| Objective: Nonarteritic anterior ischemic optic neuropathy (NAION) is acommon multifactorial optic nerve disease characterized by sudden painlessvisual loss and/or segmental defect in the visual field, optic disc edema in theeraly phase and atrophy in the late phase. Clinically there is still no effectivetherapy to recover the visual function in the affected eyes and prevent theoccurrence of the same disease in the contralateral eyes. Systemicglucocorticoid usage in acute NAION eyes with obvious optic disc edema hascertain therapeutic effect. It can rapidly eliminate the optic disc edema, andimprove the prognosis in acute NAION eyes, but its side effects are severer.The aim of this study is to investigate the effectiveness of intravitrealtriamcinolone acetonide injection (IVTA), retrobulbar triamcinolone acetonideinjection (RBTA) and conventional therapy in the treatment of acute NAIONeyes with obvious optic disc edema, in order to find out a safe and effectivetherapy for acute NAION.Methods: In accordance with the matching principle of clinical databefore treatment,38eyes with best corrected visual acuity (BCVA) less thanor equal to0.4of38acute NAION patients were divided into three groups(bad vision groups):12eyes of12patients in the IVTA group were treatedwith single IVTA4mg/0.1ml+conventional therapy,13eyes of13patients inthe RBTA group were treated with single RBTA20mg/0.5ml+conventionaltherapy, and13eyes of13patients in the conventional therapy group weretreated only with conventional therapy. Also in accordance with the matchingprinciple of clinical data before treatment,24eyes with BCVA better than0.4of23acute NAION patients were divided into two groups (good vision groups):12eyes of12patients in the RBTA group were treated with singleRBTA20mg/0.5ml+conventional therapy, and12eyes of11patients in theconventional therapy group were treated only with conventional therapy. Theconventional therapy for all patients were consistent. All NAION eyes wereexamed BCVA, intraocular pressure and degree of optic disc edema beforetreatment and1,2,3,4,6,8,10,12weeks after treatment, visual field beforetreatment and4,8,12weeks after treatment, and fundus fluoresceinangiography before treatment and4,12weeks after treatment.Results: Compared the BCVA before treatment and12weeks aftertreatment, there were significant increasing in all bad vision groups: IVTAgroup (t=6.382, P=0.000), RBTA group (t=6.620, P=0.000) and conventionaltherapy group (t=2.636, P=0.022). In the bad vision groups, the BCVAincreasing in IVTA group were significantly better than RBTA group (P=0.016)and conventional therapy group (P=0.000), and RBTA group better thanconventional therapy group (P=0.035). Compared the mean sensitivity ofvisual field before treatment and12weeks after treatment, there weresignificant improving in bad vision IVTA group (t=6.351, P=0.000) and RBTAgroup (t=3.111, P=0.009), but no significant improving in bad visionconventional therapy group (t=0.320, P=0.755). In the bad vision groups, thevisual field improving in IVTA group were significantly better than RBTAgroup (P=0.036) and conventional therapy group (P=0.000), and RBTA groupbetter than conventional therapy group (P=0.042). There was significantlyimproving visual field in good vision RBTA group (t=3.222, P=0.008), but nosignificant improving in good vision conventional therapy group (t=2.117,P=0.058). In the good vision groups, there is no significant difference in thevisual field improving between RBTA group and conventional therapy group(t=1.710, P=0.101). The optic disc edema resolved within2.92±0.08weeksafter treatment in bad vision IVTA group, and no complications occurred suchas intraocular inflammation, intravitreal hemorrhage and corticosteroidglaucoma. The mean resolution time of optic disc edema were6.23±1.35and5.72±1.30weeks after treatment in bad and good vision RBTA groups respectively,7.83±1.27and7.50±1.23weeks afetr treatment in bad and goodvision conventional therapy groups. In the bad vision groups, the meanresolution time of optic disc edema in IVTA group were significantly shorterthan RBTA group (P=0.000) and conventional therapy group (P=0.000), andRBTA group significantly shorter than conventional therapy group (P=0.002).In the good vision groups, the mean resolution time of optic disc edema inRBTA group was significantly shorter than conventional therapy group(t=2.416, P=0.024).Conclusion: IVTA and RBTA may rapidly eliminate optic disc edema,increase visual acuity and improve visual field,and are relatively safe andeffective in the treatment of acute NAION eyes when combined withconventional therapy. The effectiveness of IVTA is better than RBTA. Furtherlarge sample, randomized, controlled, clinical trial studies to prove the safetyand effectiveness of IVTA and RBTA are merited... |
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