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Published in: Graefe's Archive for Clinical and Experimental Ophthalmology 2/2014

01-02-2014 | Neurophthalmology

Intravitreal triamcinolone injections in non-arteritic anterior ischemic optic neuropathy

Authors: Corina Radoi, Tony Garcia, Catherine Brugniart, Alain Ducasse, Carl Arndt

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 2/2014

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Abstract

Background

In non-arteritic anterior ischemic optic neuropathy (NA-AION), no treatments have demonstrated to be effective in recovering visual loss in randomized clinical trials. Oral steroids have been evaluated, and small series of intravitreal triamcinolone acetonide (IVTA) injection in NA-AION have been reported. The purpose of our study was to report the visual outcome and morphological changes in response to a single IVTA injection as a treatment for patients with NA-AION.

Patients and methods

The charts of 36 patients with visual symptoms and optic disc swelling caused by NA-AION were evaluated. Twenty-one patients had received 4 mg IVTA and were compared with 15 non-treated patients. Visual acuity (VA), retinal nerve fiber layer thickness and static visual field were evaluated after 6 months.

Results

VA improvement at 6 months is statistically better in the treated group than in the non-treated group (p = 0.0035). In the treated group, there was a significant inverse correlation between the delay of the injection and the visual acuity achieved at 6 months (p < 0.0083**, r = −0.56). A significant improvement of the visual field was noted in the injected group when compared with the non-treated group at 6 months (p < 0.0028).

Discussion

In this retrospective study, patients receiving IVTA in the acute phase of NA-AION have better improvement of VA and visual field during the follow-up period of 6 months. However, only a large randomized controlled trial may enable to evaluate the benefits of IVTA Injections on visual outcome in NA-AION.
Literature
1.
go back to reference Miller GR, Smith JL (1966) Ischemic optic neuropathy. Am J Ophthalmol 62:103–115PubMed Miller GR, Smith JL (1966) Ischemic optic neuropathy. Am J Ophthalmol 62:103–115PubMed
2.
go back to reference Repka MX (1975) Clinical profile and long-term implications of anteriorischemic optic neuropathy. Brain 98:689–708CrossRef Repka MX (1975) Clinical profile and long-term implications of anteriorischemic optic neuropathy. Brain 98:689–708CrossRef
3.
go back to reference Olver JM, Spalton DJ, McCarney ACE (1990) Microvascular study of the retrolaminar optic nerve in man. The possible significance in anterior ischaemic optic neuropathy. Eye 4:7–24PubMedCrossRef Olver JM, Spalton DJ, McCarney ACE (1990) Microvascular study of the retrolaminar optic nerve in man. The possible significance in anterior ischaemic optic neuropathy. Eye 4:7–24PubMedCrossRef
4.
go back to reference Beri M, Klugman MR, Kohler JA, Hayreh SS (1987) Anterior ischemic optic neuropathy VII. Incidence of bilaterality and various influencing factors. Ophthalmology 94:1020–1028PubMedCrossRef Beri M, Klugman MR, Kohler JA, Hayreh SS (1987) Anterior ischemic optic neuropathy VII. Incidence of bilaterality and various influencing factors. Ophthalmology 94:1020–1028PubMedCrossRef
5.
go back to reference Hayreh SS (1974) Anterior ischaemic optic neuropathy III. Treatment, prophylaxis, and differential diagnosis. Br J Ophthalmol 58:98l–989l Hayreh SS (1974) Anterior ischaemic optic neuropathy III. Treatment, prophylaxis, and differential diagnosis. Br J Ophthalmol 58:98l–989l
6.
go back to reference Hayreh SS (1990) Anterior ischaemic optic neuropathy: differentiation of arteritic from non-arteritic type and its management. Eye 4:25–41PubMedCrossRef Hayreh SS (1990) Anterior ischaemic optic neuropathy: differentiation of arteritic from non-arteritic type and its management. Eye 4:25–41PubMedCrossRef
7.
go back to reference Hayreh SS, Podhajsky PA, Zimmerman B (1999) Role of nocturnal arterial hypotension in optic nerve head ischemic disorders. Ophthalmologica 213:76–96PubMedCrossRef Hayreh SS, Podhajsky PA, Zimmerman B (1999) Role of nocturnal arterial hypotension in optic nerve head ischemic disorders. Ophthalmologica 213:76–96PubMedCrossRef
8.
go back to reference Beck RW, Servais GE, Hayreh SS (1987) Anterior ischemic optic neuropathy IX. Cup-to-disc ratio and its role in pathogenesis. Ophthalmology 94:1503–1508PubMedCrossRef Beck RW, Servais GE, Hayreh SS (1987) Anterior ischemic optic neuropathy IX. Cup-to-disc ratio and its role in pathogenesis. Ophthalmology 94:1503–1508PubMedCrossRef
9.
go back to reference The Ischemic Optic Neuropathy Decompression Trial Research Group (1995) Optic nerve decompression surgery for nonarteritic anterior ischemic optic neuropathy (NAION) is not effective and may be harmful. JAMA 273:625–632CrossRef The Ischemic Optic Neuropathy Decompression Trial Research Group (1995) Optic nerve decompression surgery for nonarteritic anterior ischemic optic neuropathy (NAION) is not effective and may be harmful. JAMA 273:625–632CrossRef
10.
go back to reference Newman NJ, Scherer R, Langenberg P, Kelman S, Feldon S, Kaufman D, Dickersin K, Ischemic Optic Neuropathy Decompression Trial Research Group (2002) The fellow eye in NAION: report from the ischemic optic neuropathy decompression trial follow-up study. Am J Ophthalmol 134:317–328PubMedCrossRef Newman NJ, Scherer R, Langenberg P, Kelman S, Feldon S, Kaufman D, Dickersin K, Ischemic Optic Neuropathy Decompression Trial Research Group (2002) The fellow eye in NAION: report from the ischemic optic neuropathy decompression trial follow-up study. Am J Ophthalmol 134:317–328PubMedCrossRef
11.
go back to reference Ischemic Optic Neuropathy Decompression Trial Research Group (2000) Ischemic optic neuropathy decompression trial: twenty-four-month update. Arch Ophthalmol 118:793–798CrossRef Ischemic Optic Neuropathy Decompression Trial Research Group (2000) Ischemic optic neuropathy decompression trial: twenty-four-month update. Arch Ophthalmol 118:793–798CrossRef
12.
go back to reference Beck RW, Hayreh SS, Podhajsky PA, Tan E-S, Moke PS (1997) Aspirin therapy in nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol 123:212–217PubMed Beck RW, Hayreh SS, Podhajsky PA, Tan E-S, Moke PS (1997) Aspirin therapy in nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol 123:212–217PubMed
13.
go back to reference Rootman DB, Gill HS, Margolin EA (2013) Intravitreal bevacizumab for the treatment of nonarteritic anterior ischemic optic neuropathy: a prospective trial. Eye (Lond) 27(4):538CrossRef Rootman DB, Gill HS, Margolin EA (2013) Intravitreal bevacizumab for the treatment of nonarteritic anterior ischemic optic neuropathy: a prospective trial. Eye (Lond) 27(4):538CrossRef
14.
go back to reference Hayreh SS, Zimmerman MB (2008) Non-arteritic anterior ischemic optic neuropathy: role of systemic corticosteroid therapy. Graefes Arch Clin Exp Ophthalmol 246(7):1029PubMedCentralPubMedCrossRef Hayreh SS, Zimmerman MB (2008) Non-arteritic anterior ischemic optic neuropathy: role of systemic corticosteroid therapy. Graefes Arch Clin Exp Ophthalmol 246(7):1029PubMedCentralPubMedCrossRef
15.
go back to reference Bailey IL, Lovie JE (1976) New design principles for visual acuity letter charts. Am J Optom Physiol Opt 53(11):740PubMedCrossRef Bailey IL, Lovie JE (1976) New design principles for visual acuity letter charts. Am J Optom Physiol Opt 53(11):740PubMedCrossRef
16.
go back to reference Colenbrander A (1994) The functional vision score: a coordinated scoring system for visual impairments, disabilities and handicaps. In: Kooijman A et al. (eds) Low vision: Research and new developments in rehabilitation. Studies in Health Technology and Informatics. IOS Press, Amsterdam, p 552 Colenbrander A (1994) The functional vision score: a coordinated scoring system for visual impairments, disabilities and handicaps. In: Kooijman A et al. (eds) Low vision: Research and new developments in rehabilitation. Studies in Health Technology and Informatics. IOS Press, Amsterdam, p 552
17.
go back to reference Jonas JB, Degenring RF, Kreissig I, Akkoyun I, Kamppeter BA (2005) Intraocular pressure elevation after intravitreal triamcinolone acetonide injection. Ophthalmology 112(4):593PubMedCrossRef Jonas JB, Degenring RF, Kreissig I, Akkoyun I, Kamppeter BA (2005) Intraocular pressure elevation after intravitreal triamcinolone acetonide injection. Ophthalmology 112(4):593PubMedCrossRef
18.
go back to reference Vasconcelos-Santos DV, Nehemy PG, Schachat AP, Nehemy MB (2008) Secondary ocular hypertension after intravitreal injection of 4 mg of triamcinolone acetonide: incidence and risk factors. Retina 28(4):573PubMedCrossRef Vasconcelos-Santos DV, Nehemy PG, Schachat AP, Nehemy MB (2008) Secondary ocular hypertension after intravitreal injection of 4 mg of triamcinolone acetonide: incidence and risk factors. Retina 28(4):573PubMedCrossRef
19.
go back to reference Hayreh SS, Podhajsky PA, Zimmerman B (1997) Non-arteritic anterior ischemic optic neuropathy—time of onset of visual loss. Am J Ophthalmol 124:641–647PubMed Hayreh SS, Podhajsky PA, Zimmerman B (1997) Non-arteritic anterior ischemic optic neuropathy—time of onset of visual loss. Am J Ophthalmol 124:641–647PubMed
20.
21.
go back to reference Jonas JB, Spandau UH, Harder B, Saunder G (2007) Intravitreal triamcinolone acetonide for treatment of acute nonarteritic anterior ischemic optic neuropathy. Graefes Arch Clin Exp Ophthalmol 245(5):749PubMedCrossRef Jonas JB, Spandau UH, Harder B, Saunder G (2007) Intravitreal triamcinolone acetonide for treatment of acute nonarteritic anterior ischemic optic neuropathy. Graefes Arch Clin Exp Ophthalmol 245(5):749PubMedCrossRef
22.
go back to reference Yaman A, Selver OB, Saatci AO, Soylev MF (2008) Intravitreal triamcinolone acetonide injection for acute non-arteritic anterior ischaemic optic neuropathy. Clin Exp Optom 91(6):561–565PubMedCrossRef Yaman A, Selver OB, Saatci AO, Soylev MF (2008) Intravitreal triamcinolone acetonide injection for acute non-arteritic anterior ischaemic optic neuropathy. Clin Exp Optom 91(6):561–565PubMedCrossRef
23.
go back to reference Kaderli B, Avci R, Yucel A, Guler K, Gelisken O (2007) Intravitreal triamcinolone improves recovery of visual acuity in nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol 27:164–168PubMedCrossRef Kaderli B, Avci R, Yucel A, Guler K, Gelisken O (2007) Intravitreal triamcinolone improves recovery of visual acuity in nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol 27:164–168PubMedCrossRef
24.
go back to reference Sohn BJ, Chun BY, Kwon JY (2009) The effect of an intravitreal triamcinolone acetonide injection for acute nonarteritic anterior ischemic optic neuropathy. Korean J Ophthalmol 23(1):59–61PubMedCentralPubMedCrossRef Sohn BJ, Chun BY, Kwon JY (2009) The effect of an intravitreal triamcinolone acetonide injection for acute nonarteritic anterior ischemic optic neuropathy. Korean J Ophthalmol 23(1):59–61PubMedCentralPubMedCrossRef
25.
go back to reference Hayreh SS (2008) Intravitreal triamcinolone for non-arteritic anterior ischemic optic neuropathy. J Neuroophthalmol 28:77–78PubMedCrossRef Hayreh SS (2008) Intravitreal triamcinolone for non-arteritic anterior ischemic optic neuropathy. J Neuroophthalmol 28:77–78PubMedCrossRef
26.
go back to reference Hayreh SS, Zimmerman MB (2007) Optic disc edema in non-arteritic anterior ischemic optic neuropathy. Graefes Arch Clin Exp Ophthalmol 245:1107–1121PubMedCrossRef Hayreh SS, Zimmerman MB (2007) Optic disc edema in non-arteritic anterior ischemic optic neuropathy. Graefes Arch Clin Exp Ophthalmol 245:1107–1121PubMedCrossRef
27.
go back to reference Hayreh SS (1969) Blood supply of the optic nerve head and its role in optic atrophy, glaucoma and oedema of the optic disc. Br J Ophthalmol 53:721–748PubMedCrossRef Hayreh SS (1969) Blood supply of the optic nerve head and its role in optic atrophy, glaucoma and oedema of the optic disc. Br J Ophthalmol 53:721–748PubMedCrossRef
28.
go back to reference Hayreh SS (1978) Fluids in the anterior part of the optic nerve in health and disease. Surv Ophthalmol 23:1–25PubMedCrossRef Hayreh SS (1978) Fluids in the anterior part of the optic nerve in health and disease. Surv Ophthalmol 23:1–25PubMedCrossRef
29.
go back to reference Hayreh SS (2001) The blood supply of the optic nerve head and the evaluation of it -Myth and reality. Prog Retin Eye Res 20:563–593PubMedCrossRef Hayreh SS (2001) The blood supply of the optic nerve head and the evaluation of it -Myth and reality. Prog Retin Eye Res 20:563–593PubMedCrossRef
30.
go back to reference Osako T, Chuman H, Maekubo T (2013) Effects of steroid administration and transcorneal electrical stimulation on the anatomical and electrophysiological deterioration of nonarteritic ischemic optic neuropathy in a rodent model. Jpn J Ophthalmol 57(4):402–409PubMedCrossRef Osako T, Chuman H, Maekubo T (2013) Effects of steroid administration and transcorneal electrical stimulation on the anatomical and electrophysiological deterioration of nonarteritic ischemic optic neuropathy in a rodent model. Jpn J Ophthalmol 57(4):402–409PubMedCrossRef
31.
go back to reference Chuman H, Kawano N, Kozawa M (2013) Vasodilatory effects of anti-vascular endothelium growth factor (VEGF) antibody, corticosteroid, and nitric oxide on the posterior ciliary artery. Jpn J Ophthalmol 57(3):320–326PubMedCrossRef Chuman H, Kawano N, Kozawa M (2013) Vasodilatory effects of anti-vascular endothelium growth factor (VEGF) antibody, corticosteroid, and nitric oxide on the posterior ciliary artery. Jpn J Ophthalmol 57(3):320–326PubMedCrossRef
32.
go back to reference Hayreh SS (2005) Prevalent misconceptions about acute retinal vascular occlusive disorders. Prog Retin Eye Res 24:493–519PubMedCrossRef Hayreh SS (2005) Prevalent misconceptions about acute retinal vascular occlusive disorders. Prog Retin Eye Res 24:493–519PubMedCrossRef
33.
go back to reference Hayreh SS, Zimmerman MB, Podhajsky P, Alward WL (1994) Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders. Am J Ophthalmol 117:603–624PubMed Hayreh SS, Zimmerman MB, Podhajsky P, Alward WL (1994) Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders. Am J Ophthalmol 117:603–624PubMed
34.
go back to reference McLeod D, Marshall J, Kohner EM (1980) Role of axoplasmic transport in the pathophysiology of ischaemic disc swelling. Br J Ophthalmol 64:247–261PubMedCrossRef McLeod D, Marshall J, Kohner EM (1980) Role of axoplasmic transport in the pathophysiology of ischaemic disc swelling. Br J Ophthalmol 64:247–261PubMedCrossRef
35.
go back to reference Kesler A, Irge D, Rogowski O, Bornstein N, Berliner S, Shapira I, Shani ST, Ben Assayag E (2009) High-sensitivity C-reactive protein measurements in patients with non-arteritic anterior ischaemic optic neuropathy: a clue to the presence of a microinflammatory response. Acta Ophthalmol 87(2):216PubMedCrossRef Kesler A, Irge D, Rogowski O, Bornstein N, Berliner S, Shapira I, Shani ST, Ben Assayag E (2009) High-sensitivity C-reactive protein measurements in patients with non-arteritic anterior ischaemic optic neuropathy: a clue to the presence of a microinflammatory response. Acta Ophthalmol 87(2):216PubMedCrossRef
Metadata
Title
Intravitreal triamcinolone injections in non-arteritic anterior ischemic optic neuropathy
Authors
Corina Radoi
Tony Garcia
Catherine Brugniart
Alain Ducasse
Carl Arndt
Publication date
01-02-2014
Publisher
Springer Berlin Heidelberg
Published in
Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 2/2014
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-013-2499-9

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