Materiały źródłowe

• #1 Optic Neuritis: Symptoms, Causes & Treatment Options

  https://my.clevelandclinic.org/health/diseases/14256-optic-neuritis

  Optic neuritis is when inflammation in your optic nerve causes pain, vision loss and other symptoms. Timely diagnosis and treatment may help optic neuritis and limit or delay more severe long-term effects or conditions. […] The treatment for optic neuritis generally involves one or two key approaches: […] Intravenous (IV) anti-inflammatory drugs (steroids). Reducing inflammation limits damage to your optic nerve. That should reduce pain and help with vision loss. The standard treatment course is high-dose IV or oral steroids for three to five days. After that, your provider may prescribe lower-dose oral steroids for you to continue taking. (The oral medication dosage gradually decreases, so it’s important to take them as prescribed.) […] Treating any underlying causes or contributing factors. These treatments vary. Examples include antibiotics for bacterial infections, or treatments like plasma exchange (PLEX) to reduce immune system activity if tests show you have an autoimmune disorder like NMO or MOGAD.

• #2 Optic Neuritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557853/

  High-dose intravenous corticosteroids to reduce inflammation and accelerate recovery. […] For individuals with underlying conditions like multiple sclerosis, disease-modifying therapies may be introduced to help prevent future episodes. […] The mainstay of treatment for optic neuritis is high-dose corticosteroids, typically administered intravenously for a short course, followed by an oral taper. […] Intravenous methylprednisolone is commonly used to accelerate visual recovery, although it does not affect the long-term visual outcome. […] For patients with recurrent optic neuritis or underlying multiple sclerosis or NMOSD, long-term immunomodulatory therapies such as interferon, glatiramer acetate, and monoclonal antibodies like rituximab may be considered to reduce the risk of further attacks.

• #3 Optic neuritis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/optic-neuritis/symptoms-causes/syc-20354953

  Most people who have a single episode of optic neuritis eventually recover their vision without treatment. Sometimes steroid medications may speed the recovery of vision after optic neuritis. […] Side effects of treatment. Steroid medications used to treat optic neuritis subdue your immune system, which causes your body to become more susceptible to infections. Other side effects include mood changes and weight gain.

• #4

  https://www.aao.org/eye-health/diseases/what-is-optic-neuritis

  Some people get better without any treatment for optic neuritis. However, many people need treatment to improve vision or, at least, keep their symptoms from getting worse. […] The most common treatment is a medicine called corticosteroids. For most people, taking corticosteroids helps improve their vision a lot. Sometimes, it can even help vision return to what it was before optic neuritis. However, for people with multiple sclerosis or other conditions, treatment usually does not bring their vision back to what it was before optic neuritis. […] It is very important to see an ophthalmologist if you have optic neuritis symptoms. Treatment can keep symptoms from getting worse and could save your vision.

• #5 Acute Management of Optic Neuritis: An Evolving Paradigm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6370553/

  The current management of acute optic neuritis (ON) is focused on expediting visual recovery through the use of high-dose intravenous corticosteroids. […] Initial reports suggested that ON associated with aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) autoantibodies are associated with poor and good visual outcomes, respectively. […] Nevertheless, these findings suggest that early diagnosis and disease-specific therapeutics may be key to minimizing injury, improving recovering, and preventing future vision loss after ON. […] Since the completion of the ONTT in 1992, high-dose intravenous methylprednisolone (IVMP) has been the treatment of choice for immediate therapy of acute ON. IVMP (1,000 mg daily for 3 days) followed by oral prednisone (1 mg/kg/d for 11 days) accelerated visual recovery and improved short-term, but not long-term, functional outcomes.

• #6 Optic Neuritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557853/

  High-dose intravenous corticosteroids to reduce inflammation and accelerate recovery. […] For individuals with underlying conditions like multiple sclerosis, disease-modifying therapies may be introduced to help prevent future episodes. […] The mainstay of treatment for optic neuritis is high-dose corticosteroids, typically administered intravenously for a short course, followed by an oral taper. […] Intravenous methylprednisolone is commonly used to accelerate visual recovery, although it does not affect the long-term visual outcome. […] For patients with recurrent optic neuritis or underlying multiple sclerosis or NMOSD, long-term immunomodulatory therapies such as interferon, glatiramer acetate, and monoclonal antibodies like rituximab may be considered to reduce the risk of further attacks.

• #7 Considerations for the Management of Optic Neuritis in the Inpatient Setting

  https://practicalneurology.com/diseases-diagnoses/ms-immune-disorders/considerations-for-the-management-of-optic-neuritis-in-the-inpatient-setting/31976/

  Ever since the Optic Neuritis Treatment Trial results were published in 1992, IVMP at a total dose of 1,000 mg daily for at least 3 days has been the standard treatment for acute optic neuritis. This is true regardless of cause, keeping in mind that antimicrobial therapy may need to be administered concomitantly if infectious sources are suspected or confirmed. […] Subsequent studies have investigated the use of oral steroids, intravenous immunoglobulin (IVIg), and plasma exchange (PLEX) as well. All these options may be available to the neurohospitalist at the time of evaluation of an acute optic neuritis attack, and knowledge and discernment are needed for effective treatment. […] It has long been known that treatment with IVMP generally speeds the time to visual recovery after optic neuritis but does not change the degree of eventual recovery. However, this is generally untrue for cases of NMOSD-related optic neuritis; in such cases, early treatment with IVMP within 5 days of symptom onset is crucial for improving the chances of complete or nearly complete visual acuity recovery in the long run.

• #8 Optic neuritis | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/optic-neuritis

  Optic neuritis usually improves on its own. In some cases, steroid medications are used to reduce inflammation in the optic nerve. Possible side effects from steroid treatment include weight gain, mood changes, facial flushing, stomach upset and insomnia. […] Steroid treatment is usually given by vein (intravenously). Intravenous steroid therapy quickens vision recovery, but it doesn’t appear to affect the amount of vision you’ll recover for typical optic neuritis. […] When steroid therapy fails and severe vision loss persists, a treatment called plasma exchange therapy might help some people recover their vision. Studies haven’t yet confirmed that plasma exchange therapy is effective for optic neuritis. […] If you have optic neuritis, and you have two or more brain lesions evident on MRI scans, you might benefit from multiple sclerosis medications, such as interferon beta-1a or interferon beta-1b, that may delay or help prevent MS. These injectable medications are used for people at high risk of developing MS. Possible side effects include depression, injection site irritation and flu-like symptoms.

• #9 Demyelinating Optic Neuritis – EyeWiki

  https://eyewiki.org/Demyelinating_Optic_Neuritis

  Demyelinating optic neuritis (ON) in an adult is one of the most common reasons for a young patient to seek consultation with a neuro-ophthalmologist. […] The final amount of vision recovery is independent of treatment with or without corticosteroids, however in the ON Treatment Trial (ONTT), intravenous (IV) steroids hastened the speed of recovery but not the final visual outcome compared with either oral prednisone (1 mg/kg/day) or placebo. Thus, although the natural history and prognosis of typical ON is very favorable with or without steroid treatment, steroids can be considered for speeding the rate of recovery. […] Oral prednisone alone in standard doses (1 mg/kg/day) however is not recommended for ON because in the ONTT there was a higher rate of recurrence compared to either placebo or intravenous (IV) steroids followed by oral prednisone. Higher dose (1250 mg/day) oral prednisone however could be considered on a case by case basis.

• #10 Demyelinating Optic Neuritis – EyeWiki

  https://eyewiki.org/Demyelinating_Optic_Neuritis

  Treatment involves 1000 mg IV methylprednisolone daily for 3 days followed by an 11 day oral prednisone taper. This treatment has been shown to accelerate visual recovery, but not improve long-term outcomes. […] Side effects of IV steroids should be fully discussed, especially in diabetics. […] Low dose (60 mg/day) oral steroids are contraindicated in patients who have acute ON especially in patients that carry a diagnosis of MS. […] Some MS specialists and neuro-ophthalmologists are using a methylprednisolone (Solumedrol) smoothie. Instead of administering the 1 gram of Solumedrol IV, they dilute the powder in a smoothie drink and the patient drinks one dose daily for 3 days. The smoothie drink camouflages the bitter taste. […] IV steroid treated patients recovered faster within the first 4-6 weeks post onset. However at 6 months to 10 years out, there was no statistical difference in final visual outcome between IV-steroid treated patients and placebo. […] Oral steroids in conventional doses alone are contraindicated for acute ON because of higher rate of recurrences of ON.

• #11 Optic Neuritis Clinical Guide | Cleveland Clinic

  https://my.clevelandclinic.org/departments/neurological/depts/multiple-sclerosis/ms-approaches/optic-neuritis

  When a patient presents with acute inflammatory ON, treatment includes possible methylprednisolone, 1000mg IV daily for 3-5 days, followed by prednisone taper (60mg for 4 days, 40mg daily for 4 days, then 20mg daily for 4 days). However, a clinician may opt to defer steroids based upon the patients clinical characteristics. In the Optic Neuritis Treatment Trial (ONTT), visual recovery was faster in patients receiving IV methylprednisolone compared to those receiving placebo or oral prednisone. […] If a patient has visual acuity worse than 20/40, use of IV methylprednisolone followed by a prednisone taper is recommended. If visual acuity is better than 20/40, treatment with IV methylprednisolone should be considered if a patient has baseline visual impairment in the fellow eye, severe pain, scotoma, or an occupation that demands visual precision. If a patients brain MRI demonstrates gadolinium enhancing lesions, the impetus to treat with IV methylprednisolone is higher.

• #12 Optic Neuritis Clinical Guide | Cleveland Clinic

  https://my.clevelandclinic.org/departments/neurological/depts/multiple-sclerosis/ms-approaches/optic-neuritis

  Following an episode of typical ON, patients can be followed using several clinical and imaging modalities to monitor recovery. Visual acuity tends to recover over a period of weeks, and begins 2-4 weeks after onset. Monitoring of RNFL and GCL thinning following an episode of ON generally reveals RNFL thinning as early as 4 weeks, but up to 6 months after the clinical episode. […] The prognosis for subjective visual recovery after acute demyelinating optic neuritis due to MS is generally good, and recovery begins within 2 to 4 weeks. However, objective evidence including low contrast letter acuity and OCT measures demonstrate longstanding evidence of damage following each ON episode. […] If a patient has recurrent optic neuritis, an underlying cause cannot be identified, and steroid responsiveness is apparent, the diagnosis of CRION should be considered. CRION refers to a relapsing form of optic neuritis characterized by inflammation. Patients with CRION tend to have recurrent ON upon steroid withdrawal, so chronic immunosuppression is generally advised with medications including azathioprine, methotrexate, or IVIG. Another consideration in recurrent ON is anti-MOG syndrome, an increasingly recognized etiology of central nervous system demyelinating disease, including optic neuritis.

• #13

• #14 Optic Neuritis Treatment – Vision and Eye Health

  https://www.vision-and-eye-health.com/optic-neuritis-treatment/

  When there is an underlying infection, blood tests and other investigations will be required to determine the causative organism. Once the organism is identified, the infection should be treated with the appropriate antibiotic or anti-viral as soon as possible. […] The Optic Neuritis Treatment Trial (ONTT) was a large multi-center trial that researched the role of corticosteroids (or steroids for short) in optic neuritis. It found that intravenous administration of steroid did not make any difference to the final visual outcome at 5 years when compared with no treatment nor did it protect from multiple sclerosis over the long term. What steroid therapy did was to speed up the recovery process. […] Plasma exchange works by temporarily clearing the blood of antibodies that attack the myelin sheath. This helps to stop further demyelination and inflammation of the optic nerve. It is sometimes used if the optic neuritis does not improve despite steroid therapy. Plasma exchange may help in up to 70% of those with severe, unresponsive optic neuritis.

• #15 Optic neuritis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/optic-neuritis/diagnosis-treatment/drc-20354958

  Optic neuritis usually improves on its own. In some cases, steroid medications are used to reduce inflammation in the optic nerve. Possible side effects from steroid treatment include weight gain, mood changes, facial flushing, stomach upset and insomnia. […] Steroid treatment is usually given by vein (intravenously). Intravenous steroid therapy quickens vision recovery, but it doesn’t appear to affect the amount of vision you’ll recover for typical optic neuritis. […] When steroid therapy fails and severe vision loss persists, a treatment called plasma exchange therapy might help some people recover their vision. Studies haven’t yet confirmed that plasma exchange therapy is effective for optic neuritis. […] If you have optic neuritis, and you have two or more brain lesions evident on MRI scans, you might benefit from multiple sclerosis medications, such as interferon beta-1a or interferon beta-1b, that may delay or help prevent multiple sclerosis (MS). These injectable medications are used for people at high risk of developing MS. Possible side effects include depression, injection site irritation and flu-like symptoms.

• #16 Optic neuritis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/optic-neuritis/symptoms-causes/syc-20354953

  Most people who have a single episode of optic neuritis eventually recover their vision without treatment. Sometimes steroid medications may speed the recovery of vision after optic neuritis. […] Side effects of treatment. Steroid medications used to treat optic neuritis subdue your immune system, which causes your body to become more susceptible to infections. Other side effects include mood changes and weight gain.

• #17 How far should I manage acute optic neuritis as an ophthalmologist? A United Kingdom perspective | Eye

  https://www.nature.com/articles/s41433-024-03164-4

  If there is poor initial response to IVMP, Plasma Exchange (PLEX) may be considered. This is particularly effective in AQP4-ON and MOG-ON. […] In our centres, knowing that an urgent MRI will be performed soon (within 2 days to 2 weeks), we generally do not await the MRI result to start high-dose corticosteroid therapy in suspected or relapsed non-MS-ON cases, in cases of severe vision loss, or second eyes. […] We ask our eye casualty doctors to counsel patients about the evidence from the ONTT, and the side effects and contraindications to corticosteroid therapy (Box 1), in order to offer patient choice around starting a short course of methylprednisolone, especially when the patient presents within 48h of symptom onset. […] We typically co-prescribe a calcium and vitamin D supplement for bone protection, and a proton pump inhibitor for gastric protection.

• #18 Optic neuritis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/optic-neuritis/diagnosis-treatment/drc-20354958

  Optic neuritis usually improves on its own. In some cases, steroid medications are used to reduce inflammation in the optic nerve. Possible side effects from steroid treatment include weight gain, mood changes, facial flushing, stomach upset and insomnia. […] Steroid treatment is usually given by vein (intravenously). Intravenous steroid therapy quickens vision recovery, but it doesn’t appear to affect the amount of vision you’ll recover for typical optic neuritis. […] When steroid therapy fails and severe vision loss persists, a treatment called plasma exchange therapy might help some people recover their vision. Studies haven’t yet confirmed that plasma exchange therapy is effective for optic neuritis. […] If you have optic neuritis, and you have two or more brain lesions evident on MRI scans, you might benefit from multiple sclerosis medications, such as interferon beta-1a or interferon beta-1b, that may delay or help prevent multiple sclerosis (MS). These injectable medications are used for people at high risk of developing MS. Possible side effects include depression, injection site irritation and flu-like symptoms.

• #19 Acute Management of Optic Neuritis: An Evolving Paradigm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6370553/

  Despite extensive clinical data supporting the benefit and safety of high-dose corticosteroid administration for acute ON treatment, it remains unclear whether early treatment with high-dose corticosteroids is optimal for all causes of ON, and whether other treatments should be substituted or combined with corticosteroids to improve visual outcome. […] Intravenous immunoglobulin (IVIg) and plasma exchange (PLEX) are alternative immunomodulatory therapies that may offer additional benefit for acute ON treatment. […] PLEX has been used successfully in the treatment of steroid refractory ON and NMOSD-ON. […] Immunoadsorption (IA) is an alternative form of therapeutic apheresis that allows for selective removal of antibodies from plasma using modified membranes. […] For individuals who are unresponsive to IVMP and PLEX, immunosuppression with intravenous cyclophosphamide may represent an avenue of final resort. […] Recent prospective studies have evaluated novel therapeutic approaches for neuroprotection and remyelination in acute ON. […] A treatment rationale for ON would be incomplete without consideration of the potential for recurrent vision loss.

• #20 Considerations for the Management of Optic Neuritis in the Inpatient Setting

  https://practicalneurology.com/diseases-diagnoses/ms-immune-disorders/considerations-for-the-management-of-optic-neuritis-in-the-inpatient-setting/31976/

  A lack of response to the first round of IVMP in NMOSD-related optic neuritis should not prompt treatment with more IVMP. Using multiple rounds of IVMP has not been shown to improve visual outcomes. […] IVIg has not been shown to be beneficial in the acute treatment of optic neuritis, despite its potential role in maintenance or preventative therapy in the outpatient setting. […] Careful consideration should be made as to whether the individual meets the diagnostic criteria for MS or for another disease. It is well known that some DMTs for MS, such as the interferons, natalizumab, and the S1P modulators including fingolimod, can worsen NMOSD. Therefore, use of a broad-spectrum DMT, such as rituximab, which acts against both MS and antibody-driven autoimmune disorders, could be considered. […] For these cases, discharging the patient on maintenance therapy with daily oral prednisone or a prolonged oral prednisone taper may be warranted.

• #21 Adult Optic Neuritis Treatment & Management: Approach Considerations, Steroid Therapy, Medical Care

  https://emedicine.medscape.com/article/1217083-treatment

  Plasma exchange has been used successfully in the treatment of steroid-refractory ON and NMOSD-ON. Depending on the study, improvement in visual function has been noted in 45% to 55% of treated patients. […] […] Deschamps et al found that half of patients with poor visual recovery (visual acuity worse than or equal to 20/200) after high-dose INSM experienced improvement to visual acuity of 20/30 or better after PLEX. […] […] Immunoadsorption is an alternative form of therapeutic apheresis that allows for selective removal of antibodies from plasma using modified membranes. […] […] For individuals who are unresponsive to IVMP and PLEX, immunosuppression with intravenous (IV) cyclophosphamide may represent an avenue of final resort. […] […] The ONTT protocol used intravenous steroids (methylprednisolone 250 mg qid for 3 days) with oral steroid taper and showed a decreased short-term risk for development of MS in patients with central nervous system (CNS) white matter plaques, but they had no long-term protective benefit from MS. […]

• #22 Optic Neuritis: Symptoms, Causes, Tests, Diagnosis, Treatment

  https://www.webmd.com/multiple-sclerosis/optic-neuritis-ms-vision

  Optic Neuritis Treatment […] The condition often goes away on its own. To help you heal faster, your doctor will probably give you high-dose steroid drugs through an IV. This treatment may also lower your risk of other MS problems or delay its start if its the cause. But while these drugs help the swelling go down, they wont make a difference in your vision. […] In special cases, your doctor may suggest other treatments, such as: […] Intravenous immune globulin (IVIG): You may also hear it called plasma exchange. This is a medication made from blood. You get it through a vein in your arm. Its costly, and doctors arent completely sure that it works. But it may be an option if you have severe symptoms and can’t use steroids or they havent helped you. You can get this treatment long-term if you have optic neuritis and your brain MRI shows you have lesions. […] Vitamin B12 shots. Its rare, but optic neuritis can happen when the body has too little of this nutrient. In these cases, doctors can prescribe extra vitamin B12. […] If your optic neuritis results from a disease, your doctor will treat that condition.

• #23 Optic Neuritis Treatment – Vision and Eye Health

  https://www.vision-and-eye-health.com/optic-neuritis-treatment/

  Unfortunately, trials have generally found intravenous immunoglobulins to have no clinical benefit. However, with sustained pulsed dosing, intravenous immunoglobulins may benefit those with optic neuritis that is resistant to steroid therapy. […] Large multi-center trials, such as the Controlled High-risk Avonex MS Prevention Study (CHAMPS) and Early Treatment of MS Study (ETOMS), have found that interferon may prevent or delay the onset of multiple sclerosis symptoms. […] Treatment for CCSVI is aimed at restoring normal venous flow from the brain. This can be achieved with angioplasty or liberation procedure essentially dilating the abnormal, narrow veins with balloons and/or stents. […] As far as optic neuritis is concerned, there is currently no information available regarding any possible link between CCSVI and optic neuritis. There is also no data about liberation therapy and the role it plays in optic neuritis treatment.

• #24 Optic Neuritis Treatment, Symptoms, Diagnosis & Causes

  https://www.medicinenet.com/optic_neuritis/article.htm

  Although there is no evidence that the use of oral nonsteroidal anti-inflammatory drugs (NSAIDs) have an effect on ultimate visual outcomes, they are effective in decreasing the pain on eye movement often associated with optic neuritis. […] Various disease-modifying agents, including Glatiramer acetate (Copaxone), interferon beta-1a (Avonex, Rebif), interferon beta-1b (Betaseron, Extavia), mitoxantrone (Novantrone), and natalizumab (Tysabri), are used to decrease episodes of demyelination in patients with suspected or proven multiple sclerosis. […] Intravenous immunoglobulin (IVIg) and plasma exchange (PLEX) are alternative immunomodulatory therapies that may offer additional benefit for acute optic neuritis. […] Two monoclonal antibodies, eculizumab (Soliris) and Inebilizumab (Uplizna), and a recombinant humanized antibody, enspryng (Satralizumab-MWGE) have been recently FDA approved for the treatment of neuromyelitis optica. […] Good nutrition and hydration, avoidance of tobacco, and refraining from vigorous exercise or over-heating is often recommended during the acute phase of optic neuritis.

• #25 Diagnosis and Management of Optic Neuritis

  https://www.reviewofophthalmology.com/article/diagnosis-and-management-of-optic-neuritis

  IVIG, along with intravenous methylprednisolone, can be somewhat effective in preventing NMOSD relapses and extending the time period between attacks as long as it’s given within days of onset. […] Three prescription medications are now approved for patients with AQP4 antibody-positive NMOSD, namely eculizumab, inebilizumab and satralizumab. […] Our job is to make as rapid a diagnosis as we can, to treat as quickly as possible. Or forgo a definitive diagnosis, and just start treating, based on presentation, history and any other available information. […] In lectures, he points out certain features that would bias the diagnosis towards a rare disease. In these situations, he advises plasma exchange from the start. As for risk vs benefit, he says overtreatment is preferable to the time lost fiddling around to figure it out.

• #26 Acute Management of Optic Neuritis: An Evolving Paradigm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6370553/

  Despite extensive clinical data supporting the benefit and safety of high-dose corticosteroid administration for acute ON treatment, it remains unclear whether early treatment with high-dose corticosteroids is optimal for all causes of ON, and whether other treatments should be substituted or combined with corticosteroids to improve visual outcome. […] Intravenous immunoglobulin (IVIg) and plasma exchange (PLEX) are alternative immunomodulatory therapies that may offer additional benefit for acute ON treatment. […] PLEX has been used successfully in the treatment of steroid refractory ON and NMOSD-ON. […] Immunoadsorption (IA) is an alternative form of therapeutic apheresis that allows for selective removal of antibodies from plasma using modified membranes. […] For individuals who are unresponsive to IVMP and PLEX, immunosuppression with intravenous cyclophosphamide may represent an avenue of final resort. […] Recent prospective studies have evaluated novel therapeutic approaches for neuroprotection and remyelination in acute ON. […] A treatment rationale for ON would be incomplete without consideration of the potential for recurrent vision loss.

• #27 Adult Optic Neuritis Treatment & Management: Approach Considerations, Steroid Therapy, Medical Care

  https://emedicine.medscape.com/article/1217083-treatment

  Plasma exchange has been used successfully in the treatment of steroid-refractory ON and NMOSD-ON. Depending on the study, improvement in visual function has been noted in 45% to 55% of treated patients. […] […] Deschamps et al found that half of patients with poor visual recovery (visual acuity worse than or equal to 20/200) after high-dose INSM experienced improvement to visual acuity of 20/30 or better after PLEX. […] […] Immunoadsorption is an alternative form of therapeutic apheresis that allows for selective removal of antibodies from plasma using modified membranes. […] […] For individuals who are unresponsive to IVMP and PLEX, immunosuppression with intravenous (IV) cyclophosphamide may represent an avenue of final resort. […] […] The ONTT protocol used intravenous steroids (methylprednisolone 250 mg qid for 3 days) with oral steroid taper and showed a decreased short-term risk for development of MS in patients with central nervous system (CNS) white matter plaques, but they had no long-term protective benefit from MS. […]

• #28 Acute Management of Optic Neuritis: An Evolving Paradigm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6370553/

  Despite extensive clinical data supporting the benefit and safety of high-dose corticosteroid administration for acute ON treatment, it remains unclear whether early treatment with high-dose corticosteroids is optimal for all causes of ON, and whether other treatments should be substituted or combined with corticosteroids to improve visual outcome. […] Intravenous immunoglobulin (IVIg) and plasma exchange (PLEX) are alternative immunomodulatory therapies that may offer additional benefit for acute ON treatment. […] PLEX has been used successfully in the treatment of steroid refractory ON and NMOSD-ON. […] Immunoadsorption (IA) is an alternative form of therapeutic apheresis that allows for selective removal of antibodies from plasma using modified membranes. […] For individuals who are unresponsive to IVMP and PLEX, immunosuppression with intravenous cyclophosphamide may represent an avenue of final resort. […] Recent prospective studies have evaluated novel therapeutic approaches for neuroprotection and remyelination in acute ON. […] A treatment rationale for ON would be incomplete without consideration of the potential for recurrent vision loss.

• #29 Adult Optic Neuritis Treatment & Management: Approach Considerations, Steroid Therapy, Medical Care

  https://emedicine.medscape.com/article/1217083-treatment

  Plasma exchange has been used successfully in the treatment of steroid-refractory ON and NMOSD-ON. Depending on the study, improvement in visual function has been noted in 45% to 55% of treated patients. […] […] Deschamps et al found that half of patients with poor visual recovery (visual acuity worse than or equal to 20/200) after high-dose INSM experienced improvement to visual acuity of 20/30 or better after PLEX. […] […] Immunoadsorption is an alternative form of therapeutic apheresis that allows for selective removal of antibodies from plasma using modified membranes. […] […] For individuals who are unresponsive to IVMP and PLEX, immunosuppression with intravenous (IV) cyclophosphamide may represent an avenue of final resort. […] […] The ONTT protocol used intravenous steroids (methylprednisolone 250 mg qid for 3 days) with oral steroid taper and showed a decreased short-term risk for development of MS in patients with central nervous system (CNS) white matter plaques, but they had no long-term protective benefit from MS. […]

• #30 Optic neuritis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/optic-neuritis/diagnosis-treatment/drc-20354958

  Optic neuritis usually improves on its own. In some cases, steroid medications are used to reduce inflammation in the optic nerve. Possible side effects from steroid treatment include weight gain, mood changes, facial flushing, stomach upset and insomnia. […] Steroid treatment is usually given by vein (intravenously). Intravenous steroid therapy quickens vision recovery, but it doesn’t appear to affect the amount of vision you’ll recover for typical optic neuritis. […] When steroid therapy fails and severe vision loss persists, a treatment called plasma exchange therapy might help some people recover their vision. Studies haven’t yet confirmed that plasma exchange therapy is effective for optic neuritis. […] If you have optic neuritis, and you have two or more brain lesions evident on MRI scans, you might benefit from multiple sclerosis medications, such as interferon beta-1a or interferon beta-1b, that may delay or help prevent multiple sclerosis (MS). These injectable medications are used for people at high risk of developing MS. Possible side effects include depression, injection site irritation and flu-like symptoms.

• #31 Optic neuritis: Prognosis and treatment – UpToDate

  https://www.uptodate.com/contents/optic-neuritis-prognosis-and-treatment

  Optic neuritis: Prognosis and treatment […] The prognosis and treatment of demyelinating optic neuritis will be reviewed in this topic. […] TREATMENT […] Acute treatment […] – Corticosteroids […] – Alternative acute immunomodulatory therapy […] Disease-modifying therapy […] Treatment in children […] Investigational treatments.

• #32

  https://journals.lww.com/ijo/fulltext/2011/59020/management_of_optic_neuritis.7.aspx

  Optic Neuritis Treatment Trial (ONTT) was the first major study that provided information on the natural history, role of steroids in treatment and risk of development of MS. […] The results showed that the intravenous steroid group recovered vision faster compared to those treated with oral administration or placebo, but the difference in the rate of recovery subsided within 1 month. […] Based on the findings of the ONTT, the study group made several recommendations: Treatment with oral prednisolone in conventional doses alone, is contraindicated. […] A recent study regarding the use of intravenous methylprednisolone given at regular intervals has been completed. […] At present the immunomodulating drugs that have been shown to reduce the development and severity of CDMS include interferon -1a (Avonex, Rebif), interferon -1b (Betaseron) and Glatiramer acetate.

• #33 Patient’s Guide to Optic Neuritis – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/neurology/neuro-ophthalmology/optic-neuritis

  Treatment with intravenous corticosteroids (i.e., Solu-Medrol) helps reduce the risk that a patient with Optic Neuritis will develop MS within two years. […] However, beyond two years, treatment with steroids does not affect the likelihood of developing MS. Treatment with intravenous steroids may also speed up the recovery of vision, although it does not ultimately change the extent to which vision recovers. […] For patients with optic neuritis who have an increased risk of developing MS (on the basis of an abnormal brain MRI), many studies support the early use of medications aimed to reduce the risk of MS. […] In the past several years, oral medications called fingolimod (Gilenya), BG-12 (Tecfidera), and teriflunomide (Aubagio) have recently been approved for the treatment of established MS, and some of these are used following isolated Optic Neuritis. […] Older medicines that have been used to treat MS include interferon beta-1a (Avonex or Rebif), interferon beta-1b (Betaseron), or glatiramer acetate (Copaxone). […] These medicines all require an injection, varying from once a week to several times a week.

• #34 Optic neuritis – Wikipedia

  https://en.wikipedia.org/wiki/Optic_neuritis

  Modern medical practice employs high-dose steroids, such as IV methylprednisolone, as the first-line treatment for optic neuritis. […] High dose steroids may be given intravenously (IV) or orally, though IV steroids such as methylprednisolone are typically recommended. Studies, including the Optic Neuritis Treatment Trial (ONTT), support such a guideline based on the statistically significant outcomes showing the efficacy of this treatment modality in restoring visual acuity and lessening ON’s other associated symptoms. […] Immunosuppressants may also be used in treatment. […] Pain relief may also be used.

• #35 Optic neuritis | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/optic-neuritis

  Optic neuritis usually improves on its own. In some cases, steroid medications are used to reduce inflammation in the optic nerve. Possible side effects from steroid treatment include weight gain, mood changes, facial flushing, stomach upset and insomnia. […] Steroid treatment is usually given by vein (intravenously). Intravenous steroid therapy quickens vision recovery, but it doesn’t appear to affect the amount of vision you’ll recover for typical optic neuritis. […] When steroid therapy fails and severe vision loss persists, a treatment called plasma exchange therapy might help some people recover their vision. Studies haven’t yet confirmed that plasma exchange therapy is effective for optic neuritis. […] If you have optic neuritis, and you have two or more brain lesions evident on MRI scans, you might benefit from multiple sclerosis medications, such as interferon beta-1a or interferon beta-1b, that may delay or help prevent MS. These injectable medications are used for people at high risk of developing MS. Possible side effects include depression, injection site irritation and flu-like symptoms.

• #36 Considerations for the Management of Optic Neuritis in the Inpatient Setting

  https://practicalneurology.com/diseases-diagnoses/ms-immune-disorders/considerations-for-the-management-of-optic-neuritis-in-the-inpatient-setting/31976/

  Ever since the Optic Neuritis Treatment Trial results were published in 1992, IVMP at a total dose of 1,000 mg daily for at least 3 days has been the standard treatment for acute optic neuritis. This is true regardless of cause, keeping in mind that antimicrobial therapy may need to be administered concomitantly if infectious sources are suspected or confirmed. […] Subsequent studies have investigated the use of oral steroids, intravenous immunoglobulin (IVIg), and plasma exchange (PLEX) as well. All these options may be available to the neurohospitalist at the time of evaluation of an acute optic neuritis attack, and knowledge and discernment are needed for effective treatment. […] It has long been known that treatment with IVMP generally speeds the time to visual recovery after optic neuritis but does not change the degree of eventual recovery. However, this is generally untrue for cases of NMOSD-related optic neuritis; in such cases, early treatment with IVMP within 5 days of symptom onset is crucial for improving the chances of complete or nearly complete visual acuity recovery in the long run.

• #37 Diagnosis and Management of Optic Neuritis

  https://www.reviewofophthalmology.com/article/diagnosis-and-management-of-optic-neuritis

  In the late 1980s and early 1990s, the Optic Neuritis Treatment Trial compared patients with newly developed optic neuritis treated with either oral prednisone, IV methylprednisolone or placebo. They found no long-term benefits to visual outcomes and that those with optic neuritis recovered their sight, with or without medication. […] We used to say that there’s no urgency to treat, says Dr. Sergott. Ophthalmologists and neuro-ophthalmologists assumed ON was synonymous with MS. MS is a very serious disease, but for patients with ON and MS, their vision will improve quite well without steroids. […] That all changed when biomarkers for two CNS-attacking autoimmune diseases were discovered in the mid-2000s. […] In NMOSD, patients with this disease are anti-aquaporin-4 antibody-positive. The disease moves quickly. These patients don’t have a lot of time to wait for treatment, Dr. Sergott says. They will get irreversible damage that they can’t repair. In MOGAD, the immune system attacks a protein called the myelin oligodendrocyte glycoprotein, found on the CNS sheath. MOGAD also affects the optic nerves and brain. These patients also require treatment within a week after symptom onset to limit the severity of the attack.

• #38 Considerations for the Management of Optic Neuritis in the Inpatient Setting

  https://practicalneurology.com/diseases-diagnoses/ms-immune-disorders/considerations-for-the-management-of-optic-neuritis-in-the-inpatient-setting/31976/

  A lack of response to the first round of IVMP in NMOSD-related optic neuritis should not prompt treatment with more IVMP. Using multiple rounds of IVMP has not been shown to improve visual outcomes. […] IVIg has not been shown to be beneficial in the acute treatment of optic neuritis, despite its potential role in maintenance or preventative therapy in the outpatient setting. […] Careful consideration should be made as to whether the individual meets the diagnostic criteria for MS or for another disease. It is well known that some DMTs for MS, such as the interferons, natalizumab, and the S1P modulators including fingolimod, can worsen NMOSD. Therefore, use of a broad-spectrum DMT, such as rituximab, which acts against both MS and antibody-driven autoimmune disorders, could be considered. […] For these cases, discharging the patient on maintenance therapy with daily oral prednisone or a prolonged oral prednisone taper may be warranted.

• #39 Moran CORE | Optic Neuritis–How to assess for optic neuritis and ddx

  https://morancore.utah.edu/section-05-neuro-ophthalmology/optic-neuritis-how-to-assess-for-optic-neuritis-and-ddx/

  The presence of AQP4-Ab portends a worse prognosis and is often minimally responsive to steroids. Early consideration of plasma exchange should occur in a patient with optic neuritis with known AQP4-Ab or with high suspicion. […] All patients with AQP4-Ab should be treated long-term with immunosuppression, such as rituximab, azathioprine, or complement inhibitors. It is important to note that some MS DMTs worsen AQP4-Ab related disease. […] Other causes of optic neuritis such as infection or autoimmune diseases require treatment of the underlying disease itself.

• #40 Adult Optic Neuritis: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/1217083-overview

  Eculizumab, a monoclonal antibody that targets C5, is the first drug specifically approved by the US Food and Drug Administration (FDA) for adults with neuromyelitis optica spectrum disorder (NMOSD) who are seropositive for anti-aquaporin-4 (AQP4) antibody. […] The FDA has also approved inebilizumab, a monoclonal antibody that binds to CD19, and satralizumab for the treatment of NMOSD in adults who are seropositive for anti-aquaporin-4 or AQP4 antibody.

• #41 Adult Optic Neuritis Treatment & Management: Approach Considerations, Steroid Therapy, Medical Care

  https://emedicine.medscape.com/article/1217083-treatment

  Finding professional help early in optic neuritis (ON) is important. The Optic Neuritis Treatment Trial (ONTT) was a carefully performed, randomized, clinical trial that yielded useful information. Despite the ONTT, the treatment of ON remains somewhat controversial. From a vision standpoint, observation without steroid treatment versus intravenous steroid treatment showed no difference in ultimate visual outcome at the 5-year mark. […] […] Eculizumab, a monoclonal antibody that targets C5, is the first drug approved by the FDA for adults with neuromyelitis optica spectrum disorder (NMOSD) who are antiaquaporin-4 antibodypositive. Approval was based on the PREVENT clinical trial. Results showed that eculizumab reduced the risk for NMOSD relapse by 94.2% compared with placebo. […] […] Inebilizumab is a monoclonal antibody that targets CD19, a protein expressed on a broad range of B cells, including antibody-secreting plasmablasts and plasma cells. After binding to CD19, these cells are rapidly depleted from the circulation. […]

• #42

  https://journals.lww.com/ijo/fulltext/2021/09000/approach_to_optic_neuritis__an_update.7.aspx

  Neuromyelitis optic spectrum disorder (NMOSD) is a debilitating disease with severe relapses and permanent disability. Therefore, it is important to plan long-term immunosuppression to maintain remission and prevent relapses. Various immunosuppressants like azathioprine, methotrexate, and mycophenolate are the commonly used agents. […] Myelin oligodendrocyte associated ON (MOG-ON) has a good visual prognosis but has more frequent relapses as compared to MS and NMO. The maintenance therapy includes oral steroids slowly tapered over few weeks followed by azathioprine 50-100 mg/day of steroids. […] Chronic recurrent inflammatory ON (CRION) also needs long-term immune suppression to prevent relapses. After treatment of acute attack, the patient is maintained on low-dose corticosteroids. Immunosuppressants like azathioprine, methotrexate, cyclophosphamide, or mycophenolate have been shown to be beneficial for long-term remission. […] Various agents like erythropoietin, anti-LINGO antibodies, and phenytoin are being explored for neuroprotection and remyelination.

• #43 Optic Neuritis: A Brief Review

  https://www.uspharmacist.com/article/optic-neuritis-a-brief-review

  Based upon Neuromyelitis Optica Study Group treatment guidelines, various DMDs are indicated for NMO. Azathioprine or rituximab are considered first-line agents, while methotrexate, mitoxantrone, mycophenolate, and tocilizumab are alternative second- or third-line choices. […] Long-term corticosteroid treatment is necessary with some of the atypical ON etiologies to prevent relapse. […] It is pertinent to note that there are no established, definitive treatment guidelines for atypical ON. Evidence is mostly retrospective, observational, and not derived from randomized, controlled clinical studies. This constitutes mainly level IV evidence for clinical studies, on a scale of I to V, with level I being the strongest evidence and level V being the weakest. […] Demyelination and axonal loss are the major reasons for vision loss or impairment. Corticosteroids and DMDs cannot reverse these pathologic changes, but they may improve visual function in the short term. Thus, research has focused on investigational drugs to stop the progression of demyelination and axonal loss, repair the existing damage, and lead to better long-term visual outcomes, but to date none have been clinically successful.

• #44 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=134&contentid=44

• #45

  https://journals.lww.com/ijo/fulltext/2021/09000/approach_to_optic_neuritis__an_update.7.aspx

  Patients with MOG-ON and CRION show significant visual recovery in response to intravenous steroid treatment (intravenous methylprednisolone 1 g/day for 35 days). In these disease conditions, patients are often placed a prolonged, slow oral steroid taper over 68 weeks. […] The treatment effect of intravenous steroids is limited for patients with NMOSD and repeated steroid treatment in these patients has not been shown to improve the rate of disease remission. […] Plasmapheresis is indicated for patients with acute ON who fail to respond to standard intravenous steroid treatment, experience recurrent disease, or those with either proven or suspected NMOSD. […] The treatment of MS includes disease-modifying drugs (DMD) such as interferon, immunomodulators like glatiramer acetate (GA) and fingolimod, and monoclonal antibodies like natalizumab.

• #46 Moran CORE | Optic Neuritis–How to assess for optic neuritis and ddx

  https://morancore.utah.edu/section-05-neuro-ophthalmology/optic-neuritis-how-to-assess-for-optic-neuritis-and-ddx/

  The optic neuritis treatment trial showed us that patients with typical optic neuritis have the same recovery with or without treatment. Patients who received high dose IV steroids (total of 1g/day x 3 days followed by oral taper) experienced quicker recovery, however. […] More recently, bioequivalent mega dose oral prednisone (1250 mg/day x 3-5 days) has been used for optic neuritis/MS relapses. While it is common to treat typical optic neuritis with high dose steroids, one should discuss with the patient the risks of steroids, along with the evidence indicating that long-term outcomes are unchanged. […] The importance of identifying atypical optic neuritis is the change in the approach to treatment. MOG-Ab associated optic neuritis is commonly very responsive to steroids with good recovery, though may have a higher risk of relapse. MOG-Ab patients with only one episode of optic neuritis with good recovery may be monitored without disease modifying treatment. MOG-Ab patients with additional lesions, incomplete recovery, or recurrent disease are more likely to need long-term immunosuppression.

• #47

  https://journals.lww.com/ijo/fulltext/2021/09000/approach_to_optic_neuritis__an_update.7.aspx

  Neuromyelitis optic spectrum disorder (NMOSD) is a debilitating disease with severe relapses and permanent disability. Therefore, it is important to plan long-term immunosuppression to maintain remission and prevent relapses. Various immunosuppressants like azathioprine, methotrexate, and mycophenolate are the commonly used agents. […] Myelin oligodendrocyte associated ON (MOG-ON) has a good visual prognosis but has more frequent relapses as compared to MS and NMO. The maintenance therapy includes oral steroids slowly tapered over few weeks followed by azathioprine 50-100 mg/day of steroids. […] Chronic recurrent inflammatory ON (CRION) also needs long-term immune suppression to prevent relapses. After treatment of acute attack, the patient is maintained on low-dose corticosteroids. Immunosuppressants like azathioprine, methotrexate, cyclophosphamide, or mycophenolate have been shown to be beneficial for long-term remission. […] Various agents like erythropoietin, anti-LINGO antibodies, and phenytoin are being explored for neuroprotection and remyelination.

• #48 Optic Neuritis Clinical Guide | Cleveland Clinic

  https://my.clevelandclinic.org/departments/neurological/depts/multiple-sclerosis/ms-approaches/optic-neuritis

  Following an episode of typical ON, patients can be followed using several clinical and imaging modalities to monitor recovery. Visual acuity tends to recover over a period of weeks, and begins 2-4 weeks after onset. Monitoring of RNFL and GCL thinning following an episode of ON generally reveals RNFL thinning as early as 4 weeks, but up to 6 months after the clinical episode. […] The prognosis for subjective visual recovery after acute demyelinating optic neuritis due to MS is generally good, and recovery begins within 2 to 4 weeks. However, objective evidence including low contrast letter acuity and OCT measures demonstrate longstanding evidence of damage following each ON episode. […] If a patient has recurrent optic neuritis, an underlying cause cannot be identified, and steroid responsiveness is apparent, the diagnosis of CRION should be considered. CRION refers to a relapsing form of optic neuritis characterized by inflammation. Patients with CRION tend to have recurrent ON upon steroid withdrawal, so chronic immunosuppression is generally advised with medications including azathioprine, methotrexate, or IVIG. Another consideration in recurrent ON is anti-MOG syndrome, an increasingly recognized etiology of central nervous system demyelinating disease, including optic neuritis.

• #49

  https://journals.lww.com/ijo/fulltext/2021/09000/approach_to_optic_neuritis__an_update.7.aspx

  Neuromyelitis optic spectrum disorder (NMOSD) is a debilitating disease with severe relapses and permanent disability. Therefore, it is important to plan long-term immunosuppression to maintain remission and prevent relapses. Various immunosuppressants like azathioprine, methotrexate, and mycophenolate are the commonly used agents. […] Myelin oligodendrocyte associated ON (MOG-ON) has a good visual prognosis but has more frequent relapses as compared to MS and NMO. The maintenance therapy includes oral steroids slowly tapered over few weeks followed by azathioprine 50-100 mg/day of steroids. […] Chronic recurrent inflammatory ON (CRION) also needs long-term immune suppression to prevent relapses. After treatment of acute attack, the patient is maintained on low-dose corticosteroids. Immunosuppressants like azathioprine, methotrexate, cyclophosphamide, or mycophenolate have been shown to be beneficial for long-term remission. […] Various agents like erythropoietin, anti-LINGO antibodies, and phenytoin are being explored for neuroprotection and remyelination.

• #50 Optic Neuritis: Causes and Treatment | Doctor

  https://patient.info/doctor/acute-optic-neuritis

  Refer to an ophthalmologist and/or neurologist. Usually, an ophthalmologist is involved in the initial assessment, diagnosis and treatment. Further management regarding the risk of MS (below) usually requires neurological expertise. […] Corticosteroids are generally used during the acute phase: Treatment with methylprednisolone speeds up visual recovery in the acute phase, but has no effect on final visual acuity. Side-effects of corticosteroids can be serious. Therefore, they are usually reserved for patients who need to hasten visual recovery, such as those with poor vision in the fellow eye or bilateral visual loss, or for occupational reasons. […] The further management of optic neuritis will depend on which subtype of optic neuritis is diagnosed. Those who have relapses after reduction of corticosteroids may need immunosuppression. There are several disease-modifying treatments approved for multiple sclerosis, and there are other immunosuppressive strategies used to treat optic neuritis associated with antibodies to MOG or aquaporin 4 and chronic relapsing inflammatory optic neuropathy; these include azathioprine, methotrexate, mycophenolate, rituximab and plasma exchange.

• #51 Treatment and Relapse Prevention of Typical and Atypical Optic Neuritis

  https://www.mdpi.com/1422-0067/23/17/9769

  Treatment and Relapse Prevention of Typical and Atypical Optic Neuritis […] Optic neuritis (ON) is an inflammatory condition involving the optic nerve. […] Appropriate and timely diagnosis is essential to rapidly decide on the appropriate treatment, maximize visual recovery, and minimize recurrences. This review paper aims at presenting the currently available state-of-the-art treatment strategies for typical and atypical ON, both in the acute phase and in the long-term. […] Corticosteroid use has traditionally been the common approach for the treatment of ON, with the first implementation dating back to the 1950s. […] The current standard of care for typical optic neuritis, still based on the results of the ONTT, is either no treatment in mild cases or the administration of intravenous steroids to accelerate visual recovery. […] A proton pump inhibitor may also be given to prevent peptic ulcers. There is no role for low-dose oral prednisone. […] The ONTT showed that vision recovered faster in the intravenous group than in the other groups, although the difference among the three groups had faded by 30 days. […] The study findings demonstrated that the natural course of visual functions after an episode of typical optic neuritis, either treated or untreated, is one of a rapid visual recovery beginning within 2 weeks after the onset of symptoms, with most of the recovery often taking place after 4 to 6 weeks, and further slow recovery over several months, even up to 1 year. […] The findings of the ONTT also indicated that recurrences of optic neuritis occurred more commonly in patients treated with oral prednisolone alone. […] The ONTT also found that among the 389 patients without a diagnosis of clinically probable or definite MS at study entry, the intravenous steroid group showed a lower rate of development of clinically definite MS within the first 2 years than did the placebo or prednisone groups. […] Intravenous immunoglobulin (IVIg) has a potential role in the management of acute optic neuritis, though evidence is limited, and the agent is typically reserved for the treatment of patients with steroid-refractory ON. […] The current standard of care for typical optic neuritis, still based on the results of the ONTT, is either no treatment in mild cases or the administration of intravenous steroids to accelerate visual recovery. […] The early treatment of CIS is not favored by all experts. […] The goal of MS treatment is to delay the onset of additional clinical relapses and possibly long-term disability. […] The first opportunity to initiate disease-modifying therapy in patients with MS may actually be when they are in the clinically isolated syndrome (CIS) stage, i.e., before conversion to clinically definite MS (CDMS). […] The treatment of MOGAD has been largely extrapolated from AQP4-IgG NMOSD and is currently understandardized, still based on clinical experience and observational studies, with no approved drugs, to date, for long-term relapse prevention in adult patients. […] The treatment of MOGAD has been largely extrapolated from AQP4-IgG NMOSD and is currently understandardized, still based on clinical experience and observational studies, with no approved drugs, to date, for long-term relapse prevention in adult patients. […] The main characteristic of patients with chronic relapsing inflammatory optic neuropathy (CRION) is the rapid and excellent response to corticosteroid therapy, as well steroid dependence, with relapses within weeks or months after the withdrawal of or a decrease in corticosteroids. […] For the time being, treatment recommendations are based on the activity of the disease and the clinical experience with related disorders, as no CRION-specific formal guidelines have been established yet.

• #52 Optic Neuritis Treatment – Vision and Eye Health

  https://www.vision-and-eye-health.com/optic-neuritis-treatment/

  When there is an underlying infection, blood tests and other investigations will be required to determine the causative organism. Once the organism is identified, the infection should be treated with the appropriate antibiotic or anti-viral as soon as possible. […] The Optic Neuritis Treatment Trial (ONTT) was a large multi-center trial that researched the role of corticosteroids (or steroids for short) in optic neuritis. It found that intravenous administration of steroid did not make any difference to the final visual outcome at 5 years when compared with no treatment nor did it protect from multiple sclerosis over the long term. What steroid therapy did was to speed up the recovery process. […] Plasma exchange works by temporarily clearing the blood of antibodies that attack the myelin sheath. This helps to stop further demyelination and inflammation of the optic nerve. It is sometimes used if the optic neuritis does not improve despite steroid therapy. Plasma exchange may help in up to 70% of those with severe, unresponsive optic neuritis.

• #53 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=134&contentid=44

• #54 Considerations for the Management of Optic Neuritis in the Inpatient Setting

  https://practicalneurology.com/diseases-diagnoses/ms-immune-disorders/considerations-for-the-management-of-optic-neuritis-in-the-inpatient-setting/31976/

  Ever since the Optic Neuritis Treatment Trial results were published in 1992, IVMP at a total dose of 1,000 mg daily for at least 3 days has been the standard treatment for acute optic neuritis. This is true regardless of cause, keeping in mind that antimicrobial therapy may need to be administered concomitantly if infectious sources are suspected or confirmed. […] Subsequent studies have investigated the use of oral steroids, intravenous immunoglobulin (IVIg), and plasma exchange (PLEX) as well. All these options may be available to the neurohospitalist at the time of evaluation of an acute optic neuritis attack, and knowledge and discernment are needed for effective treatment. […] It has long been known that treatment with IVMP generally speeds the time to visual recovery after optic neuritis but does not change the degree of eventual recovery. However, this is generally untrue for cases of NMOSD-related optic neuritis; in such cases, early treatment with IVMP within 5 days of symptom onset is crucial for improving the chances of complete or nearly complete visual acuity recovery in the long run.

• #55 How to Manage Pediatric Optic Neuritis

  https://www.reviewofophthalmology.com/article/how-to-manage-pediatric-optic-neuritis

  The treatment regimen often prescribed for adults with typical isolated demyelinating optic neuritis is dictated by the Optic Neuritis Treatment Trial. No such trial has yet been performed for children with optic neuritis. As a result, there’s no standard regimen for treatment of pediatric optic neuritis, and the choice of treatment is dependent upon the clinician. […] Using data on adults from the ONTT and applying it to children, the initial treatment of choice for pediatric optic neuritis is intravenous methylprednisolone for three to five days (20 to 30 mg/kg/d, 1 g maximum). Some physicians follow this with an oral prednisone taper similar to that in the ONTT. In cases of refractory vision loss or more extensive CNS involvement, intravenous immunoglobulin or plasma exchange are used as well. Lack of improvement despite treatment should raise your level of suspicion for neuromyelitis optica or NMO-SD. […] Treatment of neuromyelitis optica and multiple sclerosis is beyond the scope of this article, and should be managed by a pediatric neurologist or neuroimmunologist, with vision monitoring performed by the ophthalmologist.

• #56 How to Manage Pediatric Optic Neuritis

  https://www.reviewofophthalmology.com/article/how-to-manage-pediatric-optic-neuritis

  The treatment regimen often prescribed for adults with typical isolated demyelinating optic neuritis is dictated by the Optic Neuritis Treatment Trial. No such trial has yet been performed for children with optic neuritis. As a result, there’s no standard regimen for treatment of pediatric optic neuritis, and the choice of treatment is dependent upon the clinician. […] Using data on adults from the ONTT and applying it to children, the initial treatment of choice for pediatric optic neuritis is intravenous methylprednisolone for three to five days (20 to 30 mg/kg/d, 1 g maximum). Some physicians follow this with an oral prednisone taper similar to that in the ONTT. In cases of refractory vision loss or more extensive CNS involvement, intravenous immunoglobulin or plasma exchange are used as well. Lack of improvement despite treatment should raise your level of suspicion for neuromyelitis optica or NMO-SD. […] Treatment of neuromyelitis optica and multiple sclerosis is beyond the scope of this article, and should be managed by a pediatric neurologist or neuroimmunologist, with vision monitoring performed by the ophthalmologist.

• #57 Optic neuritis | Great Ormond Street Hospital

  https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/optic-neuritis/

  Steroids are given to reduce the inflammation around the optic nerves. They can be given into a vein (infusion) for three days or sometimes given by mouth (orally). […] Steroids shorten the duration of the symptoms, but they do not improve the long-term outcome.

• #58 Optic Neuritis

  https://aapos.org/glossary/optic-neuritis

  Most children with optic neuritis get better on their own. Vision usually starts to improve in a few weeks. Many kids get back to their normal vision. In some cases, doctors may give medicines (corticosteroids/steroids) to help speed up healing. Certain causes of optic neuritis (mentioned above) have their own special treatments. Some kids may treatment for a long time to make vision better and keep the problem from coming. Sadly, a small number of children do not get their vision back even with best treatments.

• #59 Optic Neuritis | Causes, Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/o/optic-neuritis

  Early diagnosis and treatment give the child a better chance of recovery. Most children get their vision back after treatment with medication. […] The goal of treatment is to find and control inflammation in the optic nerve. First, a child receives steroids through the veins to quiet the inflammation. This helps speed recovery. […] In cases that are caused by an autoimmune disease, doctors may prescribe medicines that calm the immune system (called immunotherapies) to improve symptoms. They also help prevent optic neuritis from coming back. […] The Multiple Sclerosis and Neuroimmunology Center is home to specially trained doctors who treat optic neuritis in children. Our team is prepared to care for your child’s unique needs, from diagnosis to treatment to long-term follow-up. Receiving this well-coordinated care in one location can improve outcomes.

• #60 Optic Neuritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557853/

  Recent trends in the management of optic neuritis have focused on improving diagnostic accuracy and exploring novel therapeutic options. […] Neuroprotective therapies in optic neuritis are gaining increasing attention for their potential to preserve axonal integrity and prevent permanent vision loss, particularly in patients with multiple sclerosis or NMOSD. […] Agents such as phenytoin, which has shown some neuroprotective properties, are being investigated in clinical trials. […] Furthermore, research into remyelinating therapies, such as anti-LINGO-1 monoclonal antibodies, offers promising future options for reducing inflammation and promoting the repair of damaged myelin. […] Guidelines provided by the American Academy of Neurology, the American Academy of Ophthalmology, and the National Multiple Sclerosis Society (NMSS) recommend the use of high-dose intravenous corticosteroids for managing optic neuritis and emphasize the importance of early neuroimaging, particularly MRI, to assess the risk of multiple sclerosis. […] Visual rehabilitation services are essential for patients with significant residual visual impairment. […] Continuous monitoring of visual acuity, color vision, and contrast sensitivity over time is critical, especially in cases where visual recovery may be prolonged or incomplete.

• #61 Re-evaluating the treatment of acute optic neuritis | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/86/7/799

  Intravenous immunoglobulin (IVIg) and plasma exchange (PLEX) also have been studied for the treatment of AON. […] PLEX has demonstrated efficacy in the treatment of refractory AON and AON associated with neuromyelitis optica (NMO). […] Systemic infusion of erythropoietin with and without methylprednisolone has demonstrated beneficial effects on retinal ganglion cell (RGC) function and survival in a rat model of experimental autoimmune encephalomyelitis. […] Recent studies have shown that -melanocyte stimulating hormone and adrenocorticotropic hormone (ACTH) have anti-inflammatory effects in a number of models of acute CNS and ocular inflammation. […] The array of MS therapies has increased rapidly over the past decade. […] The ability of these therapies to minimise injury or promote recovery after acute demyelination, however, has rarely been evaluated.

• #62 Optic Neuritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557853/

  Recent trends in the management of optic neuritis have focused on improving diagnostic accuracy and exploring novel therapeutic options. […] Neuroprotective therapies in optic neuritis are gaining increasing attention for their potential to preserve axonal integrity and prevent permanent vision loss, particularly in patients with multiple sclerosis or NMOSD. […] Agents such as phenytoin, which has shown some neuroprotective properties, are being investigated in clinical trials. […] Furthermore, research into remyelinating therapies, such as anti-LINGO-1 monoclonal antibodies, offers promising future options for reducing inflammation and promoting the repair of damaged myelin. […] Guidelines provided by the American Academy of Neurology, the American Academy of Ophthalmology, and the National Multiple Sclerosis Society (NMSS) recommend the use of high-dose intravenous corticosteroids for managing optic neuritis and emphasize the importance of early neuroimaging, particularly MRI, to assess the risk of multiple sclerosis. […] Visual rehabilitation services are essential for patients with significant residual visual impairment. […] Continuous monitoring of visual acuity, color vision, and contrast sensitivity over time is critical, especially in cases where visual recovery may be prolonged or incomplete.

• #63 Optic Neuritis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26245

  Neuroprotective therapies in optic neuritis are gaining increasing attention for their potential to preserve axonal integrity and prevent permanent vision loss, particularly in patients with multiple sclerosis or NMOSD. Agents such as phenytoin, which has shown some neuroprotective properties, are being investigated in clinical trials. Furthermore, research into remyelinating therapies, such as anti-LINGO-1 monoclonal antibodies, offers promising future options for reducing inflammation and promoting the repair of damaged myelin. These emerging therapies may be crucial to altering the natural course of demyelinating optic neuritis.[8] […] High-dose intravenous corticosteroids (eg, methylprednisolone 1g/day for 35 days) followed by an oral prednisone taper is the cornerstone of treatment for acute optic neuritis. Steroids help reduce inflammation, accelerate visual recovery, and lessen the severity of symptoms. However, studies like the Optic Neuritis Treatment Trial (ONTT) indicate that steroid use does not alter the long-term visual prognosis, though it can shorten the recovery period. Oral corticosteroids alone without an intravenous lead-in are generally not recommended as they may increase the risk of recurrence.[53]

• #64 OCS-05: Acute Optic Neuritis – Symptoms & Treatment – OculisDisease Page Rollovers

  https://oculis.com/our-commitment/acute-optic-neuritis/

  OCS-05, a novel first-in-class peptidomimetic small molecule, has the potential to become a neuroprotective therapy for acute optic neuritis and other neuro-ophthalmic diseases. […] While corticosteroids are used to shorten the attack and accelerate recovery of acute visual symptoms, there remains an unmet medical need for therapies that either preserve vision or provide neuroprotection after an acute episode of optic neuritis. […] OCS-05 is an investigational drug and has not received regulatory approval for commercial use in any country. […] The trial met the primary endpoint of safety and achieved statistical significance on several key efficacy-based secondary endpoints, highlighting neuroprotective structural benefit and the ability to improve visual function in patients suffering from acute optic neuritis.

• #65 OCS-05: Acute Optic Neuritis – Symptoms & Treatment – OculisDisease Page Rollovers

  https://oculis.com/our-commitment/acute-optic-neuritis/

  Acute optic neuritis is a rare disease characterized by acute inflammation and demyelination of the optic nerve. While corticosteroids are used to shorten the attack, there is no specific treatment approved for acute optic neuritis and unmet needs remain for neuroprotective therapies that can prevent vision loss.

• #66 Optic Neuritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557853/

  Recent trends in the management of optic neuritis have focused on improving diagnostic accuracy and exploring novel therapeutic options. […] Neuroprotective therapies in optic neuritis are gaining increasing attention for their potential to preserve axonal integrity and prevent permanent vision loss, particularly in patients with multiple sclerosis or NMOSD. […] Agents such as phenytoin, which has shown some neuroprotective properties, are being investigated in clinical trials. […] Furthermore, research into remyelinating therapies, such as anti-LINGO-1 monoclonal antibodies, offers promising future options for reducing inflammation and promoting the repair of damaged myelin. […] Guidelines provided by the American Academy of Neurology, the American Academy of Ophthalmology, and the National Multiple Sclerosis Society (NMSS) recommend the use of high-dose intravenous corticosteroids for managing optic neuritis and emphasize the importance of early neuroimaging, particularly MRI, to assess the risk of multiple sclerosis. […] Visual rehabilitation services are essential for patients with significant residual visual impairment. […] Continuous monitoring of visual acuity, color vision, and contrast sensitivity over time is critical, especially in cases where visual recovery may be prolonged or incomplete.

• #67 Low Vision Therapy for Optic Neuritis | Therapy Achievements

  https://therapy-a.com/news/low-vision-therapy-for-optic-neuritis/

  Sudden loss of vision with accompanying eye pain is not only frightening but also instantly debilitating. […] A combination of pharmaceutical treatment with low vision therapy for optic neuritis is an effective way to improve your ability to function. […] Low vision therapy is for people with significant visual impairment that cannot be corrected fully with glasses, contact lenses, medication or eye surgery. […] Low vision therapists assess your lighting needs and help you identify lamps and light sources to optimize your vision. […] Low vision therapists assess the effectiveness of magnifiers and colored lenses to optimize your vision and provide training for how to use them most effectively. […] Low vision therapist teach you compensatory scanning strategies to enable you to have the greatest field of vision possible.

• #68 Loss Of Vision | Eyesight Restore After Optic Neuritis and Neuromyelitis Optica

  https://www.restorevisionclinic.com/loss-of-vision/optic-neuritis-optic-nerve-damage-treatment/

  Long lasting clinical application of Fedorov Restoration Therapy for patients with optic neuritis has shown that it improves visual acuity, contrast and expand a patients field of vision. […] In all cases, treatment should be initiated as soon as possible to prevent long-term vision loss. […] Fedorov Restoration Therapy has been proven to help reduce vision deficits resulting from prolonged optic neuritis. […] Scientific studies have shown that patients can experience an increase in visual acuity of about 18%, and an increase in visual field ranging from 14% to 29%. […] We have also shown that most of the effects of Fedorov Restoration Therapy are stable over time and, in many cases, repeat courses of treatment can lead to a more significant improvement in sight. […] Initial positive changes can be observed during the first 10 sessions of Fedorov Therapy. […] In most cases, you should see a stable improvement within four to eight weeks after the treatment. […] The improvement of quality of life is our main goal. We reach this through a combination of different medical approaches, such as Fedorov Therapy, visual training, and medications.

• #69 Optic Neuritis Clinical Guide | Cleveland Clinic

  https://my.clevelandclinic.org/departments/neurological/depts/multiple-sclerosis/ms-approaches/optic-neuritis

  Following an episode of typical ON, patients can be followed using several clinical and imaging modalities to monitor recovery. Visual acuity tends to recover over a period of weeks, and begins 2-4 weeks after onset. Monitoring of RNFL and GCL thinning following an episode of ON generally reveals RNFL thinning as early as 4 weeks, but up to 6 months after the clinical episode. […] The prognosis for subjective visual recovery after acute demyelinating optic neuritis due to MS is generally good, and recovery begins within 2 to 4 weeks. However, objective evidence including low contrast letter acuity and OCT measures demonstrate longstanding evidence of damage following each ON episode. […] If a patient has recurrent optic neuritis, an underlying cause cannot be identified, and steroid responsiveness is apparent, the diagnosis of CRION should be considered. CRION refers to a relapsing form of optic neuritis characterized by inflammation. Patients with CRION tend to have recurrent ON upon steroid withdrawal, so chronic immunosuppression is generally advised with medications including azathioprine, methotrexate, or IVIG. Another consideration in recurrent ON is anti-MOG syndrome, an increasingly recognized etiology of central nervous system demyelinating disease, including optic neuritis.

• #70 Optic Neuritis Clinical Guide | Cleveland Clinic

  https://my.clevelandclinic.org/departments/neurological/depts/multiple-sclerosis/ms-approaches/optic-neuritis

  Given this risk of developing MS or other neuro-inflammatory disorders following ON, brain MRI should be repeated in 6 months, then after 1 year, to evaluate for the development of lesions that could indicate the development of MS via dissemination in time following a clinically isolated syndrome (CIS). Patients should be followed clinically for development of new neurological symptoms that could be consistent with a demyelinating event.

• #71 Optic Neuritis Clinical Guide | Cleveland Clinic

  https://my.clevelandclinic.org/departments/neurological/depts/multiple-sclerosis/ms-approaches/optic-neuritis

  Following an episode of typical ON, patients can be followed using several clinical and imaging modalities to monitor recovery. Visual acuity tends to recover over a period of weeks, and begins 2-4 weeks after onset. Monitoring of RNFL and GCL thinning following an episode of ON generally reveals RNFL thinning as early as 4 weeks, but up to 6 months after the clinical episode. […] The prognosis for subjective visual recovery after acute demyelinating optic neuritis due to MS is generally good, and recovery begins within 2 to 4 weeks. However, objective evidence including low contrast letter acuity and OCT measures demonstrate longstanding evidence of damage following each ON episode. […] If a patient has recurrent optic neuritis, an underlying cause cannot be identified, and steroid responsiveness is apparent, the diagnosis of CRION should be considered. CRION refers to a relapsing form of optic neuritis characterized by inflammation. Patients with CRION tend to have recurrent ON upon steroid withdrawal, so chronic immunosuppression is generally advised with medications including azathioprine, methotrexate, or IVIG. Another consideration in recurrent ON is anti-MOG syndrome, an increasingly recognized etiology of central nervous system demyelinating disease, including optic neuritis.

• #72 Typical and atypical optic neuritis – diagnosis and initial management | Eye News

  https://www.eyenews.uk.com/education/top-tips/post/typical-and-atypical-optic-neuritis-diagnosis-and-initial-management

  Monitor visual acuity, colour vision and visual fields at follow-up visits. […] For typical optic neuritis, it is very important to discuss the natural history of their condition including the high probability that vision will usually recover well and to discuss the risks and benefits of steroid treatment. […] Patients should also be counselled that there is a risk of developing MS in the future. […] Long-term immunosuppressive treatment was required to control inflammation.

• #73 Optic Neuritis Clinical Guide | Cleveland Clinic

  https://my.clevelandclinic.org/departments/neurological/depts/multiple-sclerosis/ms-approaches/optic-neuritis

  Given this risk of developing MS or other neuro-inflammatory disorders following ON, brain MRI should be repeated in 6 months, then after 1 year, to evaluate for the development of lesions that could indicate the development of MS via dissemination in time following a clinically isolated syndrome (CIS). Patients should be followed clinically for development of new neurological symptoms that could be consistent with a demyelinating event.

• #74 Optic Neuritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557853/

  Recent trends in the management of optic neuritis have focused on improving diagnostic accuracy and exploring novel therapeutic options. […] Neuroprotective therapies in optic neuritis are gaining increasing attention for their potential to preserve axonal integrity and prevent permanent vision loss, particularly in patients with multiple sclerosis or NMOSD. […] Agents such as phenytoin, which has shown some neuroprotective properties, are being investigated in clinical trials. […] Furthermore, research into remyelinating therapies, such as anti-LINGO-1 monoclonal antibodies, offers promising future options for reducing inflammation and promoting the repair of damaged myelin. […] Guidelines provided by the American Academy of Neurology, the American Academy of Ophthalmology, and the National Multiple Sclerosis Society (NMSS) recommend the use of high-dose intravenous corticosteroids for managing optic neuritis and emphasize the importance of early neuroimaging, particularly MRI, to assess the risk of multiple sclerosis. […] Visual rehabilitation services are essential for patients with significant residual visual impairment. […] Continuous monitoring of visual acuity, color vision, and contrast sensitivity over time is critical, especially in cases where visual recovery may be prolonged or incomplete.

• #75 Optic Neuritis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26245

  Although still under investigation, agents like citicoline and brimonidine are being explored for their potential neuroprotective effects in optic neuritis. Additionally, growing evidence supports Vitamin D’s role in immune regulation and its potential to reduce multiple sclerosis risk in patients with optic neuritis. Individuals with optic neuritis should thus be advised to maintain adequate Vitamin D levels.[55] […] Guidelines provided by the American Academy of Neurology, the American Academy of Ophthalmology, and the National Multiple Sclerosis Society (NMSS) recommend the use of high-dose intravenous corticosteroids for managing optic neuritis and emphasize the importance of early neuroimaging, particularly MRI, to assess the risk of multiple sclerosis. For NMOSD, updated guidelines endorse the early use of immunosuppressive therapies to prevent relapses and mitigate the risk of optic neuritis recurrence.

• #76 From diagnosis to treatment: exploring the mechanisms underlying optic neuritis in multiple sclerosis | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-025-06105-1

  One of the leading hypotheses for the limited ability of most current DMTs to meaningfully prevent disease worsening in MS is their restricted capacity to cross the BBB. These DMTs also struggle to reach and exert a significant effect on the cells that orchestrate inflammation in the CNS compartment.

• #77 Re-evaluating the treatment of acute optic neuritis | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/86/7/799

  Given the significant visual improvement observed in the ONTT placebo group, future clinical trials to evaluate new AON treatments will likely require significant patient numbers to ensure adequate powering. […] The data acquired from this and other ongoing AON trials will likely provide the foundation for using AON as a paradigm disorder for clinical and translational studies of demyelinating disease.

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