The efficacy of local glucocorticosteroid therapy in nonarteritic anterior ischemic optic neuropathy

Abstract

BACKGROUND: Non-arteritic anterior ischemic optic neuropathy is the second most common optic neuropathy after glaucoma. The effectiveness of the glucocorticosteroid therapy use for the non-arteritic anterior ischemic optic neuropathy treatment remains a subject of debate. Currently, the search for markers of the diseases therapeutic window is under way. AIM: The aim of this study is to evaluate the use of local glucocorticosteroid therapy as an emergency care for non-arteritic anterior ischemic optic neuropathy. MATERIALS AND METHODS: 41 patients with non-arteritic anterior ischemic optic neuropathy were enrolled in the study. To evaluate optic nerve head and macula morphometric characteristics, optical coherence tomography was performed, additionally, diameters of arteries and veins were assessed at 4 vascular arcades. Patients were divided into 2 groups according to the presence of intraretinal fluid. The first (main) group consisted of 23 patients with intraretinal fluid, in the second (control) group 18 patients without intraretinal fluid were included. The first group was further divided into two subgroups according to the medical aid recourse periods up to 5 days, and from 6 to 21 days (subgroup 1 9 patients, subgroup 2 14 patients). RESULTS: Correlations between the dynamics of optic nerve head edema changes and the caliber of arteries (negative correlation) and that of veins (positive correlation) were revealed. Sub-tenon injection of long-acting glucocorticosteroid did not lead to morpho-functional improvement in first group patients. Local short-acting glucocorticosteroid therapy accomplished in the acute period of the disease made it possible to achieve an improvement in best corrected visual acuity during the first month in group 1 patients without any further worsening of it. CONCLUSIONS: When providing emergency care to patients with non-arteritic anterior ischemic optic neuropathy during the first 5 days from the disease onset, the local use of glucocorticosteroid therapy is advisable.