Abstract

SA.15.03

Fluocortolone improves short-term and long-term visual outcome in patients with NAION

Verena Prokosch, Solon Thanos
Experimentelle Ophthalmologie, Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Münster, Münster

Objective
Nonarteriitic anterior ischemic optic neuropathy (NAION) is a leading cause of sudden irreversible vision loss occurring especially among individuals older than 50 years. No treatment has been proven to reverse or limit the course of this disease up to now, although pentoxifyllin is routinely used.
The purpose was to study the beneficial effect of fluocortolone in patients with acute onset of NAION in respect of short- term and long- term visual outcome.
Methods
Prospective, quasi randomized intervention trial involving 60 patients with acute NAION, whereas 30 patients were alternating assigned to the control and the case group, respectively. The control group received pentoxifyllin for 7 days as a standard therapy and the case group was additionally treated with 1mg/kg bodyweight methylprednisolon for 5 days with subsequent reduction of the dose gradually over time. Primary outcome measures were changes in best corrected visual acuity looking at the visual acuity at the initial, after three days of therapy and at 6-month visits.
Results
There was a significant difference in improvement of visual acuity between the control and the case group. Patients receiving fluocortolone in acute NAION were more likely to experience improvement and less likely to have worsened visual acuity (mean visus initially: 0,3, after 3 days 0,4 and after 6 month 0,53) than control patients (mean initial visus: 0,5; after 3 days: 0,5 and after 6 month 0,42). The effect was seen after three days and even better at 6- month visits.
Conclusions
This was the first prospective randomized intervention trial showing the beneficial effect of fluocortolone in terms of visual outcome of patients with NAION. Fluocortolone appeared to be adjuvant in the treatment of recent-onset NAION concerning long- term and short- term visual outcome. Whenever there are no contraindications secondary administration of fluocortolone should be seriously considered in NAION.

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