Clinical features and visual function of recurrent neuromyelitis optica / 中华眼底病杂志

ABSTRACT

Objective To observe the clinical features and visual function of recurrent neuromyelitis optica (NMO).Methods Thirty-four patients with NMO were enrolled in this retrospective case series study.The patients included two males and 32 females.The average first onset age was (35.03± 14.56) years old and the average recurrent rate were (4.24±2.45) times.The recurrent rate of optic neuritis (ON) ranged from two to 12 times.The recurrent rate of ON was two times in 15 eyes of 10 patients,≥three times in 37 eyes of 24 patients.Vision acuity,direct ophthalmoscope,fundus pre-set lens examination,visual field and visual evoked potential (VEP) were evaluated.Clinical features were observed.The abnormal rate of optic nerve including optic edema and atrophy; abnormal rate of visual field including decreasing retinal sensitivity,central and paracentral scotoma,ring scotoma,half field defects,tunnel visual field,visual field centrality constriction; abnormal rate of VEP including Prolonged latent phase and/or decreasing amplitude of P100 wave from patients of first episode or recurrence was analyzed.Serum NMO-IgG was detected from 28 patients hy indirect immunofluorescence technique to observe its positive rate.Results All patients were characterized by repeated episodes of ON and myelitis.The main clinical feature of ON was visual loss,and the main clinical features of myelitis included sensory disability,dyskinesia and vesicorectal disorder.Blindness rate was 41.67％ after the first attack of ON,33.33％ after two relapses,and 64.86％ after ≥ three relapses.The difference of blindness rate between first attack and two episodes was not significant (x2=0.270,P=0.603).However,the blindness rate in patients having ≥ three episodes was significantly higher than those having two episodes (x2=4.300,P=0.038).With recurrence rate increasing,the abnormal rate of the optic nerve (x2 =6.750,P =0.034) and VEP(x2 =6.990,P =0.030)increased.But the abnormal rate of visual field did not increase along with recurrent rate (x2 =0.660,P=0.718).Seropositive rate of NMO-IgG did not differ significantly between patients with first attack ON and that with recurrent ON (x2 =1.510,P =0.470).But the seropositive patients had significantly higher bilateral blindness rate than seronegative patients (x2=5.063,P=0.027).Conclusions NMO are characterized by recurrent ON and myelitis.Visual loss,sensory disability,dyskinesia and vesicorectal disorder are the main clinical features.With recurrence rate increasing,the blindness rate,abnormalities the optic nerve and the abnormity rate of VEP increase.Seropositive recurrent NMO patients have higher bilateral blindness rate than seronegative patients.