transvitreal optic neurotomy for non-arteritic anterior ischemic optic neuropathy

purpose: to evaluate the role of transvitreal optic neurotomy (ton) in the management of non-arteritic anterior ischemic optic neurotomy (naion). methods: sixteen eyes of 16 patients with recent onset naion (less than six weeks duration) were included in this single-masked randomized controlled trial. the patients were randomized to ton (8 eyes) versus observation alone (8 eyes). pre- and postoperative visual acuity and visual field as well as complications of the procedure were evaluated. results: after six months of follow up, six eyes in the ton group and two eyes in the observation group had improvement in visual acuity (p=0.04). mean visual improvement was significantly better in the ton versus the observation group three (0.8±0.49 vs 0.24±0.45 logmar, p=0.03) and six (1.04±0.83 vs 0.24±0.45 logmar, p=0.03) months postoperatively. time to achieve best-corrected visual acuity was not significantly different between the groups. visual field improvement in the ton group was significantly better than the observation group at final follow up. conclusion: ton is effective in the management of recent onset naion in terms of visual acuity and visual field improvement. a multicenter randomized clinical trial with larger sample size is needed to confirm these findings.