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Surgery for nonarteritic anterior ischemic optic neuropathy
1Center for Clinical Trials and US Cochrane Center, Johns Hopkins University, Bloomberg School of Public Health, 615 North Wolfe Street, Mail Rm E6152, Baltimore, MD, USA, 21205.
The Cochrane Database of Systematic Reviews
|March 13, 2015
Summary
Optic nerve decompression surgery does not improve vision for nonarteritic anterior ischemic optic neuropathy (NAION). This surgical approach for NAION also carries risks of adverse events and should be further investigated in clinical trials.
Area of Science:
- Ophthalmology
- Neurology
- Surgical Research
Background:
- Nonarteritic anterior 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 trials investigating surgical treatment for NAION.
- Searched multiple databases including CENTRAL, MEDLINE, EMBASE, PubMed, mRCT, ClinicalTrials.gov, and WHO ICTRP up to October 2014.
- One randomized trial with 258 participants was included, but stopped early due to futility.
Main Results:
- The single included trial found no evidence that surgery improved visual acuity in NAION patients.
- Slightly more patients in the surgery group experienced worsening visual acuity compared to the careful follow-up group, though not statistically significant.
- Surgery was associated with adverse events, including central retinal artery occlusion, vision loss, pain, and diplopia.
Conclusions:
- Optic nerve decompression surgery showed no beneficial effect for NAION based on the available trial.
- Further research is needed to understand NAION's etiology and prognosis.
- New NAION treatments should be rigorously tested using randomized clinical trials.
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