Plasmapheresis Affects Оphthalmological Parameters and Oxidative Stress in Patients with Multiple Sclerosis and Neuromyelitis Optica

Our purpose is to describe the effects of plasmapheresis on the ophthalmological status of patients with relapsing-remitting multiple sclerosis (RRMS) during remission and of one patient with neuromyelitis optica (NMO), and to seek a correlation with parameters of oxidative stress. Two male and three female patients with RRMS and one female patient with NMO were treated with plasmapheresis with subsequent measurement of the levels of immunoglobulins and oxidative stress parameters. Previous treatment included interferons for all patients. We evaluated 4 ophthalmological parameters including: best corrected visual acuity (BCVA), ophthalmological status with biomicroscopy and funduscopy, visual field and peripapillary retinal nerve fiber layer (RNFL) thickness. The follow up period was 24 months for the patient with NMO and an average of 13.6 months for the patients with RRMS. The status of all patients was improved according to the Expanded Disability Status Scale (EDSS) after the treatment, and they were free of relapses during the follow up period. Reduction of both immunoglobulins and reactive oxygen species (ROS) was observed after the plasmapheresis in all patients. Neither progression, nor worsening of the BCVA and the visual field-testing results were detected. The RNFL thickness showed thinning in the patient with NMO and thickening in one of the patients with multiple sclerosis (MS). The thinning of the RNFL in the NMO patient, however, could be due to her comorbidity of primary open-angle glaucoma, treated with triple antiglucomatous drops. The mean RNFL thickness in the rest of the patients remained stable. Plasmapheresis is demonstrated as a safe treatment option for patients with RRMS and NMO not only for the steroid- resistant acute episodes, but also as a basic one during remissions of the RRMS and non-acute episode of NMO as shown by the stability of the studied ophthalmological parameters.

Keywords:Plasmapheresis; Immunoglobulins A,G,M (IgA,IgG,IgM);Multiple sclerosis (MS);Neuromyelitis optica (NMO);Oxidative stress;Reactive oxygen species (ROS);Retinal nerve fiber layer (RNFL);Best corrected visual acuity (BCVA); Optical coherence tomography (OCT)