Visual outcome of patients following NAION after treatment with adjunctive fluocortolone

Article type: Research Article

Authors: Prokosch, Verena | Thanos, Solon

Affiliations: Institute of Experimental Ophthalmology, Westfälische Wilhelms-Universität Münster, Münster, Germany

Note: [] Corresponding author: Dr. Verena Prokosch, Institute of Experimental Ophthalmology, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer Campus 1, Building D15, 48149 Münster, Germany. Tel.: +49 251 8356951; Fax: +49 251 8356916; E-mail: verena.prokosch@uk-muenster.de

Abstract: Purpose: Nonarteriitic anterior ischemic optic neuropathy (NAION) is a leading cause of sudden loss of vision, which particularly affects individuals older than 50 years. Up to now there is no treatment that is effective at reversing or limiting the course of this disease. To study the short- and long-term effects of fluocortolone (FC) on the visual outcome of patients with acute NAION compared to standard treatment with pentoxifylline (PFX). Methods: A prospective, quasirandomized intervention trial was conducted involving 60 patients with acute-onset NAION. Patients in the comparison (PFX) group (n = 30) received PFX intravenously and per os for 7 days and then per os for a further 6 months, which is a standard treatment. Patients in the intervention (PFX + FC) group (n = 30) received the standard treatment plus 1 mg/kg FC for 5 days, with a subsequent stepwise dose reduction over time. As a primary outcome measure, the best corrected visual acuity (BCVA) was determined at the initial baseline consultation (i.e., before treatment), and at 3 days and 6 months after therapy onset. Visual field (VF) was analyzed using standard automated perimetry at the initial baseline examination and at 6 month after therapy onset. Changes in BCVA and visual field in the PFX and PFX + FC groups were compared and analyzed statistically. Results: Treatment with FC resulted in a significant improvement in BCVA. Patients receiving FC in acute NAION were more likely to experience improvement and less likely to have worsened visual acuity (mean BCVA scores: at baseline, 0.22; after 3 days and 6 months of treatment, 0.33 and 0.43, respectively) than PFX patients (mean BCVA scores: at baseline, 0.33; after 3 days and 6 months of treatment, 0.33 and 0.28, respectively; p < 0.002 and 0.001). The beneficial effect was even more marked 6 months after therapy onset. Remarkably, patients with a baseline BCVA score of >=0.05 profited significantly by FC treatment (p < 0.006 and 0.001), whereas those with a baseline BCVA score of <0.05 did not (p < 0.4). PFX did not improve BCVA. However, VF did not show any significant improvement due to FC therapy. Conclusion: This is the first prospective randomized intervention trial that demonstrates the distinctive beneficial effects of FC in terms of the visual outcome of patients with NAION compared to standard treatment with only PFX. FC significantly improves both short- and long-term visual acuity in patients with moderate BCVA impairment due to recent onset of NAION, while VF did not show any significant improvement; however, PFX did neither enhance BCVA nor VF. Administration of FC should be seriously considered for the treatment of NAION whenever there are no contraindications.

Keywords: Nonarteriitic anterior ischemic optic neuropathy, fluocortolone, visual acuity, pentoxifylline, short- and long-term visual outcome, visual acuity

DOI: 10.3233/RNN-120292

Journal: Restorative Neurology and Neuroscience, vol. 32, no. 3, pp. 381-389, 2014