徳島大学病院における抗MOG抗体陽性視神経炎の臨床像の検討

Clinical features of anti-MOG antibody-positive optic neuritis at Tokushima University Hospital

要約　目的：抗ミエリンオリゴデンドロサイト糖蛋白質（MOG）抗体陽性視神経炎（MOG-ON）の臨床像の報告。

対象と方法：2017年6月〜2023年4月に徳島大学病院でMOG-ONと診断された10例15眼について臨床的特徴を検討した。

結果：平均発症年齢は36.6±25.1歳（小児3例），男性5例，女性5例，片眼性5例，両眼性5例，発症時の自覚症状は眼痛7例，頭痛4例，発熱3例，排尿障害2例であり，視野障害は中心暗点が8眼で最多であった。MRI検査を施行した全例で視神経全長の腫脹を認めた。眼外病変として脊髄炎1例，小児群全例に急性散在性脳脊髄炎を併発した。治療は全例でステロイドパルス療法，2例で免疫グロブリン療法，1例で血液浄化療法，1例で両者が併用された。平均logMAR視力は初診時1.12±0.69から治療後−0.13±0.06と著明に改善し，視野障害は消失した。維持療法としてプレドニゾロン内服が行われ，3例が再発した。

結論：眼痛や視神経全長におよぶ病変を高率に認め，治療後の最終視力は良好であったが，小児群では頻回のパルス療法と併用療法が必要であった。再発も多く長期的な経過観察が必要である。

Abstract　Purpose：To report the clinical features of anti-MOG antibody-positive optic neuritis（MOG-ON）.

Subject and method：We examined the clinical characteristics of 15 eyes of 10 patients diagnosed with MOG-ON at Tokushima University Hospital from June 2017 to April 2023.

Results：The average age at onset was 36.6±25.1 years（three patients were aged below 15 years）；five patients were male and five were female. Further, five cases were unilateral and five were bilateral. Subjective symptoms at onset were eye pain in seven patients cases and headache in four patients. Three patients had fever and two had dysuria, and the most common visual field disorder was central scotoma in eight eyes. Swelling of the entire length of the optic nerve was observed in all patients on MRI examination. Extraocular lesions included myelitis in one case and Acute disseminated encephalomyelitis in all cases in the pediatric group. Steroid pulse therapy was performed in all cases, with immunoglobulin therapy in two cases, blood purification therapy in one case, and a combination of both in one case. The mean logMAR visual acuity was markedly improved from 1.12±0.69 at the initial examination to −0.13±0.06 after treatment, and visual field defects disappeared. Oral prednisolone was administered as maintenance therapy, and recurrence was observed in three patients.

Conclusion：Eye pain and lesions extending along the entire length of the optic nerve were observed at a high rate. Although the final visual acuity after treatment was good, frequent pulse therapy and combination therapy were required in the pediatric group. Recurrence is common, and long-term follow-up is required.