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Park, Shin, and Chun: Additional Retrobulbar Triamcinolone Acetonide Injection for Retrobulbar Optic Neuritis Patients
Original Article

J Korean Ophthalmol Soc 2013;54(1):117-122.

Published online: 25 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.1.117

Additional Retrobulbar Triamcinolone Acetonide Injection for Retrobulbar Optic Neuritis Patients

Joon Ho Park, MD, Jae Pil Shin, MD, PhD, Bo Young Chun, MD, PhD

Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea

Address reprint requests to Bo Young Chun, MD, PhD Department of Ophthalmology, Kyungpook National University Hospital #200 Dongdeok-ro, Jung-gu, Daegu 700-721, Korea Tel: 82-53-420-5806, Fax: 82-53-426-6552 E-mail: byjun424@hotmail.com

Received 25 May 2012       Accepted 28 August 2012

Copyright © 2013 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the effect of additional retrobulbar triamcinolone acetonide (TA) injection on early recovery of visual acuity in retrobulbar optic neuritis patients.

Methods

A prospective, randomized clinical study including 30 patients with retrobulbar optic neuritis was conducted between March 2003 and June 2007. Patients were divided into 2 groups: Group 1 (n = 9) with retrobulbar triamcinolone (TA, 40 mg/1 ml) injection on the first day of ONTT protocol, and group 2 (n = 21) with conventional ONTT protocol. The following parameters were measured and analyzed: patient's sex, age, pupillary reactions, color vision, visual field, and best-corrected visual acuity before treatment, and after 1 day, 1 week, 2 weeks, 1 month, and 3 months of follow-up.

Results

Mean visual acuity before treatment was 1.00 ± 0.89 log MAR units in group 1 and 0.98 ± 0.75 log MAR units in group 2. One day after injection, visual acuity was better in group 1 (0.50 ± 0.42 log MAR units) than in group 2 (0.73 ± 0.61 log MAR units), however, there was no statistically significant difference between the 2 groups (p = 0.07). There was no significant difference in visual acuity, recovery of RAPD, color vision, or visual field at 3 months of follow-up. No serious side effect related to retrobulbar TA injection was observed.

Conclusions

Additional retrobulbar TA injection may help optic neuritis patients who have a need for prompt visual recovery. However, further studies are required to ascertain whether this procedure can help early recovery of visual acuity in retrobulbar optic neuritis patients.

Keywords: Best corrected visual acuity, Retrobulbar optic neuritis, Retrobulbar triamcinolone acetonide injection

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Figure 1.
Mean BCVA before treatment and after 1 day, 1 week, 2 weeks, 1 month, and 3 months of follow-up.
jkos-54-117f1.tif
Table 1.
Patient data
  Group 1 Group 2 p-value
Age (yr) 39.89 ± 14.00 33.14 ± 15.71 0.12*
Sex     1.00†
   Male 3 6  
   Female 6 15  
Mean BCVA at diagnosis (log MAR) 1.00 ± 0.89 0.98 ± 0.75 0.95*
Follow-up period (mons) 4.52 ± 1.08 5.79 ± 1.42 0.28*

Values are presented as mean ± SD or number.

SD = standard deviation; BCVA = best corrected visual acuity.

* Mann-Whitney U test

† Fisher's exact test.

Table 2.
Comparison of the amount of VA changes between 2 groups
Time interval after treatment The amount of VA changes* (log MAR)
Group 1 Group 2 p-value†
1 day 0.53 ± 0.58 0.26 ± 0.45 0.07
1 wk 0.74 ± 0.64 0.71 ± 0.69 0.94
2 wks 0.87 ± 0.76 0.93 ± 0.73 0.86
1 mon 0.92 ± 0.81 0.96 ± 0.75 0.93
3 mons 0.97 ± 0.88 0.99 ± 0.76 0.98

Values are presented as mean ± SD.

SD = standard deviation.

* Differences between BCVA of the day at diagnosis and BCVA during treatment

† Mann-Whitney U test.

Table 3.
BCVA at 3 months after treatment
BCVA at 3 mons (Snellen) Group 1 Group 2 p-value
≥20/20 7/9 (78) 14/21 (67) 0.68*
20/25->20/30 2/9 (22) 5/21 (24) 1.00*
20/30->20/40 0/9 (0) 2/21 (9) 1.00*
Mean time of regain VA of 20/20 (day) 26.9 ± 32.1 33.0 ± 44.3 0.73†

Values are presented as number (%) or mean ± SD.

BCVA = best corrected visual acuity; VA= visual acuity.

* Fisher's exact test

† Mann-Whitney U test.

Table 4.
Correlations between clinical factors and BCVA at 3 months after treatment*
  Group 1 Group 2
Initial visual acuity (r = 0.314, p = 0.449) (r = 0.021, p = 0.933)
Age of patient (r = −0.218, p = 0.604) (r = −0.513, p = 0.025)
Gender of patient (r = 0.330, p = 0.425) (r = 0.155, p = 0.525)
Duration of symptom before treatment (r = 0.291, p = 0.501) (r = 0.324, p = 0.438)

* Spearman's correlation.

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