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Neuromyelitis Optica (NMO) is a demyelinating inflammatory disorder of the spinal cord and optic nerve. As per American Society For Apheresis (ASFA) guidelines, Therapeutic Plasma Exchange (TPE) is considered as a second-line treatment in patients with weak or no response to steroid therapy. A patient of NMO presented to the tertiary care institute with a sudden loss of vision in the right eye. The patient was resistant to steroid treatment and improved significantly with TPE. Hence, TPE may be an effective treatment modality in steroid-resistant NMO with vision loss.