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M. S. Floyd, T. J. Whittaker; Visual Outcomes of Patients With Neuromyelitis Optica While Receiving Rituximab vs. Standard Treatment. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1439.
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To compare the visual outcome of patients with Devic’s Disease who undergo treatment with Rituximab vs. other immune modulating treatment.
A retrospective chart review was conducted on 12 eyes (6 patients) with Neuromyelitis Optica treated at Kansas University Medical Center. Patients were diagnosed by NMO IgG antibodies, or clinical history, examination, and imaging. Patients with multiple sclerosis, tumor, and cerebral vascular disease were excluded. Visual acuity and Humphrey visual fields at the initial visit, 1 month, 3 to 6 months, and 1 year were collected. Data recorded during relapses was avoided due to inconsistency. Medical treatment, relapse, and symptoms were documented. A statistically significant change in acuity was defined as 3 Snellen lines and visual field greater than 2 db.
Charts were reviewed from 2000 to 2008. The age range was 38 to 58. All patients except 1 were followed for at least 3 months. This patient had recently enrolled and is still being evaluated. 3 patients were diagnosed by NMO IgG and 3 clinically. All patients were treated initially with steroids. 1 patient was treated with only steroids, 1 with only rituximab, and 4 with other immune modulating drugs such as mycophenolate moxetil, methotrexate, and plaquenil (2 of these were then switched to rituximab). Visual acuity was stable at 1 year in 2 of 3 rituximab patients. One patient receiving Rituximab who experienced visual decline was experiencing loss prior to therapy. 2 of 3 patients in the non-Rituximab treatment group had a decline in acuity. The following is a list of complications: leg and arm dysarthria and paresthesia, urine retention, nausea, neck pain, and hospitalization. There were 24 relapses reported with an average of 1.7 per year. 79 % of episodes occurred during the spring and fall.
Data from these patients indicate that Rituximab may be more effective than steroids and immune modulating drugs in treatment of visual acuity and visual field loss. There is no definitive trend regarding relapse rate between the groups. There may be a correlation between relapse and seasonal changes. This is a difficult group to study as medical records are imperfect because patients follow with multiple specialties and data is often obtained when the patient is having a relapse. These patients need to be followed for a longer duration and a larger sample size would be optimal.
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