J Korean Ophthalmol Soc.  2017 Oct;58(10):1176-1182. 10.3341/jkos.2017.58.10.1176.

Therapeutic Effect of Steroids in Patients with Non-arteritic Anterior Ischemic Optic Neuropathy

• Eun JS
• Lee MW
• Kyung SE

• KMID: 2393170
• DOI: http://doi.org/10.3341/jkos.2017.58.10.1176

Abstract

PURPOSE
To investigate the effect of steroid treatment (intravenous injection, oral) in patients with non-arteritic anterior ischemic optic neuropathy (NAION).
METHODS
From January, 2005 to December, 2016, 41 patients who were diagnosed with NAION and observed for more than 6 months were included in this study. The treatment was decided based on patient's choice after explaining the advantages and disadvantages of steroid therapy. The patients were divided into three groups (intravenous steroid injection, oral steroid, no treatment). Initial visual acuity, final visual acuity, degree of visual field defect, fluorescein angiography, visual evoked potential and brain magnetic resonance imaging were analyzed by chart review.
RESULTS
The chief complaints of the 41 NAION patients at the first visit were decreased visual acuity (n = 24), visual field defect (n = 10), no symptoms (n = 4), diplopia (n = 2), and floaters (n = 1). The distribution of the patients according to steroid administration method was 15 patients with intravenous steroid injection, 14 patients with oral steroid and 12 patients with no treatment. The improvement in visual acuity was greatest in intravenous steroid injection (87%), oral steroid (43%) and no treatment (33%) in that order.
CONCLUSIONS
In a retrospective comparison of treatment effects after explaining the advantages and disadvantages of steroid therapy in patients with NAION, the intravenous steroid injection group showed 87% improvement in visual acuity and an odds ratio of 5.5 (95% confidence interval [CI] 1.05-28.88, p-value 0.04), while the oral steroid group showed 43% improvement and an odds ratio of 1.5 (95% CI 0.30-7.43, p-value 0.62). The steroid treatment group showed better visual acuity improvement than the no treatment group, and the intravenous steroid injection group showed 5.5 times greater improvement in visual acuity compared to the no treatment group.

Keyword

Non-arteritic anterior ischemic optic neuropathy; Steroid; Visual field

MeSH Terms

Brain
Diplopia
Evoked Potentials, Visual
Fluorescein Angiography
Humans
Magnetic Resonance Imaging
Methods
Odds Ratio
Optic Neuropathy, Ischemic*
Retrospective Studies
Steroids*
Visual Acuity
Visual Fields
Steroids

Figure

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  Figure 1 Plot of visual acuity at final visit versus at initial visit. The points in the improved region represent eyes that improved at final visit: in the IV steroid group 87%, PO steroid group 43% and in the no treatment group 33%. VA = visual acuity; IV = intravenous; PO = per oral.

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