How do you approach the management of acute attacks of MOGAD-associated optic neuritis?

If vision loss is severe and has not improved after corticosteroids/IVIG, I would consider plasma exchange (PLEX). Although we do not have controlled studies of PLEX in MOGAD, it is often used for cases of fulminant demyelination in other neuroinflammatory disorders.

I would likely have PLEX followed by IVIG for maintenance if this is a recurrence.