Treatment of nonarteritic anterior ischemic optic neuropathy.
Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common clinical presentation of acute ischemic damage to the optic nerve. Most treatments proposed for NAION are empirical and include a wide range of agents presumed to act on thrombosis, on the blood vessels, or on the disk edema itself. Others are presumed to have a neuroprotective effect. Although there have been multiple therapies attempted, most have not been adequately studied, and animal models of NAION have only recently emerged. The Ischemic Optic Neuropathy Decompression Trial, the only class I large multicenter prospective treatment trial for nonarteritic anterior ischemic optic neuropathy, found no benefit from surgical intervention. One recent large, nonrandomized controlled study suggested that oral steroids might be helpful for acute NAION. Others recently proposed interventions are intravitreal injections of steroids or anti-vascular endothelial growth factor (anti-VEGF) agents. There are no class I studies showing benefit from either medical or surgical treatments. Most of the literature on the treatment of NAION consists of retrospective or prospective case series and anecdotal case reports. Similarly, therapies aimed at secondary prevention of fellow eye involvement in NAION remain of unproven benefit.
Atkins
Edward J
EJ
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.
Bruce
Beau B
BB
Newman
Nancy J
NJ
Biousse
Valérie
V
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001167:Arteritis / Q000628:therapy; D019299:Decompression, Surgical; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D013508:Ophthalmologic Surgical Procedures; D018917:Optic Neuropathy, Ischemic / Q000209:etiology / Q000628:therapy*; D012307:Risk Factors; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
D020533:Angiogenesis Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D005938:Glucocorticoids; D042461:Vascular Endothelial Growth Factor A