Clinical outcomes of radial optic neurotomy versus pars plana vitrectomy in recent onset non-arteritic anterior ischemic optic neuropathy

Abstract

Introduction

This study investigated the effect of pars plana vitrectomy (VIT) versus pars plana vitrectomy combined with radial optic neurotomy (RON) on recent onset non-arteritic anterior ischemic optic neuropathy (NAION).

Methods

In this prospective interventional case series, individuals with recent-onset NAION, lower than one month and low vision (lower than 20/200) were recruited. Patients randomly underwent either VIT, or RON.

Results

34 eyes of 34 patients were included in this study. 10, 9, and 15 eyes were randomly included in VIT, RON, and control groups, respectively. The BCVA of the VIT group improved significantly from 1.84 ± 0.5 logMAR at baseline to 1.29 ± 0.67, 0.93 ± 0.53, and 0.77 ± 0.47 logMAR at 1, 3, and 6 months, respectively (Ps < 0.05). The corresponding values for RON group were 1.73 ± 0.53 logMAR at baseline, which improved to 1.04 ± 0.65, 0.64 ± 0.28, and 0.61 ± 0.26 logMAR at the same follow-up visit times (P < 0.05).

The corresponding values for the control group were 1.6 ± 0.58 log MAR at baseline, which improved to 1.03 ± 0.29, 1.00 ± 0.32, and 0.32 ± 0.83 log MAR at the same follow-up visit times. There was no significant statistical difference in BCVA between the three groups. However, both interventions resulted in statistically significant improvement in mean deviation (MD) of visual field (VF) compared with the control group at the end of 6 months (VIT P = 0.006, RON P = 0.043). RNFLT decreased from baseline 235.3 ± 44.01 to 75.6 ± 17.68 at 1 month in the VIT group (P < 0.001), from baseline 268.22 ± 65.9 to 76.67 ± 10.59 at 1 month in RON (P < 0.001), while it decreased from baseline 179.48 ± 39.02 to 112.92 ± 44.51 at 1 month in the control group.

Conclusion

VIT and RON showed promising results in terms of MD of VF, and optic disc edema resolved faster in these groups compared to the control group in recent onset NAION. A larger sample size study is deemed necessary to generalize the results of this study.

Keywords

Non-arteritic ischemic optic neuropathy radial optic neurotomy vitreopapillary traction pars plana vitrectomy retinal nerve fiber layer thickness.

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References

Hattenhauer

Leavitt

Hodge

, et al. Incidence of nonarteritic anteripr ischemic optic neuropathy. Am J Ophthalmol 1997; 123: 103–107.

Hayreh

Zimmerman

. Nonarteritic anterior ischemic optic neuropathy: refractive error and its relationship to cup/disc ratio. Ophthalmology 2008; 115: 2275–2281.

Tamhankar

Volpe

. Nonarteritic ischemic optic neuropathy: Prognosis and treatment. UpToDate Brazis P (Ed) Acessed Aug. 2018;17.

Atkins

. Nonarteritic anterior ischemic optic neuropathy. Curr Treat Options Neurol 2011; 13: 92–100.

Miller

Arnold

. Current concepts in the diagnosis, pathogenesis and management of nonarteritic anterior ischaemic optic neuropathy. Eye (London, England) 2015; 29: 65–79.

Parsa

Hoyt

. Nonarteritic anterior ischemic optic neuropathy (NAION): a misnomer. Rearranging pieces of a puzzle to reveal a nonischemic papillopathy caused by vitreous separation. Ophthalmology 2015; 122: 439–442.

Soheilian

Koochek

Yazdani

, et al. Transvitreal optic neurotomy for nonarteritic anterior ischemic optic neuropathy. Retina (Philadelphia, Pa) 2003; 23: 692–697.

Opremcak

Bruce

Lomeo

, et al. Radial optic neurotomy for central retinal vein occlusion: a retrospective pilot study of 11 consecutive cases. Retina (Philadelphia, Pa) 2001; 21: 408–415.

Modarres

Sanjari

Falavarjani

. Vitrectomy and release of presumed epipapillary vitreous traction for treatment of nonarteritic anterior ischemic optic neuropathy associated with partial posterior vitreous detachment. Ophthalmology 2007; 114: 340–344.

10.

Hayreh

Zimmerman

. Non-arteritic anterior ischemic optic neuropathy: role of systemic corticosteroid therapy. Graefes Arch Clin Exp Ophthalmol 2008; 246: 1029–1046.

11.

Dickersin

. Surgery for nonarteritic anterior ischemic optic neuropathy. Cochrane Database of Systematic Reviews 2015; 3: CD001538.

12.

Ischemic optic neuropathy decompression trial: twenty-four-month update. Arch Ophthalmol (Chicago, Ill : 1960) 2000; 118: 793–798.

13.

Saito

Tomidokoro

Sugimoto

, et al. Optic disc topography and peripapillary retinal nerve fiber layer thickness in nonarteritic ischemic optic neuropathy and open-angle glaucoma. Ophthalmology 2006; 113: 1340–1344.