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Visual outcome of mega-dose intravenous corticosteroid treatment in non-arteritic anterior ischemic optic neuropathy - retrospective analysis.

Kinori M, Ben-Bassat I, Wasserzug Y, Chetrit A, Huna-Baron R - BMC Ophthalmol (2014)

Bottom Line: VA at end of follow-up did not improve in either groups (p = 0.8 treated group, p = 0.1 control group).No improvement and no difference in VF defects were found by either quadrant analysis (p = 0.1 treated group, p = 0.5 control group) or MD analysis (p = 0.2, treated group, p = 0.9 control group).VA and VF parameters tended to be worse in the treated group, although without statistical significance.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neuro-Ophthalmology unit, The Goldschleger Eye Institute, Sheba Medical Center, Tel- Hashomer, Israel affiliated to the Sackler school of medicine, Tel Aviv university, Tel Aviv, Israel. mkinori@hotmail.com.

ABSTRACT

Background: To date, non arteritic anterior ischemic optic neuropathy (NAION) is still incurable. We wish to evaluate the effect of intravenous (IV) corticosteroids on the visual outcome of NAION patients.

Methods: Visual parameters were retrospectively compared between NAION patients treated with IV corticosteroids and untreated NAION patients (control). Visual acuity (VA) and Humphrey automated static perimetry visual field (VF) defects of the affected eye were compared between groups at baseline, 1, 3, 6 months, and end of follow-up visits. The VF analysis consisted of number of quadrant involvements and mean deviation (MD).

Results: Each group comprised 23 patients (24 eyes). Mean initial VA was similar in the control and treatment groups (p = 0.8). VA at end of follow-up did not improve in either groups (p = 0.8 treated group, p = 0.1 control group). No improvement and no difference in VF defects were found by either quadrant analysis (p = 0.1 treated group, p = 0.5 control group) or MD analysis (p = 0.2, treated group, p = 0.9 control group). VA and VF parameters tended to be worse in the treated group, although without statistical significance.

Conclusions: Our results suggest that IV corticosteroids may not improve the visual outcome of NAION patients. Since intravenous corticosteroids could potentially cause serious adverse effects, this treatment for NAION is questionable.

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Related in: MedlinePlus

Humphrey visual field (HVF) analysis in quadrants (upper graphs) and according to the mean deviation (MD) (lower graphs). Value above columns represents the p-value of mean quadrant involvement (upper graphs) and mean MD value (lower graphs) compared to baseline. Note that in both groups there was no change in the number of quadrant involvement at any time point. Analysis by MD showed no statistically significant difference in both groups between baseline and final values (p = 0.9 for controls, p = 0.2 for treated group). Note a mild trend toward improvement in the control group versus worsening in the treated group in the MD analysis. This trend was not shown in the analysis by quadrants involvement. *After bonferroni correction for multiple comparisons: p = 0.12.
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Figure 2: Humphrey visual field (HVF) analysis in quadrants (upper graphs) and according to the mean deviation (MD) (lower graphs). Value above columns represents the p-value of mean quadrant involvement (upper graphs) and mean MD value (lower graphs) compared to baseline. Note that in both groups there was no change in the number of quadrant involvement at any time point. Analysis by MD showed no statistically significant difference in both groups between baseline and final values (p = 0.9 for controls, p = 0.2 for treated group). Note a mild trend toward improvement in the control group versus worsening in the treated group in the MD analysis. This trend was not shown in the analysis by quadrants involvement. *After bonferroni correction for multiple comparisons: p = 0.12.

Mentions: Figure 2 shows the outcome for VF according to quadrants involved and the average MD. The initial VF showed defects in 2.4 ± 0.8 in the treated group and 2.0 ± 0.6 quadrants in the control group. This difference was statistically significant (p = 0.007), and could be explained by the bias of the clinician to treat the more severe cases with IV corticosteroids. As shown, VF defect severity remained the same in both groups throughout the follow-up period. At final visit, quadrant involvement was 2.6 ± 0.9 in the treated group and 2.2 ± 0.7 in the control group (p = 0.07). In both groups mean VF quadrant involvement was not statistically significant from baseline in all examinations. The VF defects according to MD analysis showed no statistically significant difference in the initial MD value between groups (p = 0.9), as opposed to analysis by quadrants. No statistical difference was found between groups at the end of follow-up (p = 0.2).


Visual outcome of mega-dose intravenous corticosteroid treatment in non-arteritic anterior ischemic optic neuropathy - retrospective analysis.

Kinori M, Ben-Bassat I, Wasserzug Y, Chetrit A, Huna-Baron R - BMC Ophthalmol (2014)

Humphrey visual field (HVF) analysis in quadrants (upper graphs) and according to the mean deviation (MD) (lower graphs). Value above columns represents the p-value of mean quadrant involvement (upper graphs) and mean MD value (lower graphs) compared to baseline. Note that in both groups there was no change in the number of quadrant involvement at any time point. Analysis by MD showed no statistically significant difference in both groups between baseline and final values (p = 0.9 for controls, p = 0.2 for treated group). Note a mild trend toward improvement in the control group versus worsening in the treated group in the MD analysis. This trend was not shown in the analysis by quadrants involvement. *After bonferroni correction for multiple comparisons: p = 0.12.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4017224&req=5

Figure 2: Humphrey visual field (HVF) analysis in quadrants (upper graphs) and according to the mean deviation (MD) (lower graphs). Value above columns represents the p-value of mean quadrant involvement (upper graphs) and mean MD value (lower graphs) compared to baseline. Note that in both groups there was no change in the number of quadrant involvement at any time point. Analysis by MD showed no statistically significant difference in both groups between baseline and final values (p = 0.9 for controls, p = 0.2 for treated group). Note a mild trend toward improvement in the control group versus worsening in the treated group in the MD analysis. This trend was not shown in the analysis by quadrants involvement. *After bonferroni correction for multiple comparisons: p = 0.12.
Mentions: Figure 2 shows the outcome for VF according to quadrants involved and the average MD. The initial VF showed defects in 2.4 ± 0.8 in the treated group and 2.0 ± 0.6 quadrants in the control group. This difference was statistically significant (p = 0.007), and could be explained by the bias of the clinician to treat the more severe cases with IV corticosteroids. As shown, VF defect severity remained the same in both groups throughout the follow-up period. At final visit, quadrant involvement was 2.6 ± 0.9 in the treated group and 2.2 ± 0.7 in the control group (p = 0.07). In both groups mean VF quadrant involvement was not statistically significant from baseline in all examinations. The VF defects according to MD analysis showed no statistically significant difference in the initial MD value between groups (p = 0.9), as opposed to analysis by quadrants. No statistical difference was found between groups at the end of follow-up (p = 0.2).

Bottom Line: VA at end of follow-up did not improve in either groups (p = 0.8 treated group, p = 0.1 control group).No improvement and no difference in VF defects were found by either quadrant analysis (p = 0.1 treated group, p = 0.5 control group) or MD analysis (p = 0.2, treated group, p = 0.9 control group).VA and VF parameters tended to be worse in the treated group, although without statistical significance.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neuro-Ophthalmology unit, The Goldschleger Eye Institute, Sheba Medical Center, Tel- Hashomer, Israel affiliated to the Sackler school of medicine, Tel Aviv university, Tel Aviv, Israel. mkinori@hotmail.com.

ABSTRACT

Background: To date, non arteritic anterior ischemic optic neuropathy (NAION) is still incurable. We wish to evaluate the effect of intravenous (IV) corticosteroids on the visual outcome of NAION patients.

Methods: Visual parameters were retrospectively compared between NAION patients treated with IV corticosteroids and untreated NAION patients (control). Visual acuity (VA) and Humphrey automated static perimetry visual field (VF) defects of the affected eye were compared between groups at baseline, 1, 3, 6 months, and end of follow-up visits. The VF analysis consisted of number of quadrant involvements and mean deviation (MD).

Results: Each group comprised 23 patients (24 eyes). Mean initial VA was similar in the control and treatment groups (p = 0.8). VA at end of follow-up did not improve in either groups (p = 0.8 treated group, p = 0.1 control group). No improvement and no difference in VF defects were found by either quadrant analysis (p = 0.1 treated group, p = 0.5 control group) or MD analysis (p = 0.2, treated group, p = 0.9 control group). VA and VF parameters tended to be worse in the treated group, although without statistical significance.

Conclusions: Our results suggest that IV corticosteroids may not improve the visual outcome of NAION patients. Since intravenous corticosteroids could potentially cause serious adverse effects, this treatment for NAION is questionable.

Show MeSH
Related in: MedlinePlus