A Severe Vision Restoration Case of Myelin Oligodendrocyte Glycoprotein-Antibody-Positive Optic Neuritis with Restricted Ocular Motility

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  • Ishikawa Hiroki
    Department of Ophthalmology, Kitasato University School of Medicine
  • Ishikawa Hitoshi
    Department of Orthoptics and Visual Sciences, Kitasato University School of Allied Health Sciences
  • Tatsui Sonoko
    Department of Ophthalmology, Kitasato University School of Medicine
  • Goseki Toshiaki
    Department of Ophthalmology, Kitasato University School of Medicine
  • Kanayama Shunsuke
    Department of Ophthalmology, Kitasato University School of Medicine
  • Iida Yoshihiko
    Department of Ophthalmology, Kitasato University School of Medicine
  • Shoji Nobuyuki
    Department of Ophthalmology, Kitasato University School of Medicine

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  • 眼球運動障害を伴った視力回復不良の抗MOG抗体陽性視神経炎の1例

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Abstract

<p>　A 74-year-old woman presented to our department with the chief complaints of right visual field narrowing, eye pain, and rapid vision loss. At the first visit, her visual acuity was “hand motion”in the right eye and 1.2 in the left eye. The right eye showed a relative afferent pupillary defect（RAPD）. Restricted ocular motility was observed in all directions. No findings other than bilateral cataract were detected. Head fat-suppressed T2-weighted magnetic resonance imaging（MRI）showed swelling and high intensity from the right retrobulbar optic nerve via the chiasm to the optic tract.</p><p>　Based on these findings, optic neuritis was suspected, and a steroid pulse therapy（methylprednisolone 1,000 mg for 3 days）was provided. During the progress, anti-myelin oligodendrocyte glycoprotein antibody（MOG-Ab）was detected in the blood test at the initial visit. It was diagnosed as MOG-Ab-positive optic neuritis and orbital apex syndrome due to the spread of inflammation. After steroid pulse therapy, ocular motility disorder improved rapidly, but visual acuity did not improve; therefore, a second course of the steroid pulse therapy was provided. Head fat-suppressed T2-weighted MRI showed decreased high intensity from the right retrobulbar optic nerve, optic chiasm, and optic tract after the 2nd course of steroid pulse therapy, but visual acuity of the right eye improved only to 0.02.</p><p>　MOG-Ab-positive optic neuritis was commonly known to have good visual outcomes; however, it is necessary to consider intractable optic neuritis as in this case.</p>

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