Early corticosteroids predict visual whereas MRI lesion extent predicts retinal atrophy outcomes in MOG antibody-associated optic neuritis.

OBJECTIVE

To determine predictive factors influencing visual acuity (VA) recovery, optical coherence tomography (OCT) metrics and visual field (VF) parameters in inaugural optic neuritis (ON) of Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) patients.

METHODS

In this retrospective study, we collected orbital MRI, ophthalmological evaluations (VA, OCT, VF), and acute treatment data. MRI assessed enhancement intensity, longitudinal extent, anatomical involvement, optic perineuritis and optic nerve head edema. Ophthalmological parameters included VA, VF mean deviation (MD), peripapillary retinal nerve fiber layer (pRNFL) thickness and macular ganglion cell-inner plexiform layer (mGCIPL) volume. Prognostic factors were assessed using regression analysis.

RESULTS

We included 78 patients with inaugural MOGAD-ON. Complete VA recovery (logMAR ⩽ 0) was achieved in 69 patients (88.5%). In multivariate analysis, high-dose intravenous methylprednisolone treatment delay was the only significant prognostic factor for final VA (β = 0.36, p = 0.002) and VF MD (β = -0.31, p = 0.037). In multivariate analysis, worse nadir VA predicted thinner final pRNFL (β = -0.40, p = 0.003), while both longer MRI optic nerve lesion length (β = -0.31, p = 0.021) and poorer nadir VA (β = -0.45, p = 0.001) were significantly associated with reduced final mGCIPL volumes.

CONCLUSION

We found distinct prognostic factors between visual impairment and structural damage in MOGAD-ON, underscoring the need for prompt diagnosis and acute treatment.