Anterior ischaemic optic neuropathy: III. Treatment, prophylaxis, and differential diagnosis

Abstract

The effects of systemic corticosteroid therapy on anterior ischaemic optic neuropathy (AION) were investigated by dividing the cases into three groups: GROUP I: AION due to temporal arteritis. GROUPS II AND III: AION not due to temporal arteritis. Groups 1 and II were treated identically by corticosteroids. No medication was given to Group III. The results showed the best visual outcome in Group II patients, of whom 75 per cent. showed visual improvement as compared to only 17 per cent. in Group III. The outcome was worst in Group I. It is therefore recommended that all patients with AION should be treated as soon as possible with systemic corticosteroids, with a starting dose of at least 60 to 80 mg. prednisolone, thereafter slowly tapered to continue the treatment so long as the optic disc shows oedema in cases without temporal arteritis, and as long as indicated in temporal arteritis cases. Diamox was found useful in preventing further deterioration of vision in late cases with optic atrophy, and it is suggested that it should also be given in acute cases to lower the intraocular pressure and improve the vascular perfusion of the optic disc. The treatment of and prophylactic measures against AION are discussed.