AIM: To investigate the clinical efficacy of intravenous immunoglobulin(IVIG)in the treatment of neuromyelitis optica related optic neuritis(NMO-ON)patients with recurrent and glucocorticoid resistance. METHODS: A total of 79 NMO-ON patients with recurrent and glucocorticoid resistance admitted to the ophthalmic inpatient department of our hospital from January 2016 to January 2018 were retrospectively selected and divided into two groups according to the treatment mode. Forty-two patients(57 eyes)in the IVIG group were treated with IVIG, and 37 patients(43 eyes)in the PE group were treated with plasmapheresis. The differences in efficacy, adverse reactions and recurrence rates between the two groups were compared, as well as the changes and differences in uncorrected visual acuity, aquaporin-4 immunoglobulin G antibody(AQP4-IgG), and myelin oligodendrocyte glycoprotein antibody(MOG-IgG)antibody before and after treatment. RESULTS: The effective rates of IVIG group and PE group were 91% and 91% respectively(P>0.05). After treatment, the uncorrected visual acuity, photosensitive sense and number finger of the 2 groups were significantly improved(P<0.01), and the proportions of AQP4-IgG(+)and MOG-IgG(+)were significantly decreased(P<0.001)compared with those before treatment, while the proportions of visual acuity, photosensitive sense and number finger, AQP4-IgG(+)and MOG-IgG(+)in the 2 groups showed no statistical difference(P>0.05). The patients in the two groups were followed up for a median of 40(29-50)mo. By the last follow-up, the recurrence rates in IVIG group and PE group were 10% and 9%, respectively(P>0.05). The incidence of adverse reactions in IVIG group was lower than that in PE group(P<0.05). CONCLUSION: Both PE and IVIG can improve the vision and symptoms of patients with NMO-ON patients with recurrent and glucocorticoid resistance, clear the pathogenic antibodies, and reduce the recurrence. The clinical efficacy of two methods is significant, but IVIG is relatively safe.