Skip to main content

Advertisement

SpringerLink
Log in

Visual and anatomical outcomes of non-arteritic anterior ischemic optic neuropathy with high-dose systemic corticosteroids

  • Neurophthalmology
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

To evaluate the visual and anatomic outcomes after systemic steroid treatment in non-arteritic anterior ischemic optic neuropathy (NAION).

Methods

Ten eyes from ten patients diagnosed with NAION and treated during the acute phase with 80 mg daily, tapering-down dose of corticosteroids were compared with a non-contemporary cohort of 27 patients that received no treatment. The visual outcomes of treated and untreated group were compared. Patients underwent complete ophthalmic examination including determination of Snellen visual acuity (VA), visual fields (VFs) (standard automated perimetry, Swedish Interactive Testing Algorithm 24–2 strategy), and optical coherence tomography (OCT) scanning of the optic nerve head at diagnosis, 6–8 weeks and 6 months after presentation.

Results

No statistical differences were found between steroid-treated and untreated NAION for the median change in VA (Mann–Whitney P = 0.28), median change in VF mean deviation (MD) and median change in VF pattern standard deviation (PSD) (Mann–Whitney P = 0.213 and P = 0.07 respectively). Statistical analysis showed no differences when comparing average RNFL loss (P = 0.871) and RNFL loss for superior, nasal, inferior and temporal optic disc quadrants between both groups. Complications occurred in three of the ten treated patients (30%); in one of them, steroid therapy had to be discontinued. Another two patients developed a NAION in their fellow eye after 2 and 3 months while on low-dose prednisone. No complications developed in the control group. The study was interrupted early due to a significantly higher rate of complications observed in the treated group (P = 0.002)

Conclusion

High-dose systemic steroid treatment did not show any beneficial effect in visual and anatomic outcomes when given during the acute phase of NAION. Furthermore, it caused serious complications in a third of the patients treated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hayreh SS (2009) Ischemic optic neuropathy. Prog Retin Eye Res 28(1):34–62

    Article  PubMed  Google Scholar 

  2. Atkins E, Bruce B, Newman N, Biousse V (2010) Treatment of nonarteritic anterior ischemic optic neuropathy. Surv Ophthalmol 55:47–63

    Article  PubMed  Google Scholar 

  3. Bonamour G (1966) Apropos de pseudo-papillites vasculaire. Bull Soc Ophtalmol Fr 79:846

    Google Scholar 

  4. Georgiades G, Konstas P, Stangos N (1966) Reflexions issues de l’etude de nombreaux cas de pseudo-papillite vasculaire. Bull Soc Ophtalmol Fr 79:506–536

    CAS  Google Scholar 

  5. Haas A, Walzl M, Jesenik F, Walzl B, Berghold A, Berglöff J, Feigl B, Faulborn J (1997) Application of HELP in nonarteritic anterior ischemic optic neuropathy: a prospective, randomized, controlled study. Graefes Arch Clin Exp Ophthalmol 235(1):14–19

    Article  PubMed  CAS  Google Scholar 

  6. Kajiwara K, Tsubota K, Hara Y (1990) High dose urokinase thrombolysis and stellate ganglion block for anterior ischemic neuropathy. Fola Ophthalmol Jpn 41(1):59–64

    Google Scholar 

  7. Kollarits CR, McCarthy RW, Corrie WS, Swann ER (1981) Norepinephrine therapy of ischemic optic neuropathy. J Clin Neuroophthalmol 1(4):283–288

    PubMed  CAS  Google Scholar 

  8. Levin LA (2007) Axonal loss and neuroprotection in optic neuropathies. Can J Ophthalmol 42(3):403–408

    Article  PubMed  Google Scholar 

  9. Hayreh SS, Zimmerman MB (2008) Non-arteritic anterior ischemic optic neuropathy: role of systemic corticosteroid therapy. Graefes Arch Clin Exp Ophthalmol 246(7):1029–1046

    Article  PubMed  CAS  Google Scholar 

  10. Contreras I, Noval S, Rebolleda G, Muñoz-Negrete FJ (2007) Follow-up of nonarteritic anterior ischemic optic neuropathy with optical coherence tomography. Ophthalmology 114(12):2338–2344

    Article  PubMed  Google Scholar 

  11. Foulds WS (1970) Visual disturbances in systemic disorders: optic neuropathy and systemic disease. Trans Ophthalmol Soc UK 89:125–146

    PubMed  CAS  Google Scholar 

  12. Hayreh SS (1974) Anterior ischaemic optic neuropathy. III. Treatment, prophylaxis, and differential diagnosis. Br J Ophthalmol 58(12):981–989

    Article  PubMed  CAS  Google Scholar 

  13. Newman NJ, Scherer R, Langenberg P, Kelman S, Feldon S, Kaufman D, Dickersin K, Ischemic Optic Neuropathy Decompression Trial Research Group (2002) The fellow eye in NAION: report from the ischemic optic neuropathy decompression trial follow-up study. Am J Ophthalmol 134(3):317–328

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Authors disclose no financial interest.

Author information

Authors and Affiliations

  1. From the Ophthalmology Service, Ramon y Cajal Hospital, Madrid, Spain

    Gema Rebolleda, Marta Pérez-López, Pilar Casas-LLera, Inés Contreras & Francisco José Muñoz-Negrete

  2. Glaucoma and Neuro-ophthalmology Service, Ramon y Cajal Hospital, Madrid, Spain

    Gema Rebolleda & Francisco José Muñoz-Negrete

  3. C/Vicente Tormo Alfonso Nº2 Esc C Pta 11, CP 46015, Valencia, Spain

    Marta Pérez-López

Authors
  1. Gema Rebolleda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marta Pérez-López
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pilar Casas-LLera
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Inés Contreras
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francisco José Muñoz-Negrete
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marta Pérez-López.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rebolleda, G., Pérez-López, M., Casas-LLera, P. et al. Visual and anatomical outcomes of non-arteritic anterior ischemic optic neuropathy with high-dose systemic corticosteroids. Graefes Arch Clin Exp Ophthalmol 251, 255–260 (2013). https://doi.org/10.1007/s00417-012-1995-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-012-1995-7

Keywords

Search

Navigation