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Erschienen in: Graefe's Archive for Clinical and Experimental Ophthalmology 10/2020

06.06.2020 | Neurophthalmology

The effect of systemic erythropoietin and oral prednisolone on recent-onset non-arteritic anterior ischemic optic neuropathy: a randomized clinical trial

verfasst von: Homayoun Nikkhah, Mahya Golalipour, Azadeh Doozandeh, Mohammad Pakravan, Mehdi Yaseri, Hamed Esfandiari

Erschienen in: Graefe's Archive for Clinical and Experimental Ophthalmology | Ausgabe 10/2020

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Abstract

Background

To evaluate the effect of systemic erythropoietin, as well as oral steroids, in the management of recent-onset non-arteritic anterior ischemic optic neuropathy (NAION).

Method

Patients diagnosed with NAION within 5 days were randomized into group A (systemic erythropoietin), group B (oral steroids), and group C (control). Group A received 10,000 units of erythropoietin twice a day for 3 days. Group B received oral prednisone 75 mg daily tapered off in 6 weeks.

Results

The mean best-corrected visual acuity (± SD) at the time of presentation was 1 ± 0.56, 1.01 ± 0.6, and 0.94 ± 0.47 logMAR in groups A, B, and C, respectively (P = 0.140); corresponding values at 6-month follow-up were 0.70 ± 0.44, 0.73 ± 0.35, and 0.75 ± 0.39 logMAR, respectively (P = 0.597). Fifty-five percent of patients in group A versus 34.3% in group B and 31.2% in group C had an improvement of at least 3 lines in the best-corrected visual acuity values at the 6th month of follow-up visit (P = 0.04). Peripapillary retinal nerve fiber layers at presentation were 189 ± 58, 193 ± 64, and 199 ± 62 micrometers, respectively (P = 0.779), which decreased to 88 ± 12, 74 ± 25, and 71 ± 18, respectively at 6-month follow-up (P = 0.041).

Conclusion

The findings of our study indicate the beneficial effects of systemic erythropoietin in preserving the function and structure of the optic nerve in recent-onset NAION.

Trial registration

Clinical registration number: IR.SBMU.ORC.REC.1397.18
Literatur
1.
Zurück zum Zitat Hayreh SS (1974) Anterior ischaemic optic neuropathy. I. Terminology and pathogenesis. Br J Ophthalmol 58:955–963CrossRef Hayreh SS (1974) Anterior ischaemic optic neuropathy. I. Terminology and pathogenesis. Br J Ophthalmol 58:955–963CrossRef
2.
Zurück zum Zitat Parsa CF, Hoyt WF (2015) Nonarteritic anterior ischemic optic neuropathy (NAION): a misnomer. Rearranging pieces of a puzzle to reveal a nonischemic papillopathy caused by vitreous separation. Ophthalmology 122:439–442CrossRef Parsa CF, Hoyt WF (2015) Nonarteritic anterior ischemic optic neuropathy (NAION): a misnomer. Rearranging pieces of a puzzle to reveal a nonischemic papillopathy caused by vitreous separation. Ophthalmology 122:439–442CrossRef
3.
Zurück zum Zitat Hayreh SS, Zimmerman MB (2007) Optic disc edema in non-arteritic anterior ischemic optic neuropathy. Graefes Arch Clin Exp Ophthalmol 245:1107–1121CrossRef Hayreh SS, Zimmerman MB (2007) Optic disc edema in non-arteritic anterior ischemic optic neuropathy. Graefes Arch Clin Exp Ophthalmol 245:1107–1121CrossRef
4.
Zurück zum Zitat Kaderli B, Avci R, Yucel A et al (2007) Intravitreal triamcinolone improves recovery of visual acuity in nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol 27:164–168CrossRef Kaderli B, Avci R, Yucel A et al (2007) Intravitreal triamcinolone improves recovery of visual acuity in nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol 27:164–168CrossRef
5.
Zurück zum Zitat Beck R (2000) Does levodopa improve visual function in NAION? Ophthalmology 107:1431–1434CrossRef Beck R (2000) Does levodopa improve visual function in NAION? Ophthalmology 107:1431–1434CrossRef
6.
Zurück zum Zitat Group TBS, The BRAION study group, Wilhelm B et al (2006) Efficacy and tolerability of 0.2% brimonidine tartrate for the treatment of acute non-arteritic anterior ischemic optic neuropathy (NAION): a 3-month, double-masked, randomised, placebo-controlled trial. Graefes Arch Clin Exp Ophthalmol 244:551–558CrossRef Group TBS, The BRAION study group, Wilhelm B et al (2006) Efficacy and tolerability of 0.2% brimonidine tartrate for the treatment of acute non-arteritic anterior ischemic optic neuropathy (NAION): a 3-month, double-masked, randomised, placebo-controlled trial. Graefes Arch Clin Exp Ophthalmol 244:551–558CrossRef
7.
Zurück zum Zitat Oguz H, Sobaci G (2008) The use of hyperbaric oxygen therapy in ophthalmology. Surv Ophthalmol 53:112–120CrossRef Oguz H, Sobaci G (2008) The use of hyperbaric oxygen therapy in ophthalmology. Surv Ophthalmol 53:112–120CrossRef
8.
Zurück zum Zitat Wilhelm H (2010) Faculty of 1000 evaluation for treatment of nonarteritic anterior ischemic optic neuropathy. F1000 - Post-publication peer review of the biomedical literature Wilhelm H (2010) Faculty of 1000 evaluation for treatment of nonarteritic anterior ischemic optic neuropathy. F1000 - Post-publication peer review of the biomedical literature
9.
Zurück zum Zitat Zhong L, Bradley J, Schubert W et al (2007) Erythropoietin promotes survival of retinal ganglion cells in DBA/2J glaucoma mice. Invest Ophthalmol Vis Sci 48:1212–1218CrossRef Zhong L, Bradley J, Schubert W et al (2007) Erythropoietin promotes survival of retinal ganglion cells in DBA/2J glaucoma mice. Invest Ophthalmol Vis Sci 48:1212–1218CrossRef
10.
Zurück zum Zitat Kashkouli MB, Pakdel F, Sanjari MS et al (2011) Erythropoietin: a novel treatment for traumatic optic neuropathy—a pilot study. Graefes Arch Clin Exp Ophthalmol 249:731–736CrossRef Kashkouli MB, Pakdel F, Sanjari MS et al (2011) Erythropoietin: a novel treatment for traumatic optic neuropathy—a pilot study. Graefes Arch Clin Exp Ophthalmol 249:731–736CrossRef
11.
Zurück zum Zitat Pakravan M, Sanjari N (2012) Erythropoietin treatment for methanol optic neuropathy. J Neuroophthalmol 32:325–328CrossRef Pakravan M, Sanjari N (2012) Erythropoietin treatment for methanol optic neuropathy. J Neuroophthalmol 32:325–328CrossRef
12.
Zurück zum Zitat Modarres M, Falavarjani KG, Nazari H et al (2011) Intravitreal erythropoietin injection for the treatment of non-arteritic anterior ischaemic optic neuropathy. Br J Ophthalmol 95:992–995CrossRef Modarres M, Falavarjani KG, Nazari H et al (2011) Intravitreal erythropoietin injection for the treatment of non-arteritic anterior ischaemic optic neuropathy. Br J Ophthalmol 95:992–995CrossRef
13.
Zurück zum Zitat Pakravan M, Esfandiari H, Sanjari N, Ghahari E (2016) Erythropoietin as an adjunctive treatment for methanol-induced toxic optic neuropathy. Am J Drug Alcohol Abuse 42:633–639CrossRef Pakravan M, Esfandiari H, Sanjari N, Ghahari E (2016) Erythropoietin as an adjunctive treatment for methanol-induced toxic optic neuropathy. Am J Drug Alcohol Abuse 42:633–639CrossRef
14.
Zurück zum Zitat Pakravan M, Esfandiari H, Hassanpour K et al (2017) The effect of combined systemic erythropoietin and steroid on non-arteritic anterior ischemic optic neuropathy: a prospective study. Curr Eye Res 42:1079–1084CrossRef Pakravan M, Esfandiari H, Hassanpour K et al (2017) The effect of combined systemic erythropoietin and steroid on non-arteritic anterior ischemic optic neuropathy: a prospective study. Curr Eye Res 42:1079–1084CrossRef
15.
Zurück zum Zitat Biousse V, Newman NJ (2015) Ischemic optic neuropathies. N Engl J Med 373:1677CrossRef Biousse V, Newman NJ (2015) Ischemic optic neuropathies. N Engl J Med 373:1677CrossRef
16.
Zurück zum Zitat Atkins EJ (2011) Nonarteritic anterior ischemic optic neuropathy. Curr Treat Options Neurol 13:92–100CrossRef Atkins EJ (2011) Nonarteritic anterior ischemic optic neuropathy. Curr Treat Options Neurol 13:92–100CrossRef
17.
Zurück zum Zitat (2000) Ischemic optic neuropathy decompression trial: twenty-four-month update. Arch Ophthalmol 118:793–798 (2000) Ischemic optic neuropathy decompression trial: twenty-four-month update. Arch Ophthalmol 118:793–798
18.
Zurück zum Zitat Pakravan M, Sanjari N, Esfandiari H et al (2016) The effect of high-dose steroids, and normobaric oxygen therapy, on recent onset non-arteritic anterior ischemic optic neuropathy: a randomized clinical trial. Graefes Arch Clin Exp Ophthalmol 254:2043–2048CrossRef Pakravan M, Sanjari N, Esfandiari H et al (2016) The effect of high-dose steroids, and normobaric oxygen therapy, on recent onset non-arteritic anterior ischemic optic neuropathy: a randomized clinical trial. Graefes Arch Clin Exp Ophthalmol 254:2043–2048CrossRef
19.
Zurück zum Zitat Hayreh SS, Zimmerman MB (2008) Non-arteritic anterior ischemic optic neuropathy: role of systemic corticosteroid therapy. Graefes Arch Clin Exp Ophthalmol 246:1029–1046CrossRef Hayreh SS, Zimmerman MB (2008) Non-arteritic anterior ischemic optic neuropathy: role of systemic corticosteroid therapy. Graefes Arch Clin Exp Ophthalmol 246:1029–1046CrossRef
20.
Zurück zum Zitat Lee AG, Biousse V (2010) Should steroids be offered to patients with nonarteritic anterior ischemic optic neuropathy? J Neuroophthalmol 30:193–198CrossRef Lee AG, Biousse V (2010) Should steroids be offered to patients with nonarteritic anterior ischemic optic neuropathy? J Neuroophthalmol 30:193–198CrossRef
21.
22.
Zurück zum Zitat Schepens CL (1954) Clinical aspects of pathologic changes in the vitreous body. Am J Ophthalmol 38:8–21CrossRef Schepens CL (1954) Clinical aspects of pathologic changes in the vitreous body. Am J Ophthalmol 38:8–21CrossRef
23.
Zurück zum Zitat Gorio A, Gokmen N, Erbayraktar S et al (2002) Recombinant human erythropoietin counteracts secondary injury and markedly enhances neurological recovery from experimental spinal cord trauma. Proc Natl Acad Sci U S A 99:9450–9455CrossRef Gorio A, Gokmen N, Erbayraktar S et al (2002) Recombinant human erythropoietin counteracts secondary injury and markedly enhances neurological recovery from experimental spinal cord trauma. Proc Natl Acad Sci U S A 99:9450–9455CrossRef
24.
Zurück zum Zitat Feng Q (2006) Beyond erythropoiesis: the anti-inflammatory effects of erythropoietin. Cardiovasc Res 71:615–617CrossRef Feng Q (2006) Beyond erythropoiesis: the anti-inflammatory effects of erythropoietin. Cardiovasc Res 71:615–617CrossRef
25.
Zurück zum Zitat Katavetin P, Tungsanga K, Eiam-Ong S, Nangaku M (2007) Antioxidative effects of erythropoietin. Kidney Int 72(Suppl 107):S10–S15 Katavetin P, Tungsanga K, Eiam-Ong S, Nangaku M (2007) Antioxidative effects of erythropoietin. Kidney Int 72(Suppl 107):S10–S15
26.
Zurück zum Zitat Haiden N, Klebermass K, Cardona F et al (2006) A randomized, controlled trial of the effects of adding vitamin B12 and folate to erythropoietin for the treatment of anemia of prematurity. Pediatrics 118:180–188CrossRef Haiden N, Klebermass K, Cardona F et al (2006) A randomized, controlled trial of the effects of adding vitamin B12 and folate to erythropoietin for the treatment of anemia of prematurity. Pediatrics 118:180–188CrossRef
27.
Zurück zum Zitat Diem R, Hobom M, Maier K et al (2003) Methylprednisolone increases neuronal apoptosis during autoimmune CNS inflammation by inhibition of an endogenous neuroprotective pathway. J Neurosci 23:6993–7000CrossRef Diem R, Hobom M, Maier K et al (2003) Methylprednisolone increases neuronal apoptosis during autoimmune CNS inflammation by inhibition of an endogenous neuroprotective pathway. J Neurosci 23:6993–7000CrossRef
28.
Zurück zum Zitat Diem R, Sättler MB, Merkler D et al (2005) Combined therapy with methylprednisolone and erythropoietin in a model of multiple sclerosis. Brain 128:375–385CrossRef Diem R, Sättler MB, Merkler D et al (2005) Combined therapy with methylprednisolone and erythropoietin in a model of multiple sclerosis. Brain 128:375–385CrossRef
Metadaten
Titel
The effect of systemic erythropoietin and oral prednisolone on recent-onset non-arteritic anterior ischemic optic neuropathy: a randomized clinical trial
verfasst von
Homayoun Nikkhah
Mahya Golalipour
Azadeh Doozandeh
Mohammad Pakravan
Mehdi Yaseri
Hamed Esfandiari
Publikationsdatum
06.06.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
Graefe's Archive for Clinical and Experimental Ophthalmology / Ausgabe 10/2020
Print ISSN: 0721-832X
Elektronische ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-020-04781-x

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