Abstract
BackgroundTo date, non arteritic anterior ischemic optic neuropathy (NAION) is still incurable. We wish to evaluate the effect of intravenous (IV) corticosteroids on the visual outcome of NAION patients.MethodsVisual parameters were retrospectively compared between NAION patients treated with IV corticosteroids and untreated NAION patients (control). Visual acuity (VA) and Humphrey automated static perimetry visual field (VF) defects of the affected eye were compared between groups at baseline, 1, 3, 6 months, and end of follow-up visits. The VF analysis consisted of number of quadrant involvements and mean deviation (MD).ResultsEach group comprised 23 patients (24 eyes). Mean initial VA was similar in the control and treatment groups (p = 0.8). VA at end of follow-up did not improve in either groups (p = 0.8 treated group, p = 0.1 control group). No improvement and no difference in VF defects were found by either quadrant analysis (p = 0.1 treated group, p = 0.5 control group) or MD analysis (p = 0.2, treated group, p = 0.9 control group). VA and VF parameters tended to be worse in the treated group, although without statistical significance.ConclusionsOur results suggest that IV corticosteroids may not improve the visual outcome of NAION patients. Since intravenous corticosteroids could potentially cause serious adverse effects, this treatment for NAION is questionable.
Highlights
To date, non arteritic anterior ischemic optic neuropathy (NAION) is still incurable
The rationale behind corticosteroid treatment, not proven, is the thought that faster resolution of optic disc edema may be associated with better visual outcome [21]
The presumed mechanism for corticosteroids improve the outcome in NAION patients is prevention of the “vicious circle” [19] in which the ischemic tissue further suffers from the secondary damage by a mechanical pressure caused by the swollen ischemic axons in an already crowded disc with a small scleral canal
Summary
Non arteritic anterior ischemic optic neuropathy (NAION) is still incurable. The presumed mechanism for corticosteroids improve the outcome in NAION patients is prevention of the “vicious circle” [19] in which the ischemic tissue further suffers from the secondary damage by a mechanical pressure caused by the swollen ischemic axons in an already crowded disc with a small scleral canal. This would not prevent the primary insult but should theoretically limit the secondary insult. Reducing capillary permeability in the optic disc by corticosteroids [21] could be another mechanism
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