NEW APPROACH

The addition of the corticosteroid fluocortolone to standard therapy improves short- and long-term visual acuity in patients with nonarteritic anterior ischemic optic neuropathy (NAION), according to a study in Restorative Neurology and Neuroscience.

In a prospective randomised trial of 60 patients with NAION, researchers from the Institute of Experimental Ophthalmology, University of Münster, Germany found that patients treated with pentoxifylline alone had no significant beneficial effects in either visual acuity or visual field after three days and six months of treatment. However, adding fluocortolone patients were significantly more likely to experience improvement and less likely to have worsened visual acuity. After six months of therapy two thirds of patients treated with the combination therapy had better long-term vision compared to only 14 per cent of those only treated with pentoxifylline alone.

The researchers note that the effects were especially pronounced when the combination therapy was given soon after the onset of symptoms. They hypothesise that since NAION is caused by ischemia of the optic nerve head, the restriction of blood supply, depending upon its degree, results in primary irreversible loss of retinal ganglion cells (RGC) and secondary delayed RGC loss related to subsequent optic-disc edema. Corticosteroids do not appear to reduce primary cell death, explaining the lack of benefit of steroid therapy in patients with a BCVA score worse than 0.05. There may be a therapeutic window for patients with moderate BCVA loss who suffer secondary RGC loss due to optic-nerve swelling.

V. Prokosch et al., Restorative Neurology and Neuroscience, “Visual outcome of patients following NAION after treatment with adjunctive fluocortolone,” 2013. DOI 10.3233/RNN-120292.