Plasma exchange for severe optic neuritis

The authors reviewed a series of 10 consecutive patients treated with plasma exchange (PE) for acute, severe optic neuritis (ON) largely unresponsive to previous high-dose IV glucocorticosteroids. PE was associated with an improvement of visual acuity according to the study criteria in 7 of 10 patients. On follow-up, three of these patients continued to improve, two remained stable, and two had worsened again. PE may be beneficial as an escalating treatment in a subset of patients with severe ON. A controlled trial is warranted.