Application of HELP in nonarteritic anterior ischemic optic neuropathy: a prospective, randomized, controlled study.
BACKGROUND
Heparin-induced extracorporeal LDL/fibrinogen precipitation (HELP) eliminates selectively fibrinogen, LDL, cholesterol, triglycerides and LP(a) from blood plasma using extracorporeal circulation. The reduction of fibrinogen and LDL by about 50% after only one procedure immediately improves the hemorheological situation.


METHODS
In a prospective, randomized, controlled study over a period of 3 months, 40 patients with nonarteritic ischemic optic neuropathy (NAION) were randomly assigned to either HELP or hemodilution therapy to determine the efficacy of these two treatments on visual acuity and fields.


RESULTS
After transformation of the Snellen acuity into logMAR units the statistical analysis did not show a significant difference between the two groups (P = 0.48). An increase of the visual acuity by two or more lines was obtained in 9 patients (47.4%) of the HELP group, 10 (52.6%) remained stable and none got worse. In the hemodilution group, visual acuity increased in patients (33.4%), 9 (42.8%) remained stable and 5 (23.8%) experienced a decrease. The calculated mean sensitivity of visual fields at baseline improved statistically significantly (P < 0.01) in the HELP group from 6.83 +/- 4.52 dB to 8.27 +/- 4.89 dB, but did not change significantly in the hemodilution group (6.25 +/- 4.12 dB to 6.12 +/- 3.92 dB).


CONCLUSIONS
The HELP system seems to be safe and more effective than hemodilution in improving the hemorheological and the functional situation in NAION and could be a promising regimen in the treatment of NAION.
Haas
A
A
Department of Ophthalmology, Karl-Franzens University of Graz, Austria.
Walzl
M
M
Jesenik
F
F
Walzl
B
B
Berghold
A
A
Berglöff
J
J
Feigl
B
B
Faulborn
J
J
D000368:Aged; D001167:Arteritis / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D001809:Blood Viscosity; D005074:Evoked Potentials, Visual / Q000502:physiology*; D005112:Extracorporeal Circulation; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005590:Fractional Precipitation; D006438:Hemodilution / Q000379:methods; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D018917:Optic Neuropathy, Ischemic / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D014792:Visual Acuity; D014794:Visual Fields
D005343:Fibrinolytic Agents; D008077:Lipoproteins, LDL; D005340:Fibrinogen; D006493:Heparin