Predictors of Long-Term Visual Acuity in a Modern Cohort of Patients With Acute Idiopathic and Multiple Sclerosis-Associated Optic Neuritis.
Predictors of Long-Term Visual Acuity in a Modern Cohort of Patients With Acute Idiopathic and Multiple Sclerosis-Associated Optic Neuritis.
复制标题
现代急性特发性和多发性硬化症相关视神经炎患者群体的长期视力预测因子。
DOI：
10.1097/wno.0000000000001870
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
DeLott,LindseyB
中科院分区：
文献类型：
--
作者：
Jarocki,Adrienne;Benard-Seguin,Etienne;Gonzalez,LizbethA;Costello,Fiona;Andrews,ChrisA;Kerber,Kevin;DeLott,LindseyB
背景：对于特发性或多发性硬化（MS）相关视神经炎（ON）患者，最大的多中心临床试验（视神经炎治疗试验[ONT]）显示了良好的视力结局，基线高对比度视力（HCVA）是1年时HCVA的唯一预测因素。我们的目的是评估长期HCVA的预测因素在现代，现实世界的人口与ON患者和以前发表的ONTT models.Methods比较：我们进行了一项回顾性，纵向，观察性研究，在密歇根大学和卡尔加里大学评估135次发作的特发性或MS相关的ON在118例患者诊断的神经眼科医生在发病后30天内（2011年1月至2021年6月）。测量的主要结局是6-18个月时的HCVA（Snellen当量）。来自93名患者的107次发作的多元线性回归模型评估了6-18个月时HCVA与年龄、性别、种族、疼痛、视盘肿胀、症状（天）、病毒性疾病前驱症状、MS状态、高剂量糖皮质激素治疗和基线HCVA之间的关联。在135次急性发作中，（109密歇根州和26卡尔加里），中位年龄为39岁（四分位距[IQR]，31-49岁），91（67.4%）为女性，（83.0%）为非西班牙裔白人，101（75.9%）有疼痛，33例（24.4%）有椎间盘水肿，8例（5.9%）有病毒前驱症状，66例（48.9%）有MS，62例（46.6%）接受糖皮质激素治疗。症状发作和诊断之间的中位（IQR）时间为6天（范围，4-11天）。基线和6-18个月时的中位（IQR）HCVA分别为20/50（20/22，20/200）和20/20（20/20，20/27）;基线时62例（45.9%）优于20/40，6-18个月时117例（86.7%）优于20/40。在线性回归模型中（基线HCVA优于CF的93例患者的n= 107次发作），仅基线HCVA（β= 0.076; P= 0.027）与长期HCVA相关。回归系数是相似的，并在95%置信区间内的系数从公布的ONTT models.Conclusions：在一个现代队列的特发性或MS相关的ON与基线HCVA优于CF的患者，长期的结果是好的，唯一的预测是基线HCVA。这些发现与之前对ONT数据的分析相似，因此，这些结果被验证用于传达有关长期HCVA结局的预后信息。
Background:For patients with idiopathic or multiple sclerosis (MS)–associated optic neuritis (ON), the largest multicenter clinical trial (Optic Neuritis Treatment Trial [ONTT]) showed excellent visual outcomes and baseline high-contrast visual acuity (HCVA) was the only predictor of HCVA at 1 year. We aimed to evaluate predictors of long-term HCVA in a modern, real-world population of patients with ON and compare with previously published ONTT models.Methods:We performed a retrospective, longitudinal, observational study at the University of Michigan and the University of Calgary evaluating 135 episodes of idiopathic or MS-associated ON in 118 patients diagnosed by a neuro-ophthalmologist within 30 days of onset (January 2011–June 2021). Primary outcome measured was HCVA (Snellen equivalents) at 6–18 months. Multiple linear regression models of 107 episodes from 93 patients assessed the association between HCVA at 6–18 months and age, sex, race, pain, optic disc swelling, symptoms (days), viral illness prodrome, MS status, high-dose glucocorticoid treatment, and baseline HCVA.Results:Of the 135 acute episodes (109 Michigan and 26 Calgary), median age at presentation was 39 years (interquartile range [IQR], 31–49 years), 91 (67.4%) were women, 112 (83.0%) were non-Hispanic Caucasians, 101 (75.9%) had pain, 33 (24.4%) had disc edema, 8 (5.9%) had a viral prodrome, 66 (48.9%) had MS, and 62 (46.6%) were treated with glucocorticoids. The median (IQR) time between symptom onset and diagnosis was 6 days (range, 4–11 days). The median (IQR) HCVA at baseline and at 6–18 months were 20/50 (20/22, 20/200) and 20/20 (20/20, 20/27), respectively; 62 (45.9%) had better than 20/40 at baseline and 117 (86.7%) had better than 20/40 at 6–18 months. In linear regression models (n= 107 episodes in 93 patients with baseline HCVA better than CF), only baseline HCVA (β= 0.076; P= 0.027) was associated with long-term HCVA. Regression coefficients were similar and within the 95% confidence interval of coefficients from published ONTT models.Conclusions:In a modern cohort of patients with idiopathic or MS-associated ON with baseline HCVA better than CF, long-term outcomes were good, and the only predictor was baseline HCVA. These findings were similar to prior analyses of ONTT data, and as a result, these are validated for use in conveying prognostic information about long-term HCVA outcomes.