Visual function may improve after high-dose methylprednisolone in patients with optic neuritis, suggests study

A new study published in the Graefe's Archive for Clinical and Experimental Ophthalmology showed that all visual function measures recovered quickly and without any side effects with oral high-dose methylprednisolone optic neuritis (ON).

Serum aquaporin-4 autoantibodies are linked to neuromyelitis optica spectrum disease (NMOSD) is an inflammatory condition affecting the central nervous system. The most prevalent manifestations of this spectrum are myelitis and optic neuritis. Usually, it presents as subacute vision loss accompanied by discomfort that is frequently made worse by eye movement.

Multiple sclerosis (MS) and ON are closely related, and their pathophysiologies are typically comparable. About 50% of ON patients will go on to acquire MS. Despite no long-term effects on visual results, corticosteroids have been used extensively to treat optic neuritis and MS relapse. Their impact on the short-term recovery of visual function has been well documented. As of now, the only proven therapy for ocular neuritis is high doses of venous corticosteroids. To evaluate the changes in visual function parameters following oral high-dose methylprednisolone in ON patients, Elodie Boureaux and her colleagues carried out this study.

The patients with acute ON were analyzed retrospectively. For 3 to 5 days, the patients were given 1 g of oral methylprednisolone daily. Before treatment, 4 days, 2 weeks, 1 month, 3 months, and 6 months after treatment, visual function was assessed using the ETDRS test for visual acuity, the 30-second automated visual field test, the contrast sensitivity test, and the color vision test. At several time points, optical coherence tomography of the ganglion cells was carried out to evaluate anatomical alterations.

The research comprised a total of 29 participants in total between September 2014 and September 2016. After 3 and 6 months, approximately 80% of patients had returned to normal visual acuity. Although this recovery of all visual function measures was shown as early as 4 days following the start of therapy, it generally happened within 15 days. During the follow-up, this study saw weakening of the ganglion cell layer, which typically happens within a month.

At 6 months, the P100 wave of visually evoked potentials was seen in every patient. 2 individuals suffered a recurrence of ON during the six-year follow-up period. Also, no significant negative impacts were noted. Overall, for individuals with ON, oral high-dose methylprednisolone may be a safe and effective therapy for visual recovery.

Source:

Boureaux, E., Laurent, C., Rodriguez, T., Le Page, E., & Mouriaux, F. (2024). Visual recovery after oral high-dose methylprednisolone in acute inflammatory optic neuropathy. In Graefe’s Archive for Clinical and Experimental Ophthalmology (Vol. 262, Issue 12, pp. 3979–3985). Springer Science and Business Media LLC. https://doi.org/10.1007/s00417-024-06568-w