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Aquaporin-4 Serostatus and Visual Outcomes in Clinically Isolated Acute Optic Neuritis

Carnero Contentti, Edgar MD; De Virgiliis, Mariana MD; Hryb, Javier Pablo MD; Gomez, Alejandra MD; Morales, Sergio MD; Celso, Julia MD; Leguizamón, Felisa MD; Chiganer, Edson MD; Di Pace, José Luis MD; Lessa, Carmen MD; Perassolo, Mónica MD

Journal of Neuro-Ophthalmology: June 2019 - Volume 39 - Issue 2 - p 165–169
doi: 10.1097/WNO.0000000000000668
Original Contribution

Background: Aquaporin-4 antibodies (AQP4-Ab) are associated with neuromyelitis optica spectrum disorder (NMOSD) and typically this disorder has a poor visual prognosis as a result of optic neuritis (ON). Our aim was to report the clinical features at onset and final visual outcomes at 6 months of patients with ON who were positive for AQP4-Ab vs. those who were negative for AQP4-Ab.

Methods: Retrospective cohort study. AQP4-Ab were tested by indirect immunofluorescence in 57 patients with a first episode of ON. All patients initially were referred for consideration of multiple sclerosis ON (MSON), NMOSD, or any other inflammatory central nervous system disorder during follow-up (41.31 ± 24.32 months). Our patients were diagnosed as having NMOSD, MSON, chronic relapsing inflammatory ON, and single isolated ON. Risk factors associated with visual outcomes of ON patients were assessed through an ordinal regression model.

Results: Positive AQP4-Ab were associated with male sex (P = 0.02), earlier age of onset (P = 0.01), and myelitis relapses (P = 0.04). Seronegative group had fewer recurrences of ON than the seropositive group (35% vs 58%, P = 0.14). Patients that were positive for AQP4-Ab did not have worse visual acuity at baseline and after 6 months. However, poor visual acuity during first attack was associated with a worse visual acuity at 6 months (odds ratio = 2.28, 95% CI [1.58–3.28], P = 0.03).

Conclusions: At 6 months, positive AQP4-Ab vs negative AQP4-Ab patients no evidence of poorer visual acuity. Lower visual acuity at baseline was associated with poor visual recovery at 6 months.

Department of Neurology (ECC, JPH, AG, SM, JLDP, MP), Hospital Carlos G. Durand, Buenos Aires, Argentina; Neuro-ophthalmology Section (MDV), Hospital P. Lagleyze, Buenos Aires, Argentina; Department of Neurology (JC, FL), Hospital Teodoro Alvarez, Buenos Aires, Argentina; and Department of Immunology and Histocompatibility (EC, CL), Hospital Carlos G. Durand, Buenos Aires, Argentina.

Address correspondence to Edgar Carnero Contentti, Department of Neurology, Hospital Carlos G. Durand, Av Diaz Velez 5044, C1405DCS, Buenos Aires, Argentina. Email:,

The authors report no conflicts of interest.

© 2019 by North American Neuro-Ophthalmology Society