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Bekir Kucuk, Uğur Acar, Koray Sevinc, Seçkin Aykas, Mesut Erdurmus, Gungor Sobaci; Intravitreal injection of erythropoietin in late-stage optic neuropathy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5537.
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Recent clinical findings have showed that erythropoietin(EPO) has both neuroprotective and neuroregenerative capabilities for axonal degenerative disease of the optic nerve. In this retrospective interventional study, we evaluated if intravitreal EPO administration has any neuroregenerative effect in patients with late-stage optic neuropathy, or not.
Twelve eyes of 12 patients with optic atrophy[(defined as overall thinning(90 µm)in the retinal nerve fiber layer(RNFL)]from definite demyelinating optic neuritis history were included. Patients who had both minimum 6-months medical history and light perception vision in the affected eye, were enrolled into the study. Using pars plana approach, 2000IU/0.2ml EPO(Eprex4000IU/0.4ml, Janssen-Cilag AG,Switzerland) was administered intravitreally with a 30-gauge needle on a tuberculin syringe. Injections were administered 3-times with 6-weeks intervals. Clinical [Best corrected visual acuity(BCVA) and opthalmoscopic and laboratory(OCT measurements, electrodiagnostic tests)] examinations were repeated at regular intervals, and final visit was performed 3-months after the third intravitreal EPO injection. The primary outcome parameters, BCVA and RNFL thickness and secondary outcome parameters, visual evoked potentials(VEP) and electroretinography(ERG) at initially and at final visit were analyzed.
No inflammatory, immunological or proliferative response was detected. The median BCVA of the patients with optic atrophy was 1.71±1(0.5-3.1)logMAR at initially and 1.69±1(0.5-3.1)logMAR at final visit. No one obtained minimum 0.2 logMAR BCVA improvement (success criteria). RNFL value was 49.1±22(22-88)µm before injections, and 48.6±20(25-81)µm after injections. The mean amplitude values of combined response in ERG(N35-P50, P50-N95) were 5.68±2(2.9-10.2)mV, 6.91±3(3.7-14.9)mV before the injections and 5.45±2.1(2.6-9.6)mV, 6.73±2.5(3.7-12)mV after the injections, respectively. The mean amplitude and latancy values of response in VEP 121.25±19.5(90-153) msn and 3.75±2.7(1.4-12)mV before the injections and 114.8±15(93-134)msn and 3.96±3.1 (0.7-12.4)mV after the injections, respectively.
Intravitreal EPO injections has no neuroregenerative effect on the optic nerve when it was administered in the late period (>6months) of optic neuropathy. Meantime, we did not find any adverse effects of this administration on visual parameters and retinal microstructures.
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