Intravitreal triamcinolone acetonide injection in the acuite phase nonarteritic anterior ischemic optic neuropathy

Abstract

Abstract Purpose In nonarteritic anterior ischaemic optic neuropathy (NA‐AION), no treatment has shown to be effective in recovering visual loss in a randomized controlled clinical trial. Oral steroids have been evaluated and small series of IVTA have been reported. The purpose of this study was to analyse the visual outcome in response to a single intravitreal triamcinolone acetonide injection (IVTA) as a treatment for patients with acute NA‐AION. Methods Consecutive patients with either significant visual loss (visual acuity < 0.4) in the first eye or optic nerve head swelling in the second eye due to acute NAION were treated with 4 mg/0.1 mL IVTA. Patient's best‐corrected visual acuity, optical coherence tomography of the retinal nerve fiber layer (RNFL) and visual field were performed before injection, visual acuity was assessed at 1 week, and 2‐12 months after. Results Visual acuity was between 0.08 and 1.0 on inclusion, it improved in 2 eyes (more than 1 line) and remained stable (+/‐ 1 line) in 4 eyes after injection. In the group of eyes reaching (n=2) or maintaining (n=1) a final visual acuity of 1.0, the delay between onset and injection was 7 days or less. In the second group of patients, final visual acuity was between 0.08 and 0.4, the delay between onset was between 2 and 3 weeks. Conclusion The clinical course of these patients suggests that an IVTA may be effective in increasing or maintaining visual acuity following an acute NAION if the treatment is applied within one week. A large randomized controlled study is required to confirm these preliminary data.