Abstract:  Objective To analyze the clinical and immunological features of blinding neuromyelitis optica spectrum disorders associated optic neuritis, and to explore the predictive factors of visual function prognosis. Design Retrospective case series. Participants Patients with blinding neuromyelitis optica spectrum disorders related optic neuritis admitted to our department from 2018 to 2022 were enrolled. Methods The patients were divided into poor prognosis group (27 cases) and good prognosis group (18 cases). The demographic characteristics, symptoms, laboratory and imaging examinations, treatment methods, and visual acuity improvement at 6 months after treatment were compared between the two groups. Main Outcome Measures Clinical features, visual acuity improvement. Results In the poor prognosis group, the proportion of patients with optic nerve involvement longer than half was higher (P=0.009), the positive rate of serum immune antibody was lower (P=0.028), and the time from onset to methylprednisolone pulse therapy was longer (P=0.032). Logistic regression showed that the length of optic nerve involvement greater than 1/2 (OR=16.247, 95%CI: 10.834-24.363, P<0.01), serological immune antibody negative (OR=13.965, 95%CI: 9.465-20.603, P<0.01), the time from onset of methylprednisolone pulse therapy (OR=1.107, 95%CI: 1.075-1.139, P<0.01) were the risk factors for poor prognosis. ROC curve analysis showed that the area under the ROC curve (AUC) for predicting poor prognosis was 0.794 (P=0.001, 95%CI： 0.659-0.928) when the time from onset was more than 7 days. Conclusions The prognosis of blinding neuromyelitis optica spectrum disorders associated with optic neuritis is poor, and the duration of methylprednisolone pulse therapy is closely related to the prognosis. (Ophthalmol CHN, 2023, 32: 392-396)

Key words: neuromyelitis optica, optic neuritis, prognosis