Background

Optic neuritis (ON) is a frequent manifestation in aquaporin-4 antibody (AQP4-IgG) seropositive neuromyelitis optica spectrum disorders (NMOSD). Due to limited samples, existing optical coherence tomography (OCT) studies are inconsistent regarding retinal changes in eyes with a history of ON (NMO-ON) and without a history of ON (NMO-NON), and their functional relevance.

Objectives

The CROCTINO (Collaborative Retrospective Study on retinal OCT in Neuromyelitis Optica) project aims to reveal correlates of retinal pathology and to generate hypotheses for prospective OCT studies in NMOSD. The objective of this study was to analyze retinal changes of AQP4-IgG seropositive NMO-ON and NMO-NON eyes in an international cross-sectional OCT dataset.

Methods

Of 656 subjects, we enrolled 283 AQP4-IgG seropositive NMOSD patients and 72 healthy controls (HC) from 22 international expert centers. OCT data was acquired with Spectralis SD-OCT, Cirrus HD-OCT and Topcon 3D OCT-1. Mean thickness for the combined ganglion cell and inner plexiform layer (GCIP) and inner nuclear layer (INL) were calculated from macular volume scans. Clinical, functional and laboratory testing were performed at discretion of each center.

Results

We compared NMO-ON eyes (N = 260), NMO-NON eyes (N = 241) and HC eyes (N = 136). GCIP was reduced in NMO-ON (57.4 ± 12.2 µm) compared with NMO-NON (75.9 ± 7.7 µm; p < 0.001) and HC (81.4 ± 5.7 µm; p < 0.001). NMO-NON had thinner GCIP (p < 0.001) compared with HC. INL was thicker in NMO-ON (40.3 ± 3.9 µm) compared with NMO-NON (38.6 ± 3.9µm; p < 0.001), but not HC (39.4 ± 2.6 µm). Microcystic macular edema were visible in 6.6 % of NMOSD eyes.

Conclusions

AQP4-IgG seropositive NMOSD is characterized by a functionally relevant loss of retinal neuroaxonal content and a - probably inflammatory - increase of INL after ON. Our study further supports the existence of attack-independent damage in the visual system of patients with AQP4-IgG seropositive NMOSD.

Background

Background:

Coronavirus 2019 (COVID-19) is a new coronavirus SARS-CoV-2 that has created a global pandemic with high mortality. People with underlying medical conditions and immune system suppression are more prone to severe infection. Neuromyelitis optica spectrum disorder (NMOSD) is a potentially disabling disease that is treated by immunosuppressive drugs. The nature of disease as well as its treatment potentially predisposes patients to various infections, including Covid-19 infection.

Objectives

Objectives:

The aim of this study was to evaluate the effect of COVID-19 pandemic on the clinical course of NMOSD patients and to assess the level of anxiety and fear in them as well as to evaluate the characteristics of Covid-19 infection in patients with NMOSD. We report some cases of COVID19 infection among our patients.

Methods

Methods and Materials:

A descriptive study was done in 140 patients (116 female and 24 male) in NMOSD Cohort clinic of Kashani hospital, Isfahan, Iran. All patients were contacted by telephone and were asked about their

infection with the Coronavirus and their treatment during its outbreak. Hospital Anxiety and Depression Scale (HADS) questionnaire were filled out via phone calls to assess patients' anxiety in pandemic.

Results

Results:

The study included 140 patients (43 seropositive). Their mean age was 36.83±9.82 and mean duration of disease was 8.06±5.09 years. They experienced overall 43 relapses within the last year (ARR:0.3) and 9 relapses during COVID19 epidemic (ARR:0.19). A total of 112 patients (80%) experienced anxiety or fear during the pandemic period.

Six patients infected by COVID-19 and one of them experienced ICU admission. There was neither death nor serious complication nor atypical presentation of COVID19. All six patients were treated by rituximab and the prevalence of COVID-19 was 4.8% in patients taking rituximab .

The mean age of these 6 patients was 37.80±17.72 and the disease duration was 7.20±3.27 years. There was not statistical difference between the mean age of infected patients and that of the rest of NMOSD population. Of the 124 patients treated with Rituximab, 32 cases postponed their treatment due to fear of infection and hospitalization. (1.95±1.16 months delay averagely).

Conclusions

Conclusion:

Our results showed that in our NMOSD patients, in spite of suppression of the immune system, neither incidence nor the serious complication of covid-19 infection was high. Therefore, regarding the disabling nature of NMOSD as well as prolonged epidemic period, it may be reasonable to continue the routine treatment of these patients along with more training of patients to stick to health protection instructions. We also found that patients with NMOSD are more prone to anxiety and fear of pandemic.

Background

Background:

Coronavirus 2019 (COVID-19) is a new coronavirus SARS-CoV-2 that has created a global pandemic with high mortality. People with underlying medical conditions and immune system suppression are more prone to severe infection. Neuromyelitis optica spectrum disorder (NMOSD) is a potentially disabling disease that is treated by immunosuppressive drugs. The nature of disease as well as its treatment potentially predisposes patients to various infections, including Covid-19 infection.

Objectives

Objectives:

The aim of this study was to evaluate the effect of COVID-19 pandemic on the clinical course of NMOSD patients and to assess the level of anxiety and fear in them as well as to evaluate the characteristics of Covid-19 infection in patients with NMOSD. We report some cases of COVID19 infection among our patients.

Methods

Methods and Materials:

A descriptive study was done in 140 patients (116 female and 24 male) in NMOSD Cohort clinic of Kashani hospital, Isfahan, Iran. All patients were contacted by telephone and were asked about their

infection with the Coronavirus and their treatment during its outbreak. Hospital Anxiety and Depression Scale (HADS) questionnaire were filled out via phone calls to assess patients' anxiety in pandemic.

Results

Results:

The study included 140 patients (43 seropositive). Their mean age was 36.83±9.82 and mean duration of disease was 8.06±5.09 years. They experienced overall 43 relapses within the last year (ARR:0.3) and 9 relapses during COVID19 epidemic (ARR:0.19). A total of 112 patients (80%) experienced anxiety or fear during the pandemic period.

Six patients infected by COVID-19 and one of them experienced ICU admission. There was neither death nor serious complication nor atypical presentation of COVID19. All six patients were treated by rituximab and the prevalence of COVID-19 was 4.8% in patients taking rituximab .

The mean age of these 6 patients was 37.80±17.72 and the disease duration was 7.20±3.27 years. There was not statistical difference between the mean age of infected patients and that of the rest of NMOSD population. Of the 124 patients treated with Rituximab, 32 cases postponed their treatment due to fear of infection and hospitalization. (1.95±1.16 months delay averagely).

Conclusions

Conclusion:

Our results showed that in our NMOSD patients, in spite of suppression of the immune system, neither incidence nor the serious complication of covid-19 infection was high. Therefore, regarding the disabling nature of NMOSD as well as prolonged epidemic period, it may be reasonable to continue the routine treatment of these patients along with more training of patients to stick to health protection instructions. We also found that patients with NMOSD are more prone to anxiety and fear of pandemic.