Role of plasmapheresis in neuromyelitis optica spectrum disorders

Pranathi B, Nashrah Nooreen, Madhuri Gadde, Anitha Videkar

Pdf Page Numbers :- 115-119

Pranathi B^1,*, Nashrah Nooreen¹, Madhuri Gadde1 and Anitha Videkar¹

¹Department of Ophthalmology, Krishna Institute of Medical Sciences (KIMS), Secunderabad-500003, Telangana, India

*Correspondence: Dr. B. Pranathi, Senior consultant and Head of Department, Department of Ophthalmology, Krishna Institute of Medical Sciences (KIMS), Secunderabad-500003, Telangana, India. Tel.: 040-44885050; Email: bejugum.pranathi@gmail.com

Received 20 July 2019; Revised 30 August 2019; Accepted 11 September 2019; Published 19 September 2019

Citation: Pranathi B, Nooreen N, Gadde M, Videkar A. Role of plasmapheresis in neuromyelitis optica spectrum disorders. J Med Sci Res. 2019; 7(4):115-119. DOI: http://dx.doi.org/10.17727/JMSR.2019/7-20

Copyright: © 2019 Pranathi B et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Purpose: We report a case of Neuromyelitis optica spectrum disorder (NMOSD) which has failed to respond to the first line treatment i.e. IV methylprednisolone and had responded well to the plasmapheresis.

Method: A 23-year-old female presented with complaint of sudden painless diminution of vision in both eyes which is progressive in nature associated with severe headache, with no systemic symptoms, since 10 days. On examination patient denied perception to light in both eyes. On anterior segment examination both the pupil were 6mm dilated, ill sustained and sluggishly reacting to light, rest anterior segment was normal. Fundus examination of both eyes showed hyperemic pallid disc edema with blurring of margins all around associated with tortuous vessels with foveal reflux present. We started her on IV methyl prednisolone for 3 days but did not respond, then we switched to plasmapheresis.

Results: After 2nd cycles of plasmapheresis the vision improved to hand movement in both eyes and after 7thcycle the vision improved to counting fingers at 4meters. And the patient was maintained on tapering dose of steroids (50mg/day) and azathioprine 100mg/day (2-3 mg/kg/day) was started.

Conclusions: Plasmapheresis is an effective therapy in NMOSD patients and should be considered if the patient fails to respond to the initial therapy.

Keywords: Neuromyelitis optica; painless progressive diminision of vision; sluggishly reacting pupil; hyperemic pallid disc; methylprednisolone; plasmapheresis