Purpose

To examine the role of oral steroid therapy in the treatment of nondiabetic cases of acute nonarteritic anterior ischemic optic neuropathy (NAAION).

Design

Randomized double-blind clinical trial.

Participants

Thirty-eight patients with acute nondiabetic NAAION divided into 2 arms of 19 patients each. One arm constituted the cases and the other constituted the controls.

Methods

Cases received oral steroid therapy and were designated the steroid group, whereas controls received placebo and were designated the nonsteroid group. Best-corrected visual acuity (BCVA), visual evoked response (VER), and OCT were performed at baseline, 1 month, 3 months, and 6 months after recruitment into the trial.

Main Outcome Measures

Best-corrected visual acuity, VER, and retinal nerve fiber layer changes on OCT.

Results

Both groups showed significant improvement in BCVA, VER latency, and resolution of disc edema on OCT parameters over 6 months. Final outcome showed no statistically significant difference with regard to visual acuity, although VER was better in the steroid group (P = 0.011). Best-corrected visual acuity, VER amplitude, and VER latency (P = 0.02, P = 0.02, and P = 0.04, respectively) showed a greater percentage improvement in the steroid group, which also saw a faster resolution of disc edema on OCT (1-month follow-up).

Conclusions

Oral steroids in acute NAAION did not improve the visual acuity significantly at 6 months. However, they improved resolution of disc edema significantly and enabled a greater improvement in VER parameters. This subtle benefit of oral steroids in NAAION is clinically unimportant and does not provide support for its use.

中文翻译：

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类固醇与非类固醇在非动脉性前部缺血性视神经病变中的关系 ：随机对照试验

目的

研究口服类固醇疗法在治疗非糖尿病性急性非动脉性前部缺血性视神经病变（NAAION）病例中的作用。

设计

随机双盲临床试验。

参加者

38例急性非糖尿病性NAAION患者分为2组，每组19例。一只手臂构成案件，另一只手臂构成控件。

方法

接受口服类固醇治疗的患者被指定为类固醇组，而对照组接受安慰剂的患者被指定为非类固醇组。入选试验后的基线，1个月，3个月和6个月时进行最佳矫正视力（BCVA），视觉诱发反应（VER）和OCT。

主要观察指标

最佳矫正视力，VER和OCT上的视网膜神经纤维层变化。

结果

两组均显示，在6个月内，BCVA，VER潜伏期和OCT参数的椎间盘水肿消退明显改善。尽管VER在类固醇组中更好（P  = 0.011），但最终结果在视敏度上没有统计学上的显着差异。最佳校正的视敏度，VER幅度和VER潜伏期（分别为P  = 0.02，P  = 0.02和P  = 0.04）显示类固醇组的百分比改善更大，这也显示了OCT上椎间盘水肿的解决速度更快（ 1个月的随访）。

结论

急性NAAION中的口服类固醇在6个月时并未显着改善视力。但是，它们显着提高了椎间盘水肿的分辨率，并大大改善了VER参数。口服类固醇在NAAION中的微妙优势在临床上并不重要，也无法为其使用提供支持。