Paracentral Acute Middle Maculopathy Associated with Severe Anti-Mog (Myelin Oligodendrocyte Glycoprotein)-Positive Optic Neuritis

ABSTRACT

Retinal complications in patients with inflammatory optic neuritis (ON) are generally related to post-infectious neuroretinitis and are considered uncommon in autoimmune/demyelinating ON, whether isolated or caused by multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD). More recently, however, cases with retinal complications have been reported in subjects positive for myelin oligodendrocyte glycoprotein (MOG) antibodies. We report a 53-year-old woman presenting with severe bilateral ON associated with a focal area of paracentral acute middle maculopathy (PAMM) in one eye. Visual loss recovered remarkably after high-dose intravenous corticosteroid treatment and plasmapheresis, but the PAMM lesion remained visible on both optical coherence tomography and angiography as an ischaemic lesion affecting the middle layers of the retina. The report emphasises the possible occurrence of retinal vascular complications in MOG–related optic neuritis, an important addition to the diagnosis of, and possible differentiation from, MS–related or NMOSD–related ON.

KEYWORDS:

• Optic Neuritis
• paracentral acute middle maculopathy
• myelin oligodendrocyte glycoprotein
• neuromyelitis optica spectrum disorder
• retinal ischemia

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Supported by grants from CAPES - Coordenação de Aperfeiçoamento de Nível Superior, Brasília, Brazil, and CNPq- Conselho Nacional de Desenvolvimento Científico e Tecnológico, (No 308172/2018-3), Brasília, Brazil. The funding organisations had no role in the design or conduct of this research.