuals, with a female predominance. It presents with more severe initial visual impairment, more pronounced RNFL thinning, and poorer visual recovery after standard high-dose corticosteroid pulse therapy compared to MOGAD-ON. MOGAD-ON is more common in young people and children, has a higher incidence of optic disc edema, but shows a better response to corticosteroid therapy.

Key words:  Demyelinating optic neuritis, Aquaporin-4 antibody, Myelin oligodendrocyte glycoprotein antibody