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Lenworth N Johnson, Deanna P Harris Lyttle, Gregory F Petroski; Visual Recovery and OCT Changes Following Treatment of Nonarteritic Anterior Ischemic Optic Neuropathy with Levodopa, Allopurinol and Tetracycline. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6220.
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To determine the effectiveness of levodopa alone or in combination with allopurinol and tetracycline on visual acuity, visual field, and retinal nerve fiber layer (RNFL) thickness in eyes affected by nonarteritic anterior ischemic optic neuropathy (NAION).
Retrospective cohort study involving 33 eyes of 33 patients from 119 consecutively evaluated patients with NAION. Patients evaluated within 45 days of NAION onset and who had at least one optical coherence tomography (OCT) within 1 year of NAION onset were enrolled. Patients received treatment with levodopa alone (Levodopa only) or in combination with allopurinol and tetracycline (Levodopa plus). Best corrected visual acuity converted to logMAR, mean deviation (MD) threshold sensitivity on automated perimetry, and RNFL thickness on OCT were recorded at initial visit and follow-up within 1 year of NAION onset. Primary outcome measures were changes in logMAR visual acuity, MD threshold sensitivity, and RNFL thickness.
Improvement in visual acuity by 3 or more lines was documented for 71% (5 of 7) of Levodopa only and 50% (4 of 8) of Levodopa plus eyes having an initial visual acuity of 20/60 or worse. No levodopa treated eye had worsened visual acuity. There was no significant difference (p=0.91) between the change in logMAR visual acuity for the Levodopa only (-0.43 logMAR) and Levodopa plus (-0.4 logMAR) groups. There was no significant difference (p=0.9) between the change in MD threshold sensitivity for Levodopa only (1.79 dB) and Levodopa combined (1.54 dB) groups. The average RNFL thickness decreased by 23.6% for levodopa treated eyes, in contrast with previously published reports which documented decrease in average RNFL thickness of 35% to 42% for untreated patients.
Treatment within 45 days of onset of NAION with levodopa alone or in combination with allopurinol and tetracycline improved visual acuity but not visual field. Levodopa may promote neuroprotection in NAION by decreasing retinal ganglion cell loss and subsequent RNFL thinning.
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