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：

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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, 趙云, 安建斌, 等. 玻璃體腔注射曲安奈德治療非動脈炎性前部缺血性視神經病變的臨床觀察[J]. 中華眼底病雜志, 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.	王潤生, 呂沛霖, 常倩, 等. 前部缺血性視神經病變水腫期幾種治療方案的療效評估[J]. 中華臨床醫師雜志(電子版), 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.	王潤生, 呂沛霖. 非動脈炎性前部缺血性視神經病變的臨床研究進展[J]. 眼科新進展, 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, 趙云. 非動脈炎性前部缺血性視神經病變的糖皮質激素治療[J]. 中國實用眼科雜志, 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.	曾憲濤, 莊麗萍, 楊宗國, 等. Meta分析系列之七: 非隨機實驗性研究、診斷性試驗及動物實驗的質量評價工具[J]. 中國循證心血管醫學雜志, 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, 謝雁鳴, 等. 藿香正氣丸聯合西藥治療急性胃腸炎的系統評價和meta分析[J]. 中國中藥雜志, 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.	張振坡, 張金嵩, 楊倩倩, 等. 曲安奈德后部眼球筋膜下注射與雷珠單抗玻璃體內注射治療缺血性視神經病變的療效對比[J]. 中華眼外傷職業眼病雜志, 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.	張曉, 李旭, 翟瑜如, 等. 全身應用皮質類固醇類藥物對缺血性視神經病變影響的meta分析[J]. 中國老年學雜志, 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, 趙云, 安建斌, 等. 玻璃體腔注射曲安奈德治療非動脈炎性前部缺血性視神經病變的臨床觀察[J]. 中華眼底病雜志, 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. 王潤生, 呂沛霖, 常倩, 等. 前部缺血性視神經病變水腫期幾種治療方案的療效評估[J]. 中華臨床醫師雜志(電子版), 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. 王潤生, 呂沛霖. 非動脈炎性前部缺血性視神經病變的臨床研究進展[J]. 眼科新進展, 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, 趙云. 非動脈炎性前部缺血性視神經病變的糖皮質激素治療[J]. 中國實用眼科雜志, 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. 曾憲濤, 莊麗萍, 楊宗國, 等. Meta分析系列之七: 非隨機實驗性研究、診斷性試驗及動物實驗的質量評價工具[J]. 中國循證心血管醫學雜志, 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, 謝雁鳴, 等. 藿香正氣丸聯合西藥治療急性胃腸炎的系統評價和meta分析[J]. 中國中藥雜志, 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. 張振坡, 張金嵩, 楊倩倩, 等. 曲安奈德后部眼球筋膜下注射與雷珠單抗玻璃體內注射治療缺血性視神經病變的療效對比[J]. 中華眼外傷職業眼病雜志, 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. 張曉, 李旭, 翟瑜如, 等. 全身應用皮質類固醇類藥物對缺血性視神經病變影響的meta分析[J]. 中國老年學雜志, 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.

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

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