The efficacy of local glucocorticosteroid therapy in nonarteritic anterior ischemic optic neuropathy

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Abstract

BACKGROUND: Non-arteritic anterior ischemic optic neuropathy is the second most common optic neuropathy after glaucoma. The effectiveness of the glucocorticosteroid therapy use for the non-arteritic anterior ischemic optic neuropathy treatment remains a subject of debate. Currently, the search for markers of the disease’s “therapeutic window” is under way.

AIM: The aim of this study is to evaluate the use of local glucocorticosteroid therapy as an emergency care for non-arteritic anterior ischemic optic neuropathy.

MATERIALS AND METHODS: 41 patients with non-arteritic anterior ischemic optic neuropathy were enrolled in the study. To evaluate optic nerve head and macula morphometric characteristics, optical coherence tomography was performed, additionally, diameters of arteries and veins were assessed at 4 vascular arcades. Patients were divided into 2 groups according to the presence of intraretinal fluid. The first (main) group consisted of 23 patients with intraretinal fluid, in the second (control) group 18 patients without intraretinal fluid were included. The first group was further divided into two subgroups according to the medical aid recourse periods — up to 5 days, and from 6 to 21 days (subgroup 1 — 9 patients, subgroup 2 — 14 patients).

RESULTS: Correlations between the dynamics of optic nerve head edema changes and the caliber of arteries (negative correlation) and that of veins (positive correlation) were revealed. Sub-tenon injection of long-acting glucocorticosteroid did not lead to morpho-functional improvement in first group patients. Local short-acting glucocorticosteroid therapy accomplished in the acute period of the disease made it possible to achieve an improvement in best corrected visual acuity during the first month in group 1 patients without any further worsening of it.

CONCLUSIONS: When providing emergency care to patients with non-arteritic anterior ischemic optic neuropathy during the first 5 days from the disease onset, the local use of glucocorticosteroid therapy is advisable.

About the authors

Vladimir A. Antonov

Academician I.P. Pavlov First St. Petersburg State Medical University

Author for correspondence.
Email: antonov@alborada.fi
ORCID iD: 0000-0002-5823-8367

postgraduate student

Russian Federation, Saint Petersburg

Svetlana N. Tultseva

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: tultceva@yandex.ru
ORCID iD: 0000-0002-9423-6772
SPIN-code: 3911-0704
Scopus Author ID: 57194338755

Dr. Sci. (Med.), professor

Russian Federation, Saint Petersburg

Sergey Y. Astakhov

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: astakhov73@mail.ru
ORCID iD: 0000-0003-0777-4861
SPIN-code: 7732-1150
Scopus Author ID: 56660518500

Dr. Sci. (Med.), professor

Russian Federation, Saint Petersburg

Nurguyana N. Grigoryeva

St. Petersburg Territorial Diabetological Center

Email: grinur@mail.ru
ORCID iD: 0000-0002-3877-2474
SPIN-code: 7299-4748
Scopus Author ID: 57219513060

MD, candidate of medical sciences, ophthalmologist

Russian Federation, Saint Petersburg

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2. Fig. 1. Correlations between the amount of edema of the optic disc and the diameter of arteries. Groups: red — group 1, green — group 2; A — artery diameter, μm; N — nasal; T — temporal; S — superior; I — inferior; Common — common diameter of vessels of all vascular arcades; optic nerve head prominence, μm: ONH 1 — central sector; ONH 2 — superior sector; ONH 3 — nasal sector; ONH 4 — inferior sector; ONH 5 — temporal sector

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3. Fig. 2. Correlations between the amount of edema of the optic disc and the diameter of veins. Group: red — group 1, green — group 2; V — vein diameter, μm; N — nasal; T — temporal; S — superior; I — inferior; Common — common diameter of vessels of all vascular arcades; optic nerve head prominence, μm: ONH 1 — central sector; ONH 2 — superior sector; ONH 3 — nasal sector; ONH 4 — inferior sector; ONH 5 — temporal sector

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4. Fig. 3. Intraretinal peripapillary fluid by оptical coherence tomography

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5. Fig. 4. Hyperreflective intraretinal points by оptical coherence tomography: a — at the discharge from the hospital; b — after 3 months

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6. Fig. 5. Dynamics of changes in visual acuity in patients of subgroups 1, 2 and of group 2

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7. Fig. 6. Dynamics of RNFL thickness changes in the peripapillary area according to the OCT data at various time points. Sectors: NS — nasal superior, TS — temporal superior, T — temporal, TI — temporal inferior, NI — nasal inferior, N — nasal OCT

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