• Neuro-Ophthalmology/Orbit

    This paper characterizes the clinical and neuroimaging findings in severe cases of myelin oligodendrocyte glycoprotein (MOG) antibody–positive bilateral recurrent optic neuritis (ON).

    Study design

    Three male adults (ages 18, 44, and 63 years) MOG-seropositive and aquaporin-4 (AQP4)-seronegative ON were evaluated using OCT, MRI, cerebrospinal fluid (CSF) and serological studies.

    Outcomes

    All patients experienced more than 7 relapses of ON with severe reduction of visual acuity and had a partial response to steroid treatment. Optic nerves were bilaterally affected, although unilateral relapses were more frequent than simultaneous bilateral recurrences. OCT imaging showed severe thinning of the peripapillary retinal nerve fiber layer. On MRI, investigators noted contrast-enhancing lesions that extended over more than half the length of the optic nerve. Analysis of CSF during ON episodes revealed normal findings. Severe visual deficits accumulated over time in 2 of 3 patients, despite immunosuppressive therapy.

    Limitations

    This study is limited by the small number of patients.

    Clinical significance

    This study finds MOG-seropositive recurrent ON typically has an aggressive disease course and poor functional and structural outcomes. Unlike previous reports, the severity and pattern of retinal and optic nerve damage closely resembled phenotypes commonly observed in AQP4-seropositive recurrent ON without fulfilling current diagnostic criteria for NMOSD.