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Non-arteritic anterior ischemic optic neuropathy: role of systemic corticosteroid therapy

Neurophthalmology

Abstract

Objective

To investigate systematically the role of systemic corticosteroid therapy in non-arteritic anterior ischemic optic neuropathy (NA-AION).

Methods

The study consists of a cohort of 613 consecutive patients (696 eyes), first seen in our clinic from 1973 to 2000. Of this cohort, 312 patients (364 eyes) voluntarily opted for systemic steroid therapy, and 301 (332 eyes) for no treatment. At first visit, all patients in both groups had a detailed ophthalmic and medical history, and comprehensive ophthalmic evaluation. Visual evaluation was done by recording Snellen visual acuity, and visual fields with a Goldmann perimeter. The same ophthalmic evaluation was performed at each follow-up visit. Patients in the steroid-treated group were initially given 80 mg Prednisone daily for 2 weeks, and then tapered down to 70 mg for 5 days, 60 mg for 5 days, and then cutting down by 5 mg every 5 days. Visual outcome in the two groups was compared

Results

Median follow-up was 3.8 years. At 6 months from onset of NA-AION, of the eyes with initial visual acuity 20/70 or worse and seen within 2 weeks of onset, there was visual acuity improvement in 69.8% (95% confidence interval (CI): 57.3%, 79.9%) in the treated group, compared to 40.5% (95% CI: 29.2%, 52.9%) in the untreated group (odds ratio of improvement: 3.39; 95% CI:1.62, 7.11; p = 0.001). Comparison of visual field defect at 6 months from onset of NA-AION, among those seen within 2 weeks of NA-AION onset with moderate to severe initial visual field defect, there was improvement in 40.1% (95% CI: 33.1%, 47.5%) of the treated group, and 24.5% (95% CI: 17.7%, 32.9%) of the untreated group (odds ratio: 2.06, 95% CI: 1.24, 3.40; p = 0.005). In both treated and untreated groups, the visual acuity and visual fields kept improving up to about 6 months from onset of NA-AION, and very little thereafter.

Conclusion

This study suggested that NA-AION eyes treated during the acute phase with systemic corticosteroids resulted in a significantly higher probability of improvement in visual acuity (p = 0.001) and visual field (p = 0.005) than in the untreated group. Both visual acuity and visual fields improved up to 6 months after onset of NA-AION.

Keywords

Anterior ischemic optic neuropathy Optic disc edema Optic nerve Optic nerve head ischemia Visual loss 

Notes

Acknowledgements

We are extremely grateful to Drs. Randy H. Kardon, H. Stanley Thompson and Michael Wall, and Mrs. Patricia Podhajsky for their invaluable help with the visual field evaluation.

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Department of Ophthalmology and Visual Sciences, College of MedicineUniversity of IowaIowa CityUSA
  2. 2.Department of Biostatistics, College of Public HealthUniversity of IowaIowa CityUSA
  3. 3.Department of Ophthalmology and Visual SciencesUniversity Hospitals & ClinicsIowa CityUSA

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