The effect of oral glucocorticoids on acute non-arteritic anterior ischemic optic neuropathy
10.3760/cma.j.cn511434-20210609-00304
- VernacularTitle:口服糖皮质激素治疗急性期非动脉炎性前部缺血性视神经病变疗效观察
- Author:
Fei CHEN
1
;
Feng GAO
;
Min WANG
;
Yan QIU
;
Huijun HE
;
Bing WANG
Author Information
1. 山东省滕州市中心人民医院眼科 277500
- Keywords:
Optic neuropathy, ischemic;
Glucocorticoids;
Visual fields
- From:
Chinese Journal of Ocular Fundus Diseases
2021;37(10):758-762
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To observe the clinical efficacy of oral glucocorticoids in the treatment of acute non-arteritic anterior ischemic optic neuropathy (NAION).Methods:A prospective clinical study. From December 2017 to June 2020, 40 eyes of 40 patients with acute NAION who were diagnosed in Department of Ophthalmology of Tengzhou Central People's Hospital were included in the study. All the affected eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examination of optic disc; 35 eyes (BCVA≥0.1) underwent visual field examination at the same time. The BCVA examination was carried out using the international standard decimal visual acuity chart, which was converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. The static visual field inspection was performed with Humphrey automatic perimeter to obtain the average mean deviation (MD) value. The thickness of peripapillary retinal nerve fire layer (pRNFL) around the optic disc of the affected eye was measured with an OCT instrument. According to the wishes of patients, they were divided into hormone treatment group and control group. All were given vitamin B1 and methylcobalamin orally; the hormone treatment group was given oral prednisone acetate treatment, 60 mg/d (regardless of body weight); after 2 weeks, the dose was reduced by 5 mg every 5 days, and the dose was reduced to 40 mg and maintained until optic disc edema subsides; thereafter, the dose was quickly reduced until the drug was stopped. Three and 6 months after treatment, the same equipment and methods were used for related examinations before treatment to observe the thickness changes of BCVA, MD, and pRNFL. The thickness of BCVA, MD, and pRNFL between the two groups was compared by Mann-Whitney U test. The thickness of BCVA, MD, and pRNFL before and after treatment within the group was compared by rank analysis of variance. Results:Among 40 eyes of 40 cases, 21 eyes were in the hormone treatment group, and 19 eyes were in the control group. There were differences in age, sex composition, course of disease, associated systemic risk factors, BCVA, MD, and pRNFL thickness between the two groups. There was no statistical significance ( P>0.05). At 3 and 6 months after treatment, the average logMAR BCVA of the eyes of the hormone treatment group and the control group were 0.26±0.32, 0.26±0.34, 0.28±0.30, 0.25±0.32, respectively. The visual field MD were -15.52±6.87, -15.55±6.04 dB and -14.82±7.48, -15.18±6.40 dB; pRNFL thickness was 70.38±10.22, 73.79±11.82 μm and 65.67±10.07, 69.26±10.85 μm. LogMAR BCVA ( Z=-0.014, -0.315; P=1.000, 0.768), visual field MD ( Z=-0.041, -0.068; P=0.979, 0.957), pRNFL thickness ( Z= -0.965, -1.112; P=0.347, 0.270), the difference was not statistically significant. Conclusion:Compared with the control group, oral glucocorticoid treatment of acute NAION fail to improve the visual function and morphological prognosis during the 6-month follow-up period.
