Surgery for nonarteritic anterior ischemic optic neuropathy

Area of Science:

• Ophthalmology
• Neurology
• Surgical Research

Background:

• Nonarteritic ischemic optic neuropathy (NAION) causes sudden, painless vision loss and optic disc swelling.
• The exact cause of NAION is unknown, and effective medical treatments are lacking.
• Optic nerve decompression surgery is a proposed intervention to relieve pressure around the optic nerve.

Purpose of the Study:

• To evaluate the safety and efficacy of optic nerve decompression surgery for NAION.
• To compare surgical treatment against other interventions or no treatment.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) was conducted.
• Searches included CENTRAL, MEDLINE, EMBASE, mRCT, ClinicalTrials.gov, and ICTRP up to November 2011.
• One RCT involving 258 participants was included.

Main Results:

• The sole included RCT was stopped early due to futility, with no evidence of visual acuity benefit from surgery.
• At 24 months, visual acuity improvement rates were similar between surgery (29.4%) and careful follow-up (31.0%).
• Surgery increased the risk of adverse events, including pain, diplopia, and vision loss, with one case of central retinal artery occlusion.

Conclusions:

• The single trial suggests optic nerve decompression surgery is not beneficial for NAION.
• Further research is needed to understand NAION's etiology and prognosis.
• New NAION treatments should be investigated using rigorous randomized clinical trial designs.