Criteria for the use of plasmapheresesis in optic neuritis: A practice review from French expert centers

Abstract

Introduction: Some patients remain severely disabled after an episode of optic neuritis. Several studies have shown that plasmapheresis (PE) can improve visual prognosis in the absence of satisfactory recovery after corticosteroids. However, there is no clear ophthalmological criterion for doing PE, and practices vary widely. The objective of the present study was to better define the rationales for use of PE.

Material and methods: We investigated the real-life indications for PE in French expert centers. Based on the responses to a questionnaire and the current literature, we further provided guidelines aiming to standardize the use of PE for the management of optic neuritis.

Results: Twenty expert centers completed the questionnaire. Together, they accounted for 90% of patients treated by PE in France during the study period. The main criteria for using PE were as follows: severely impaired visual acuity despite corticosteroids (mean visual acuity<0.6 logMAR or 20/80), high suspicion for neuromyelitis optica spectrum disorder, bilateral optic neuritis, or a profound visual field alteration.

Conclusion: This study provides insightful information about the real-life indications for PE in French centers for the treatment of optic neuritis. Based on our findings and the available data in the literature, we provide a decision-making algorithm for the management of optic neuritis.

Keywords: Intravenous immunoglobulin; Multiple sclerosis; Neuromyelitis optica; Optic neuritis; Plasma exchange; Plasmapheresis.