A systematic review of the effectiveness of glucocorticoids in the treatment of nonarteritic anterior ischemic optic neuropathy_Chinese Journal of Ocular Fundus Diseases

Authors：

Sun Wanyu ¹ , Liao Xing ² ,  Wang Ying ¹ , Wei Shihui ³

1. Eye Hospital, China Academy of Chinese Medical Sciences, Beijing 100040, China;
2. Center for Evidence Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, Beijing 100700, China;
3. Department of Ophthalmology, Chinese PLA General Hospital, Beijing 100039, China;

Corresponding author：

Wang Ying, Email: wangyingtcm@163.com

Keywords：

Glucocorticoids; Optic neuropathy, ischemic; Meta-analysis

DOI：

10.3760/cma.j.cn511434-20200114-00017

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the effectiveness and safety of glucocorticoids in the treatment of non-arteritic anterior ischaemic optic neuropathy (NAION).Methods Glucocorticoids published in the National Library of Medicine PubMed; Netherlands Medical Abstracts Database Embase; Cochrane Library, an evidence-based medical library; China Cnkipedia; China Biomedical Literature Service; Chongqing Vipul Chinese Science and Technology Journal Database, and Wanfang Science and Technology Journal Full Text Database were searched about computer. Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) for the treatments of NAION were subjected to meta-analysis. The search period was from the establishment of each database to March 2020. The literature was screened and data were extracted according to the inclusion and exclusion criteria. The methodological quality of the RCT and NRCT studies was evaluated using the Risk of Bias Assessment Tool and the MINORS evaluation scale, respectively. The data were analyzed using RevMan version 5.3 software which was provided by the Cochrane Collaboration Network.Results An initial search of 395 papers was conducted, and 10 papers were finally included for this meta-analysis, including 3 RCT studies and 7 NRCT studies. A total of 1057 patients with NAION were included. The 3 RCT studies were analyzed descriptively as the outcome indicators were described in different ways. A meta-analysis of 7 NRCT studies showed that patients in the treatment group showed significantly better visual prognosis (relative risk=1.28, 95% confidence interval 1.09 to 1.51, P=0.003) and retinal nerve fibre layer thickness were obviously improved (mean difference=7.76, 95% confidence interval 1.58 to 13.94, P=0.01) than the control group. Four studies reported the occurrence of adverse reactions in the treatment versus control groups. None of the above studies provided a detailed analysis of the prognosis of patients with adverse reactions.Conclusion The efficacy and safety of glucocorticoids in the treatment of NAION is unclear and needs to be validated in a larger sample of RCTs.

Citation： Sun Wanyu, Liao Xing, Wang Ying, Wei Shihui. A systematic review of the effectiveness of glucocorticoids in the treatment of nonarteritic anterior ischemic optic neuropathy. Chinese Journal of Ocular Fundus Diseases, 2021, 37(3): 224-230. doi: 10.3760/cma.j.cn511434-20200114-00017 Copy

1.	王建民, 赵云, 安建斌, 等. 玻璃体腔注射曲安奈德治疗非动脉炎性前部缺血性视神经病变的临床观察[J]. 中华眼底病杂志, 2011, 27(5): 488-489. DOI: 10.3760/cma.j.issn.1005-1015.2011.05.022.Wang JM, Zhao Y, An JB, et al. Clinical observation of intravitreal injection of triamcinolone acetonide in the treatment of non-arteritic anterior ischemic optic neuropathy[J]. Chin J Ocul Fundus Dis, 2011, 27(5): 488-489. DOI: 10.3760/cma.j.issn.1005-1015.2011.05.022.
2.	王润生, 吕沛霖, 常倩, 等. 前部缺血性视神经病变水肿期几种治疗方案的疗效评估[J]. 中华临床医师杂志(电子版), 2011, 5(12): 3469-3476. DOI: 10.3877/cma.j.issn.1674-0785.2011.12.017.Wang RS, Lyu PL, Chang Q, et al. Observation of the efficacy of several treatment strategies on patients with nonarteritic anterior ischemic optic neuropathy at edema stage[J]. Chin J Clinicicians (Electronic Edition), 2011, 5(12): 3469-3476. DOI: 10.3877/cma.j.issn.1674-0785.2011.12.017.
3.	王润生, 吕沛霖. 非动脉炎性前部缺血性视神经病变的临床研究进展[J]. 眼科新进展, 2010, 30(11): 1092-1096.Wang RS, Lyu PL. Recent clinical research advances in non-artertic anterior ischaemic optic neuropathy[J]. Rec Adv Ophthalmol, 2010, 30(11): 1092-1096.
4.	王建民, 赵云. 非动脉炎性前部缺血性视神经病变的糖皮质激素治疗[J]. 中国实用眼科杂志, 2011, 29(11): 1119-1123. DOI: 10.3760/cma.j.issn.1006-4443.2011.11.005.Wang JM, Zhao Y. Glucocorticoid therapy for non-arteritic anterior ischemic optic neuropathy[J]. Chin J Pract Ophthalmol, 2011, 29(11): 1119-1123. DOI: 10.3760/cma.j.issn.1006-4443.2011.11.005.
5.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[M]. England: John Wiley & Sons Ltd, 2011: 38.
6.	Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials[J/OL]. BMJ, 2011, 343: d5928[2011-10-18]. https://pubmed.ncbi.nlm.nih.gov/22008217/.DOI: 10.1136/bmj.d5928.
7.	曾宪涛, 庄丽萍, 杨宗国, 等. Meta分析系列之七: 非随机实验性研究、诊断性试验及动物实验的质量评价工具[J]. 中国循证心血管医学杂志, 2012, 4(6): 496-499. DOI: 10.3969/j.1674-4055.2012.06.003.Zeng XT, Zhuang LP, Yang ZG, et al. Meta analysis series of seven: non-randomized experimental research, diagnostic test and animal experiment quality evaluation tool[J]. Chin J Evid Based Cardiovase Med, 2012, 4(6): 496-499. DOI: 10.3969/j.1674-4055.2012.06.003.
8.	于丹丹, 廖星, 谢雁鸣, 等. 藿香正气丸联合西药治疗急性胃肠炎的系统评价和meta分析[J]. 中国中药杂志, 2019, 44(14): 2914-2925. DOI: 10.19540/j.cnki.cjcmm.20190513.502.Yu DD, Liao X, Xie YM, et al. Systematic review and meta-analysis of Huoxiang Zhengqi pills combined with Western medicine for acute gastroenteritis[J]. China Journal of Chinese Materia Medica, 2019, 44(14): 2914-2925. DOI: 10.19540/j.cnki.cjcmm.20190513.502.
9.	张振坡, 张金嵩, 杨倩倩, 等. 曲安奈德后部眼球筋膜下注射与雷珠单抗玻璃体内注射治疗缺血性视神经病变的疗效对比[J]. 中华眼外伤职业眼病杂志, 2019, 41(6): 450-453. DOI: 10.3760/cma.j.issn.2095-1477.2019.06.012.Zhang ZP, Zhang JS, Yang QQ, et al. Comparison of efficacy between subtenon injection of triamcinolone acetonide and intravitreal injection of ranibizumab for non-arteritic anterior ischenic optic neuropathy[J]. Chin J Ocul Traum Occupast Eye Dis, 2019, 41(6): 450-453. DOI: 10.3760/cma.j.issn.2095-1477.2019.06.012.
10.	Saxena R, Singh D, Sharma M, et al. Steroids versus no steroids in nonarteritic anterior ischemic optic neuropathy: a randomized controlled trial[J]. Ophthalmology, 2018, 125(10): 1623-1627. DOI: 10.1016/j.ophtha.2018.03.032.
11.	Radoi C, Garcia T, Brugniart C, et al. Intravitreal triamcinolone injections in non-arteritic anterior ischemic optic neuropathy[J]. Graefe's Arch Clin Exp Ophthalmol, 2014, 252(2): 339-345. DOI: 10.1007/s00417-013-2499-9.
12.	Kinori M, Ben-Bassat I, Wasserzug Y, et al. Visual outcome of mega-dose intravenous corticosteroid treatment in non-arteritic anterior ischemic optic neuropathy-retrospective analysis[J/OL]. BMC Ophthalmol, 2014, 14: 62[2014-05-03]. https://pubmed.ncbi.nlm.nih.gov/24886579/. DOI: 10.1186/1471-2415-14-62.
13.	Rebolleda G, Pérez-López M, Casas-Llera P, et al. Visual and anatomical outcomes of non-arteritic anterior ischemic optic neuropathy with high-dose systemic corticosteroids[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(1): 255-260. DOI: 10.1007/s00417-012-1995-7.
14.	Hayreh SS, Zimmerman MB. Non-arteritic anterior ischemic optic neuropathy: role of systemic corticosteroid therapy[J]. Graefe's Arch Clin Exp Ophthalmol, 2008, 246(7): 1029-1046. DOI: 10.1007/s00417-008-0805-8.
15.	Kaderli B, Avci R, Yucel A, et al. Intravitreal triamcinolone improves recovery of visual acuity in nonarteritic anterior ischemic optic neuropathy[J]. J Neuroophthalmol, 2007, 27(3): 164-168. DOI: 10.1097/WNO.0b013e31814a5a9a.
16.	Hayreh SS. Anterior ischaemic optic neuropathy. Ⅲ. treatment, prophylaxis, and differential diagnosis[J]. Br J Ophthalmol, 1974, 58(12): 981-989. DOI: 10.1136/bjo.58.12.981.
17.	Pakravan M, Sanjari N, Esfandiari H, et al. The effect of high-dose steroids, and normobaric oxygen therapy, on recent onset non-arteritic anterior ischemic optic neuropathy: a randomized clinical trial[J]. Graefe's Arch Clin Exp Ophthalmol, 2016, 254(10): 2043-2048. DOI: 10.1007/s00417-016-3451-6.
18.	Pakravan M, Esfandiari H, Hassanpour K, et al. The effect of combined systemic erythropoietin and steroid on non-arteritic anterior ischemic optic neuropathy: a prospective study[J]. Curr Eye Res, 2017, 42(7): 1079-1084. DOI: 10.1080/02713683.2016.1270328.
19.	张晓, 李旭, 翟瑜如, 等. 全身应用皮质类固醇类药物对缺血性视神经病变影响的meta分析[J]. 中国老年学杂志, 2012, 32(19): 4170-4171. DOI: 10.3969/j.issn.1005-9202.2012.19.028.Zhao X, Li X, Zhai YR, et al. Meta-analysis of the effect of systemic corticosteroids on ischemic optic neuropathy[J]. Chinese Journal of Gerontology, 2012, 32(19): 4170-4171. DOI: 10.3969/j.issn.1005-9202.2012.19.028.
20.	Chen J, Zhu J, Chen L, et al. Steroids in the treatment of nonarteritic anterior ischemic optic neuropathy: a PRISMA-compliant meta-analysis[J/OL]. Medicine (Baltimore), 2019, 98(46): e17861[2019-11-15]. https://pubmed.ncbi.nlm.nih.gov/31725628/.DOI: 10.1097/MD.0000000000017861.

1. 王建民, 赵云, 安建斌, 等. 玻璃体腔注射曲安奈德治疗非动脉炎性前部缺血性视神经病变的临床观察[J]. 中华眼底病杂志, 2011, 27(5): 488-489. DOI: 10.3760/cma.j.issn.1005-1015.2011.05.022.Wang JM, Zhao Y, An JB, et al. Clinical observation of intravitreal injection of triamcinolone acetonide in the treatment of non-arteritic anterior ischemic optic neuropathy[J]. Chin J Ocul Fundus Dis, 2011, 27(5): 488-489. DOI: 10.3760/cma.j.issn.1005-1015.2011.05.022.
2. 王润生, 吕沛霖, 常倩, 等. 前部缺血性视神经病变水肿期几种治疗方案的疗效评估[J]. 中华临床医师杂志(电子版), 2011, 5(12): 3469-3476. DOI: 10.3877/cma.j.issn.1674-0785.2011.12.017.Wang RS, Lyu PL, Chang Q, et al. Observation of the efficacy of several treatment strategies on patients with nonarteritic anterior ischemic optic neuropathy at edema stage[J]. Chin J Clinicicians (Electronic Edition), 2011, 5(12): 3469-3476. DOI: 10.3877/cma.j.issn.1674-0785.2011.12.017.
3. 王润生, 吕沛霖. 非动脉炎性前部缺血性视神经病变的临床研究进展[J]. 眼科新进展, 2010, 30(11): 1092-1096.Wang RS, Lyu PL. Recent clinical research advances in non-artertic anterior ischaemic optic neuropathy[J]. Rec Adv Ophthalmol, 2010, 30(11): 1092-1096.
4. 王建民, 赵云. 非动脉炎性前部缺血性视神经病变的糖皮质激素治疗[J]. 中国实用眼科杂志, 2011, 29(11): 1119-1123. DOI: 10.3760/cma.j.issn.1006-4443.2011.11.005.Wang JM, Zhao Y. Glucocorticoid therapy for non-arteritic anterior ischemic optic neuropathy[J]. Chin J Pract Ophthalmol, 2011, 29(11): 1119-1123. DOI: 10.3760/cma.j.issn.1006-4443.2011.11.005.
5. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[M]. England: John Wiley & Sons Ltd, 2011: 38.
6. Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials[J/OL]. BMJ, 2011, 343: d5928[2011-10-18]. https://pubmed.ncbi.nlm.nih.gov/22008217/.DOI: 10.1136/bmj.d5928.
7. 曾宪涛, 庄丽萍, 杨宗国, 等. Meta分析系列之七: 非随机实验性研究、诊断性试验及动物实验的质量评价工具[J]. 中国循证心血管医学杂志, 2012, 4(6): 496-499. DOI: 10.3969/j.1674-4055.2012.06.003.Zeng XT, Zhuang LP, Yang ZG, et al. Meta analysis series of seven: non-randomized experimental research, diagnostic test and animal experiment quality evaluation tool[J]. Chin J Evid Based Cardiovase Med, 2012, 4(6): 496-499. DOI: 10.3969/j.1674-4055.2012.06.003.
8. 于丹丹, 廖星, 谢雁鸣, 等. 藿香正气丸联合西药治疗急性胃肠炎的系统评价和meta分析[J]. 中国中药杂志, 2019, 44(14): 2914-2925. DOI: 10.19540/j.cnki.cjcmm.20190513.502.Yu DD, Liao X, Xie YM, et al. Systematic review and meta-analysis of Huoxiang Zhengqi pills combined with Western medicine for acute gastroenteritis[J]. China Journal of Chinese Materia Medica, 2019, 44(14): 2914-2925. DOI: 10.19540/j.cnki.cjcmm.20190513.502.
9. 张振坡, 张金嵩, 杨倩倩, 等. 曲安奈德后部眼球筋膜下注射与雷珠单抗玻璃体内注射治疗缺血性视神经病变的疗效对比[J]. 中华眼外伤职业眼病杂志, 2019, 41(6): 450-453. DOI: 10.3760/cma.j.issn.2095-1477.2019.06.012.Zhang ZP, Zhang JS, Yang QQ, et al. Comparison of efficacy between subtenon injection of triamcinolone acetonide and intravitreal injection of ranibizumab for non-arteritic anterior ischenic optic neuropathy[J]. Chin J Ocul Traum Occupast Eye Dis, 2019, 41(6): 450-453. DOI: 10.3760/cma.j.issn.2095-1477.2019.06.012.
10. Saxena R, Singh D, Sharma M, et al. Steroids versus no steroids in nonarteritic anterior ischemic optic neuropathy: a randomized controlled trial[J]. Ophthalmology, 2018, 125(10): 1623-1627. DOI: 10.1016/j.ophtha.2018.03.032.
11. Radoi C, Garcia T, Brugniart C, et al. Intravitreal triamcinolone injections in non-arteritic anterior ischemic optic neuropathy[J]. Graefe's Arch Clin Exp Ophthalmol, 2014, 252(2): 339-345. DOI: 10.1007/s00417-013-2499-9.
12. Kinori M, Ben-Bassat I, Wasserzug Y, et al. Visual outcome of mega-dose intravenous corticosteroid treatment in non-arteritic anterior ischemic optic neuropathy-retrospective analysis[J/OL]. BMC Ophthalmol, 2014, 14: 62[2014-05-03]. https://pubmed.ncbi.nlm.nih.gov/24886579/. DOI: 10.1186/1471-2415-14-62.
13. Rebolleda G, Pérez-López M, Casas-Llera P, et al. Visual and anatomical outcomes of non-arteritic anterior ischemic optic neuropathy with high-dose systemic corticosteroids[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(1): 255-260. DOI: 10.1007/s00417-012-1995-7.
14. Hayreh SS, Zimmerman MB. Non-arteritic anterior ischemic optic neuropathy: role of systemic corticosteroid therapy[J]. Graefe's Arch Clin Exp Ophthalmol, 2008, 246(7): 1029-1046. DOI: 10.1007/s00417-008-0805-8.
15. Kaderli B, Avci R, Yucel A, et al. Intravitreal triamcinolone improves recovery of visual acuity in nonarteritic anterior ischemic optic neuropathy[J]. J Neuroophthalmol, 2007, 27(3): 164-168. DOI: 10.1097/WNO.0b013e31814a5a9a.
16. Hayreh SS. Anterior ischaemic optic neuropathy. Ⅲ. treatment, prophylaxis, and differential diagnosis[J]. Br J Ophthalmol, 1974, 58(12): 981-989. DOI: 10.1136/bjo.58.12.981.
17. Pakravan M, Sanjari N, Esfandiari H, et al. The effect of high-dose steroids, and normobaric oxygen therapy, on recent onset non-arteritic anterior ischemic optic neuropathy: a randomized clinical trial[J]. Graefe's Arch Clin Exp Ophthalmol, 2016, 254(10): 2043-2048. DOI: 10.1007/s00417-016-3451-6.
18. Pakravan M, Esfandiari H, Hassanpour K, et al. The effect of combined systemic erythropoietin and steroid on non-arteritic anterior ischemic optic neuropathy: a prospective study[J]. Curr Eye Res, 2017, 42(7): 1079-1084. DOI: 10.1080/02713683.2016.1270328.
19. 张晓, 李旭, 翟瑜如, 等. 全身应用皮质类固醇类药物对缺血性视神经病变影响的meta分析[J]. 中国老年学杂志, 2012, 32(19): 4170-4171. DOI: 10.3969/j.issn.1005-9202.2012.19.028.Zhao X, Li X, Zhai YR, et al. Meta-analysis of the effect of systemic corticosteroids on ischemic optic neuropathy[J]. Chinese Journal of Gerontology, 2012, 32(19): 4170-4171. DOI: 10.3969/j.issn.1005-9202.2012.19.028.
20. Chen J, Zhu J, Chen L, et al. Steroids in the treatment of nonarteritic anterior ischemic optic neuropathy: a PRISMA-compliant meta-analysis[J/OL]. Medicine (Baltimore), 2019, 98(46): e17861[2019-11-15]. https://pubmed.ncbi.nlm.nih.gov/31725628/.DOI: 10.1097/MD.0000000000017861.

Previous Article
Bioinformatics analysis of transcriptome sequencing of early hypoxia damage in photoreceptor 661W cell line
Next Article
人乳头状病毒疫苗接种后视神经炎一例

Chinese Journal of Ocular Fundus Diseases

A systematic review of the effectiveness of glucocorticoids in the treatment of nonarteritic anterior ischemic optic neuropathy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content