Conservative management outcomes of Non-ischemic Anterior Ischemic Optic Neuropathy (NAION) in Diabetic patients at Tertiary health care center of Anand, Gujarat, India

Author: Esha Kshatriya (India)

Co-authors: Devendra Saxena, Priya Hingorani

Purpose

The purpose of this study is to evaluate the outcomes of use of intravenous Methyl Prednisolone in Treatment of Non Arteritic anterior ischemic optic neuropathy in Diabetic Patients Presenting to a Tertiary Care Hospital at Anand, Gujarat, India.

Setting/Venue

Ophthalmology outpatient department of shree Krishna hospital, Anand,Gujarat,India.

Methods

Diabetic Patients who presented to our out-patient department with complain of sudden painless loss of vision were serially evaluated for their vision using Snellen’s chart for distance vision and romans chart for near vision, color vision with ishihara chart, contrast sensitivity with pelli Robson, visual field by confrontation test and dilated fundus examination with indirect ophthalmoscope. After having diagnosed them as non Arteritic anterior ischemic optic neuropathy, their blood pressure and blood sugars were checked. In patients whose random blood sugars or blood pressure were not within normal limits were given corticosteroids under supervision of physician. Patients were conservatively managed with intravenous 1-gram methyl prednisolone injections daily for up to 3 consecutive days. The outcomes were evaluated daily mainly on basis of visual acuity improvement along with color vision, contrast sensitivity improvements and reduction in disc edema compared to their day of presentation at outpatient department.

Results

8 Diabetic patients were selected for this study out which 4 were male and 4 were female with their mean age as 56.5 years. After giving them Intravenous Methyl prednisolone (1 gram) we saw that 5 out of 8 i.e. 62.5% patients showed improvement in vision on Day 1, 4 out of 8 i.e. 50% patients showed improvement of vision on day 2, and 6 out of 8 i.e. 75% patients vision improved on day 3. 4 patients’ i.e. 50% showed Contrast Sensitivity improvement ,4 patients’ i.e. 50% showed color vision improvement, 7 patients’ 87.5% patients confrontation test improved along with considerable disc edema reduction in all by day 3 as compared to their day of presentation.

Conlusions

NAION is a common risk factor in diabetic patients with an unclear pathology. Hence if a diagnosis of NAION is made then as per our study, intravenous high dose corticosteroids provide a faster resolution of the compartment syndrome for the treatment of NAION by possibly decreasing capillary permeability and thereby reduces the compression of capillaries in the optic nerve head and improves blood flow, which restores visual function prove to be a good option with no significant major adverse effects seen. Thus, we can conclude that use of high dose corticosteroid has been beneficial for treatment of NAION in diabetic patients who approach timely before the stage of optic disc atrophy sets in.

Financial Disclosure

NO FINANCIAL INTERESTS