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R. A. Bueno-Garcia, J. B. Kerrison, R. A. Garcia, V. Alfaro, III, E. P. Jablon, M. Rodriguez-Fontal; Functional and Anatomic Outcomes of Intravitreal Triamcinolone Acetonide for Non-Arteritic Anterior Ischemic Optic Neuropathy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):6008.
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Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) is an infarction of the optic nerve head caused by inadequate perfusion of the posterior ciliary arteries. It is postualted that vision loss in NAION occurs from primary ischemia to the optic nerve and secondary compression from compartmentalized edema. It is postulated that pharmacologic decompression of optic nerve edema with intravitreal high dose corticosteroids might improve visual outcome. The aim of this study was to evaluate the used of triamcinolone acetonide in the treatment of NAION.
We conducted a retrospective interventional clinical case series of eight patients to review the effects of 4 mg dose of intravitreal triamcinolone acetonide as a treatment of NAION. A comprehensive ophthalmic evaluation was performed, including recording of visual acuity, visual fields with a Goldmann perimeter, and intraocular pressure; slitlamp examination of the anterior segment; ophthalmoscopy; color fundus photography; and in acute cases, fluorescein fundus angiography.
Visual acuity improved in six (85%) patients with a mean improvement of 3.5 lines. Two patients (25 %) had loss of visual acuity with a mean worsening of 4 lines. Among six patients with improved visual acuity, visual field (mean deviation) as determined by kinetic perimetry improved slightly in one patient (12.5 %) and showed no significant overall change in five patients (62.5 %). Two patients with worsening visual acuity demonstrated a relative inferior altitudinal defect that changed to an absolute inferior altitudinal defect during follow up. An inferior altitudinal visual field defect was the most common pattern in our NAION patients (four eyes). One patient developed an elevated intraocular pressure (28 mmHg) that responded to well to topical glaucoma therapy
Intravitreal steroid use in NAION has shown no benefit in one small case control study of three patients. In the present study of eight eyes, the benefit of intravitreal steroids could not clearly be demonstrated. Further studies are necessary in order to document possible benefit.
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