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Eun, Lee, and Kyung: Therapeutic Effect of Steroids in Patients with Non-arteritic Anterior Ischemic Optic Neuropathy
Original Article

Journal of the Korean Ophthalmological Society 2017; 58(10): 1176-1182.

Published online: 11 October 2017

DOI: https://doi.org/10.3341/jkos.2017.58.10.1176

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

Jun Soo Eun, MD, Myung Won Lee, MD, PhD, Sung Eun Kyung, MD, PhD

Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea.

Address reprint requests to Sung Eun Kyung, MD, PhD. Department of Ophthalmology, Dankook University Hospital, #201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea. Tel: 82-41-550-6497, Fax: 82-41-556-0524, kseeye@hanmail.net

Received 30 March 2017       Revised 29 August 2017       Accepted 20 September 2017

©2017 The Korean Ophthalmological Society

The Korean Ophthalmological Society

(open-access):

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 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.

Keywords: Non-arteritic anterior ischemic optic neuropathy, Steroid, Visual field

Figures and Tables

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.

jkos-58-1176-g001
Table 1

Demographic and clinical characteristics of non-arteritic anterior ischemic optic neuropathy patients

jkos-58-1176-i001

Values are presented as mean ± SD unless otherwise indicated.

TIA/CVA = transient ischemic attack/cerebrovascular accidents; RAPD = relative afferent pupillary defect.

*p-value obtained from the kruskal-wallis test.

Table 2

Visual acuity, visual field defect (MD) and distribution, MRI, FAG and VEP of non-arteritic anterior ischemic optic neuropathy patients

jkos-58-1176-i002

MD = mean deviation; MRI = magnetic resonance imaging; FAG = fluorescein angiography; VEP = visual evoked potential; IV = intravenous.

*p-value obtained from the kruskal-wallis test; †1/4 means initial/final visit patient's number.

Table 3

Mean visual acuity (logMAR) of Nonarteritic anterior ischemic optic neuropathy patients at initial and final visit

jkos-58-1176-i003

Notes

Conflicts of Interest The authors have no conflicts to disclose.

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