Non-arteritic Anterior Ischemic Optic Neuropathy: Role of Systemic Corticosteroid Therapy

Subretinal fluid is common in experimental non-arteritic anterior ischemic optic neuropathy

“…Rarely, human AION is treated with anti-VEGF or steroids. 17,18 Certainly, ischemia could lead to the upregulation of VEGF and perhaps contribute to the formation of subretinal fluid. However, anti-VEGF therapy has been associated with exacerbation of retinal ischemia.…”

Management of non-arteritic anterior ischemic optic neuropathy

“…Jalil et al [49] reported a case that was found to have an IOP of 56 mmHg 3 days after intravitreal injection of bevacizumab. Similarly, there are many reports showing a substantial rise in IOP a few days or weeks after intravitreal triamcinolone; by contrast, oral steroid therapy for NA-AION did not have that effect on IOP during a short-term treatment [33]. While sustained IOP rise has been recorded by these reports, we do not have information about how common it is after intravitreal ranibizumab, because the usual practice is to monitor IOP only immediately post-injection and not later on.…”

“…Systemic corticosteroid therapy A recent large, prospective study [33], based on 696 eyes, comparing the visual outcome in treated (364 eyes) versus untreated control (332 eyes) groups, with identical baseline parameters in the two groups, concluded that NA-AION eyes treated during the acute phase with systemic corticosteroids had a significantly higher probability of improvement in visual acuity and visual field than did the untreated group. In eyes with initial visual acuity of 20/70 or worse, seen within 2 weeks of onset, there was visual acuity improvement in 70% in the treated group compared to 41% in the untreated group (odds ratio of improvement: 3.39; 95% CI:1.62, 7.11; p=0.001).…”

Is There A Role for Intravitreal Pharmacotherapy in the Treatment of Acute Nonarteritic Ischemic Optic Neuropathy?

“…In fact, systemic methylprednisolone administration was shown to have a positive effect on retinal ganglion cell survival [14] . Hayreh and Zimmerman [15] investigated the visual outcome of oral 80 mg prednisolone in a large cohort of 613 acute NAION patients. They showed that treating the eyes with acute NAION with in the first 2 weeks after the onset with systemic steroids, resulted in a significantly higher probability of improvement in visual acuity and visual field, compared to untreated patients.…”