A comprehensive analysis of clinical characteristics, visual prognosis, and influencing factors in geriatric patients with demyelinating optic neuritis_Chinese Journal of Ocular Fundus Diseases

Authors：

王廉 ¹ , 张婧 ^1,2 , 陈玥 ^1,2 , 何婷 ¹ , 陈春丽 ² , 刘洪娟 ² ,  姜利斌 ²

1. Department of Ophthalmology, Beijing Puren Hospital, Beijing 100062, China; Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing 100730, China;
2. ;

Corresponding author：

姜利斌, Email: jlbjlb@sina.com

Keywords：

Geriatric patient with optic neuritis; Demyelinating optic neuritis; Clinical manifestations; Imaging; Visual prognosis

DOI：

10.3760/cma.j.cn511434-20241009-00374

Video：

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Objective To observe the clinical characteristics of elderly patients with demyelinating optic neuritis (DON), and preliminarily analyze the related factors affecting their visual prognosis. Methods A observational clinical case-control study. A total of 107 patients with DON who were diagnosed and hospitalized in Beijing Tongren Hospital and its medical alliance Department of Ophthalmology, Beijing Puren Hospital from March 2019 to October 2023 were included in this study. Detailed medical histories were recorded, including time of onset, presence of ocular pain, treatment modalities, and follow-up status. All affected eyes underwent best-corrected visual acuity (BCVA) testing, orbital magnetic resonance imaging (MRI), and laboratory tests, including erythrocyte sedimentation rate (ESR), antinuclear antibodies (ANA), extractable nuclear antigens (ENA), aquaporin-4 (AQP4) antibodies, and myelin oligodendrocyte glycoprotein (MOG) antibodies in peripheral blood. Based on age, patients were categorized into the elderly DON group (≥50 years) and the young and middle-aged DON group (＜50 years), comprising 50 and 57 cases, respectively. Furthermore, the elderly DON group was subdivided by serum-specific antibody status into the AQP4 antibody-positive ON group (AQP4-ON group), the MOG antibody-positive ON group (MOG-ON group), and the double-negative ON group (DN-ON group), with 18, 10, and 22 cases respectively. The median follow-up duration was 36 months. Follow-up assessments were conducted using the same equipment, methods, and relevant examinations as those applied at baseline. Binary logistic regression analysis was performed to identify factors associated with visual prognosis in elderly DON patients. Results Compared with the DON group of young and middle-aged people, the incidence of binocular disease, accelerated ESR, MRI imaging score, the incidence of combined cardiovascular and cerebrovascular diseases, diabetes, tumors, and the proportion of adverse reactions of glucocorticoids in the elderly group were higher, and the proportion of ocular pain was lower. The differences were statistically significant (P＜0.05). Six months after the treatment, the number of cases with BCVA＞0.3 in the affected eyes in the elderly DON group and the young and middle-aged DON group was 28 (56.0%, 28/50) and 42 (73.7%, 42/57), respectively. The number of patients with BCVA＞0.3 in the elderly DON group was significantly lower than that in the young and middle-aged DON group, and the difference was statistically significant (P=0.034). Moreover, with the increase of age, the degree of improvement in visual acuity showed a decreasing trend. The proportion of females in the AQP4-ON group, the proportion of optic chiasm and posterior optic pathway involvement in acute MRI, and the positive rate of ANA/ENA were significantly higher than those in the MOG-ON group and the DN-ON group, and the differences were statistically significant (P＜0.05). The rate of optic disc edema in the MOG-ON group was significantly higher than that in the AQP4-ON group, and the difference was statistically significant (P=0.031). One and six months after treatment, the BCVA in the MOG-ON group was significantly better than that in the AQP4-ON group and the DN-ON group, and the difference was statistically significant (P＜0.05). The results of binary logistic regression analysis showed that at the onset of the disease, BCVA＜0.01 [odds ratio (OR) =2.60, 95% confidence interval (CI) 1.23-5.52, P=0.013] and accelerated ERS (OR=4.68, 95%CI 1.08-20.18, P=0.039) was an independent risk factor affecting the prognosis of BCVA in elderly patients with DON. Conclusions There are different clinical characteristics between elderly DON patients and young and middle-aged patients. The risk of combined systemic diseases and side effects of glucocorticoids is higher, and the visual prognosis is worse. There are also differences in clinical characteristics and visual prognosis among subgroups of different serological antibodies in elderly DON. Advanced age, the lowest visual acuity at onset and immune inflammatory indicators are all factors affecting the visual prognosis of DON.

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6.	Petzold A, Fraser CL, Abegg M, et al. Diagnosis and classification of optic neuritis[J]. Lancet Neurol, 2022, 21(12): 1120-1134. DOI: 10.1016/S1474-4422(22)00200-9.
7.	中华医学会眼科学分会神经眼科学组, 兰州大学循证医学中心/世界卫生组织指南实施与知识转化合作中心. 中国脱髓鞘性视神经炎诊断和治疗循证指南(2021年)[J]. 中华眼科杂志,.1, 57(3): 171-186. DOI: 10.3760/cma. j. cn112142-20201124-00769. Ophthalmology Group, Chinese Society of Ophthalmology, Center for Evidence-based Medicine, Lanzhou University/WHO Collaborating Center for Guidelines Implementation and Knowledge Transformation. Chinese evidence-based guidelines for diagnosis and treatment of demyelinating optic neuritis[J]. Chin J Ophthalmol, 2021, 57(3): 171-186. DOI: 10.3760/cma.j.cn112142-20201124-00769.
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9.	张婧, 王廉, 姜利斌, 等. 髓鞘少突胶质细胞糖蛋白抗体阳性视神经炎糖皮质激素冲击治疗后视力预后的影响因素分析[J]. 中华眼底病杂志, 2022, 38(12): 981-987. DOI: 10.3760/cma.j.cn511434-20221107-00584.Zhang J, Wang L, Jiang LB, et al. Analysis of influencing factors related to the prognosis of visual acuity on myelin oligodendrocyte glycoprotein antibody positive optic neuritis after methylprednisolone pulse[J]. Chin J Ocul Fundus Dis, 2022, 38(12): 981-987. DOI: 10.3760/cma.j.cn511434-20221107-00584.
10.	Liu Y, Fan H, Shao Y, et al. Gut microbiota dysbiosis associated with different types of demyelinating optic neuritis in patients[J/OL]. Mult Scler Relat Disord, 2023, 72: 104619[2023-04-12]. https://pubmed.ncbi.nlm.nih.gov/36931077/. DOI: 10.1016/j.msard.2023.104619.
11.	Storoni M, Davagnanam I, Radon M, et al. Distinguishing optic neuritis in neuromyelitis optica spectrum disease from multiple sclerosis: a novel magnetic resonance imaging scoring system[J]. J Neuroophthalmol, 2013, 33(2): 123-127. DOI: 10.1097/WNO.0b013e318283c3ed.
12.	Carnero Contentti E, López PA, Criniti J, et al. Chiasmatic lesions on conventional magnetic resonance imaging during the first event of optic neuritis in patients with neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein-associated disease in a Latin American cohort[J]. Eur J Neurol, 2022, 29(3): 802-809. DOI: 10.1111/ene.15178.
13.	Santos E, Moura J, Samões R, et al. Late onset neuromyelitis optica spectrum disorders (LONMOSD) from a nationwide Portuguese study: anti-AQP4 positive, anti-MOG positive and seronegative subgroups[J/OL]. Mult Scler Relat Disord, 2022, 63: 103845[2022-05-04]. https://pubmed.ncbi.nlm.nih.gov/35594635/. DOI: 10.1016/j.msard.2022.103845.
14.	Sepulveda M, Delgado-García G, Blanco Y, et al. Late-onset neuromyelitis optica spectrum disorder: the importance of autoantibody serostatus[J/OL]. Neurol Neuroimmunol Neuroinflamm, 2019, 6(6): e607[2019-08-30]. https://pubmed.ncbi.nlm.nih.gov/31471461/. DOI: 10.1212/NXI.0000000000000607.
15.	Cai LJ, Zhang Q, Zhang Y, et al. Clinical characteristics of very late-onset neuromyelitis optica spectrum disorder[J/OL]. Mult Scler Relat Disord, 2020, 46: 102515[2020-09-19]. https://pubmed.ncbi.nlm.nih.gov/33032051/. DOI: 10.1016 /j.msard.2020.102515.
16.	Lin WS, Wang HP, Chen HM, et al. Epidemiology of pediatric multiple sclerosis, neuromyelitis optica, and optic neuritis in Taiwan[J]. J Neurol, 2020, 267(4): 925-932. DOI: 10.1007/s00415-019-09647-9.
17.	Yan H, Wang Y, Li Y, et al. Combined platelet-to-lymphocyte ratio and blood-brain barrier biomarkers as indicators of disability in acute neuromyelitis optica spectrum disorder[J]. Neurol Sci, 2024, 45(2): 709-718. DOI: 10.1007/s10072-023-07058-3.
18.	Li JY, Xue HR, Wang L, et al. Relationship of immune cells with disability and cognitive impairment in patients with neuromyelitis optica spectrum disorder[J]. Eur Rev Med Pharmacol Sci, 2023, 27(20): 9721-9728. DOI: 10.26355/eurrev_202310_34143.
19.	Wang R, Sun DR, Du Q, et al. Serum antinuclear antibodies associate with severe disease activity in neuromyelitis optica spectrum disorder[J/OL]. J Neuroimmunol, 2023, 382: 578151[2023-07-11]. https://pubmed.ncbi.nlm.nih.gov/37453208/. DOI: 10.1016/j.jneuroim.2023.578151.
20.	Kim W, Shin HG, Lee H, et al. χ-separation imaging for diagnosis of multiple sclerosis versus neuromyelitis optica spectrum disorder[J/OL]. Radiology, 2023, 307(1): e220941[2022-11-22]. https://pubmed.ncbi.nlm.nih.gov/36413128/. DOI: 10.1148/radiol.220941.
21.	Nakamura M, Ogawa R, Fujimori J, et al. Epidemiological and clinical characteristics of myelin oligodendrocyte glycoprotein antibody-associated disease in a nationwide survey[J]. Mult Scler, 2023, 29(4-5): 530-539. DOI: 10.1177/13524585231156736.
22.	Seok JM, Cho HJ, Ahn SW, et al. Clinical characteristics of late-onset neuromyelitis optica spectrum disorder: a multicenter retrospective study in Korea[J]. Mult Scler, 2017, 23(13): 1748-1756. DOI: 10.1177/1352458516685416.
23.	Song H, Chuai Y, Yang M, et al. Glial autoantibody prevalence in Chinese optic neuritis with onset after age 45: clinical factors for diagnosis[J/OL]. Front Immunol, 2023, 14: 1181908[2023-08-29]. https://pubmed.ncbi.nlm.nih.gov/37705973/. DOI: 10.3389/fimmu.2023.1181908.
24.	Yang M, Wu Y, Song H, et al. Vision prognosis and associated factors of optic neuritis in dependence of glial autoimmune antibodies[J]. Am J Ophthalmol, 2022, 239: 11-25. DOI: 10.1016/j.ajo.2022.01.015.
25.	Li HY, Cui CS, Yang HM, et al. Factors associated with disease relapse rate in the Neuromyelitis optica spectrum disorder[J]. Int J Neurosci, 2024, 134(10): 1114-1119. DOI: 10.1080 /00207454.2023.2238245. DOI: 10.1080/00207454.2023.2238245.

1. Kitley J, Leite MI, Nakashima I, et al. Prognostic factors and disease course in aquaporin-4 antibody- positive patients with neuromyelitis optica spectrum disorder from the United Kingdom and Japan[J]. Brain, 2012, 135(Pt 6): 1834-1849. DOI: 10.1093/brain/aws109.
2. Ashtari F, Mehdipour R, Eini A, et al. Epidemiologic and clinical characteristics of neuromyelitis optica spectrum disorder patients, a seven years follow-up study from Iran[J/OL]. Mult Scler Relat Disord, 2023, 77: 104852[2023-06-27]. https://pubmed.ncbi.nlm.nih.gov/37399672/. DOI: 10.1016/j.msard.2023.104852.
3. Min W, Zhang L, Wang S, et al. Clinical characteristics of late-onset neuromyelitis optica spectrum disorder[J/OL]. Mult Scler Relat Disord, 2023, 70: 104517[2023-01-15]. https://pubmed.ncbi.nlm.nih.gov/36708681/. DOI: 10.1016/j.msard.2023.104517.
4. Lotan I, Chen JJ, Hacohen Y, et al. Intravenous immunoglobulin treatment for acute attacks in myelin oligodendrocyte glycoprotein antibody disease[J]. Mult Scler, 2023, 29(9): 1080-1089. DOI: 10.1177/13524585231184738.
5. Barzegar M, Mirmosayyeb O, Nehzat N, et al. Frequency of comorbidities in neuromyelitis optica spectrum disorder[J/OL]. Mult SclerRelat Disord, 2021, 48: 102685[2020-12-09]. https://pubmed.ncbi.nlm.nih.gov/33321342/. DOI: 10.1016/j.msard.2020.102685.
6. Petzold A, Fraser CL, Abegg M, et al. Diagnosis and classification of optic neuritis[J]. Lancet Neurol, 2022, 21(12): 1120-1134. DOI: 10.1016/S1474-4422(22)00200-9.
7. 中华医学会眼科学分会神经眼科学组, 兰州大学循证医学中心/世界卫生组织指南实施与知识转化合作中心. 中国脱髓鞘性视神经炎诊断和治疗循证指南(2021年)[J]. 中华眼科杂志,.1, 57(3): 171-186. DOI: 10.3760/cma. j. cn112142-20201124-00769. Ophthalmology Group, Chinese Society of Ophthalmology, Center for Evidence-based Medicine, Lanzhou University/WHO Collaborating Center for Guidelines Implementation and Knowledge Transformation. Chinese evidence-based guidelines for diagnosis and treatment of demyelinating optic neuritis[J]. Chin J Ophthalmol, 2021, 57(3): 171-186. DOI: 10.3760/cma.j.cn112142-20201124-00769.
8. Du Q, Shi Z, Chen H, et al. Mortality of neuromyelitis optica spectrum disorders in a Chinese population[J]. Ann Clin Transl Neurol, 2021, 8(7): 1471-1479. DOI: 10.1002/acn3.51404.
9. 张婧, 王廉, 姜利斌, 等. 髓鞘少突胶质细胞糖蛋白抗体阳性视神经炎糖皮质激素冲击治疗后视力预后的影响因素分析[J]. 中华眼底病杂志, 2022, 38(12): 981-987. DOI: 10.3760/cma.j.cn511434-20221107-00584.Zhang J, Wang L, Jiang LB, et al. Analysis of influencing factors related to the prognosis of visual acuity on myelin oligodendrocyte glycoprotein antibody positive optic neuritis after methylprednisolone pulse[J]. Chin J Ocul Fundus Dis, 2022, 38(12): 981-987. DOI: 10.3760/cma.j.cn511434-20221107-00584.
10. Liu Y, Fan H, Shao Y, et al. Gut microbiota dysbiosis associated with different types of demyelinating optic neuritis in patients[J/OL]. Mult Scler Relat Disord, 2023, 72: 104619[2023-04-12]. https://pubmed.ncbi.nlm.nih.gov/36931077/. DOI: 10.1016/j.msard.2023.104619.
11. Storoni M, Davagnanam I, Radon M, et al. Distinguishing optic neuritis in neuromyelitis optica spectrum disease from multiple sclerosis: a novel magnetic resonance imaging scoring system[J]. J Neuroophthalmol, 2013, 33(2): 123-127. DOI: 10.1097/WNO.0b013e318283c3ed.
12. Carnero Contentti E, López PA, Criniti J, et al. Chiasmatic lesions on conventional magnetic resonance imaging during the first event of optic neuritis in patients with neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein-associated disease in a Latin American cohort[J]. Eur J Neurol, 2022, 29(3): 802-809. DOI: 10.1111/ene.15178.
13. Santos E, Moura J, Samões R, et al. Late onset neuromyelitis optica spectrum disorders (LONMOSD) from a nationwide Portuguese study: anti-AQP4 positive, anti-MOG positive and seronegative subgroups[J/OL]. Mult Scler Relat Disord, 2022, 63: 103845[2022-05-04]. https://pubmed.ncbi.nlm.nih.gov/35594635/. DOI: 10.1016/j.msard.2022.103845.
14. Sepulveda M, Delgado-García G, Blanco Y, et al. Late-onset neuromyelitis optica spectrum disorder: the importance of autoantibody serostatus[J/OL]. Neurol Neuroimmunol Neuroinflamm, 2019, 6(6): e607[2019-08-30]. https://pubmed.ncbi.nlm.nih.gov/31471461/. DOI: 10.1212/NXI.0000000000000607.
15. Cai LJ, Zhang Q, Zhang Y, et al. Clinical characteristics of very late-onset neuromyelitis optica spectrum disorder[J/OL]. Mult Scler Relat Disord, 2020, 46: 102515[2020-09-19]. https://pubmed.ncbi.nlm.nih.gov/33032051/. DOI: 10.1016 /j.msard.2020.102515.
16. Lin WS, Wang HP, Chen HM, et al. Epidemiology of pediatric multiple sclerosis, neuromyelitis optica, and optic neuritis in Taiwan[J]. J Neurol, 2020, 267(4): 925-932. DOI: 10.1007/s00415-019-09647-9.
17. Yan H, Wang Y, Li Y, et al. Combined platelet-to-lymphocyte ratio and blood-brain barrier biomarkers as indicators of disability in acute neuromyelitis optica spectrum disorder[J]. Neurol Sci, 2024, 45(2): 709-718. DOI: 10.1007/s10072-023-07058-3.
18. Li JY, Xue HR, Wang L, et al. Relationship of immune cells with disability and cognitive impairment in patients with neuromyelitis optica spectrum disorder[J]. Eur Rev Med Pharmacol Sci, 2023, 27(20): 9721-9728. DOI: 10.26355/eurrev_202310_34143.
19. Wang R, Sun DR, Du Q, et al. Serum antinuclear antibodies associate with severe disease activity in neuromyelitis optica spectrum disorder[J/OL]. J Neuroimmunol, 2023, 382: 578151[2023-07-11]. https://pubmed.ncbi.nlm.nih.gov/37453208/. DOI: 10.1016/j.jneuroim.2023.578151.
20. Kim W, Shin HG, Lee H, et al. χ-separation imaging for diagnosis of multiple sclerosis versus neuromyelitis optica spectrum disorder[J/OL]. Radiology, 2023, 307(1): e220941[2022-11-22]. https://pubmed.ncbi.nlm.nih.gov/36413128/. DOI: 10.1148/radiol.220941.
21. Nakamura M, Ogawa R, Fujimori J, et al. Epidemiological and clinical characteristics of myelin oligodendrocyte glycoprotein antibody-associated disease in a nationwide survey[J]. Mult Scler, 2023, 29(4-5): 530-539. DOI: 10.1177/13524585231156736.
22. Seok JM, Cho HJ, Ahn SW, et al. Clinical characteristics of late-onset neuromyelitis optica spectrum disorder: a multicenter retrospective study in Korea[J]. Mult Scler, 2017, 23(13): 1748-1756. DOI: 10.1177/1352458516685416.
23. Song H, Chuai Y, Yang M, et al. Glial autoantibody prevalence in Chinese optic neuritis with onset after age 45: clinical factors for diagnosis[J/OL]. Front Immunol, 2023, 14: 1181908[2023-08-29]. https://pubmed.ncbi.nlm.nih.gov/37705973/. DOI: 10.3389/fimmu.2023.1181908.
24. Yang M, Wu Y, Song H, et al. Vision prognosis and associated factors of optic neuritis in dependence of glial autoimmune antibodies[J]. Am J Ophthalmol, 2022, 239: 11-25. DOI: 10.1016/j.ajo.2022.01.015.
25. Li HY, Cui CS, Yang HM, et al. Factors associated with disease relapse rate in the Neuromyelitis optica spectrum disorder[J]. Int J Neurosci, 2024, 134(10): 1114-1119. DOI: 10.1080 /00207454.2023.2238245. DOI: 10.1080/00207454.2023.2238245.

Chinese Journal of Ocular Fundus Diseases

Latest ArticlesA comprehensive analysis of clinical characteristics, visual prognosis, and influencing factors in geriatric patients with demyelinating optic neuritis

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