Efficacy of Treatments in Nonarteritic Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis

Krisztina Lantos, Zsuzsa Réka Dömötör, Nelli Farkas, Szabolcs Kiss, Zsolt Szakács, András Garami, Gábor Varga, László Lujber, Reem Kanaan, Péter Hegyi, Gergely Fehér and Valéria Gaál
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Krisztina Lantos: Department of Ophthalmology, Medical School, University of Pécs, 7632 Pécs, Hungary
Zsuzsa Réka Dömötör: Department of Ophthalmology, Medical School, University of Debrecen, 4032 Debrecen, Hungary
Nelli Farkas: Institute of Bioanalysis, Medical School, University of Pécs, 7624 Pécs, Hungary
Szabolcs Kiss: Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
Zsolt Szakács: Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
András Garami: Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
Gábor Varga: Department of Oral Biology, Faculty of Dentistry, Semmelweis University, 1089 Budapest, Hungary
László Lujber: Department of Otorhinolaryngology, Medical School, University of Pécs, 7621 Pécs, Hungary
Reem Kanaan: Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
Péter Hegyi: Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
Gergely Fehér: Department of Primary Health Care, Medical School, University of Pécs, 7624 Pécs, Hungary
Valéria Gaál: Department of Ophthalmology, Medical School, University of Pécs, 7632 Pécs, Hungary

IJERPH, 2022, vol. 19, issue 5, 1-15

Abstract: Background: Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) is the second most common cause of optic nerve-related permanent visual loss in adults. Aim: We aimed to analyze the efficacy of the noninvasive and minimally invasive therapeutic options of NAION. Methods: We performed a systematic literature search in MEDLINE, EMBASE, and CENTRAL from inception to 10 June 2019 to identify the studies that report on the effect of different therapies on visual acuity (VA) and visual field (VF). Weighted mean difference (WMD) with 95% confidence interval (CI) was calculated for these outcomes. The efficacy of steroids was investigated in quantitative, oxygen, steroid plus erythropoietin (EPO), levodopa/carbidopa, memantine, and heparin-induced extracorporeal LDL/fibrinogen precipitation (HELP) therapies and other therapeutic modalities in qualitative synthesis. Results: Thirty-two studies were found to be eligible. We found that steroid therapy compared to control did not improve VA ( p = 0.182, WMD = 0.14, 95% CI: −0.07, 0.35) or VF ( p = 0.853, WMD = 0.16, 95% CI: −1.54, 1.86). Qualitative analysis could be performed for oxygen, steroid plus EPO, and HELP as well, however, none of them showed VA and VF benefit. Two individual studies found memantine and levodopa beneficial regarding VA. Conclusion: Our systematic review did not reveal any effective treatment. Further investigations are needed to find therapy for NAION.

Keywords: nonarteritic ischemic optic neuropathy; NAION; meta-analysis (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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