therapeutic effect of posterior sub-tenon methyl prednisolone in anterior ischemic optic neuropathy: a randomized clinical trial

purpose : to evaluate the therapeutic effect of posterior sub-tenon methyl prednisolone in anterior ischemic optic neuropathy, no class 1 study has shown any conclusive medical or surgical treatment for non-arteritic anterior ischemic optic neuropathy (naion). efficacy of systemic or intravitreal steroids was suggested by some studies. this study was performed to evaluate the efficacy and safety of posterior sub-tenon injection of methyl prednisolone in eyes with acute naion. methods : in a double blind randomized clinical trial, forty patients with a recent onset naion were randomly assigned into case and control groups. the case group received a single posterior sub-tenon injection of 40 mg methyl prednisolone the control group received a sham injection. the patients had complete eye examination including visual field measurement and fluorescein angiography and systemic evaluation at the beginning. eye examination was repeated at 2, 4, 6 and 8 week steps of the follow-up. visual field was rechecked at the end of the follow-up. statistical analysis used: spss 11.5 system, paired sample t-test independent sample t-test, χ2 , and anova. results : visual acuity (va) improved 0.3 logmar (three lines of snellen chart) in the case group (p<0.030), no visual improvement was observed in the control group (p<0.589). comparison between the two groups showed improvement in va (p=0.021 at two weeks, and p=0.053 at 8 weeks), visual field pattern standard deviation (psd), (p=0.034) and optic disc edema, (p=0.000) in the treatment group. no case of globe perforation or severe intraocular pressure (iop) rise was detected. conclusion : posterior sub-tenon injection of methyl prednisolone was preferred to observation in acute naion.   iranian journal of ophthalmology 201123(3):50-56 © 2011 by the iranian society of ophthalmology