ABSTRACT
Objective:To compare the clinical features of patients with anti-myelin oligodendrocyte glycoprotein immunoglobulin G antibody (MOG-IgG) positive and anti-aquaporin 4 immunoglobulin G antibody (AQP4-IgG) positive optic neuritis or neuromyelitis optic spectrum disorders (NMOSD) along with optic neuritis, and to analyze prognostic factors.Methods:A total of 106 consecutive inpatients with optic neuritis as the main manifestation and with positive serum antibodies were collected in Department of Neurology, Beijing Tongren Hospital, Capital Medical University from July 2018 to August 2019. The patients were divided into MOG-IgG-positive optic neuritis (MOG-ON) group (35 cases) and AQP4-IgG-positive optic neuritis (AQP4-ON) group (71 cases) according to serum antibody type. The average follow-up period was 14.9 months (5-26 months). The clinical features and outcomes of patients with different serotypes of optic neuritis were compared, and the prognostic factors for different outcomes were analyzed.Results:Compared with AQP4-ON patients, MOG-ON patients were more common in males [37.1%(13/35) vs 15.5%(11/71), χ2=6.274], binocular involvement [48.6%(17/35) vs 19.7%(14/71), χ2=9.432], ocular pain [82.9%(29/35) vs 62.0%(44/71), χ2=4.770], papilledema [63.5%(33/52) vs 36.5%(31/85), χ2=9.442] and peripapillary hemorrhage [15.4%(8/52) vs 2.4%(2/85), χ2=6.286], and were rare in abnormality of other autoimmune indexes [11.4%(4/35) vs 52.1%(37/71), χ2=16.360] (all of them P<0.05). Similar to AQP4-ON, supratentorial and infratentorial tissues, the long segments of the cervical and thoracic cord and all parts of visual pathway were widely involved in MOG-ON, but the anterior segment of optic nerve in orbital was more frequently involved in MOG-ON than in AQP4-ON (χ2=17.506, P<0.001), while the optic nerve sheath was less involved in MOG-ON than in AQP4-ON (χ2=4.075, P=0.044). The proportion of corrected visual acuity ≥ 0.5 in MOG-ON patients (92.3%, 48/52) post three-month of disease onset was higher than that in AQP4-ON patients (50.0%, 34/68) (χ 2=24.374, P<0.001). Positive serum MOG-IgG was a favorable factor for vision acuity recovery in optic neuritis [ OR (95% CI): 11.537(2.090-63.690)], while older onset age [ OR (95% CI): 0.945 (0.908-0.983)], involvement with other nervous system [ OR(95% CI): 0.116 (0.031-0.439)], and involvement of optic nerve sheath [ OR(95% CI): 0.246 (0.066-0.916)] were adverse factors. The recurrence rate of MOG-ON (37.1%, 13/35) was lower than that of AQP4-ON (59.2%, 42/71; χ 2=4.550, P=0.033). The presence of other nervous system involvement was the promoting factor of optic neuritis recurrence [ OR (95% CI): 6.908 (2.312-20.634)]. Conclusions:Compared with AQP4-ON, MOG-ON patients are more common in men, presenting with binocular painful vision loss, optic disc edema and peri-disc hemorrhage, and involvement of the anterior orbital segment of the optic nerve, while involvement of the optic nerve sheath and other autoimmune index abnormalities are relatively rare. MOG-ON patients have better vision recovery and fewer recurrence after treatment than AQP4-ON. Older age of onset, participation of other nervous system, and immersion of optic nerve sheath, are adverse factors for recovery of optic neuritis, and involvement of other nervous system is also a promoting factor for recurrence of optic neuritis.