Features of the application of neuroprotective therapy for traumatic optic neuropathy in the clinical setting
N.M. Moyseyenko, Cand Sc (Med)
Ivano-Frankivsk National Medical University; Ivano-Frankivsk (Ukraine)
Background: The features of the application of neuroprotective therapy for traumatic optic neuropathy (TON) in the clinical setting are not known.
Methods: Forty-nine TON patients (49 eyes) with MRI evidence of no compressive optic nerve injury were divided into group A (25 patients) and group B (24 patients) and underwent treatment. Patients of group A were treated with 1000 mg of pre-intravenous methylprednisolone daily for 3 days with subsequent gradual tapering of the dose. Patients of group B were treated with a 1000-mg methylprednisolone infusion daily for 3 days and bilateral electric phosphene stimulation (EPS) for 10 days.
Results: We demonstrated in the clinical setting that, compared to steroid-only treatment, steroids plus EPS treatment for TON is characterized by greater improvements in (a) visual acuity, (b) selectivity of action depending on the ophthalmoscopic form of TON, and (c) atrophic processes in the axial bundle of the optic nerve. After combination treatment for TON, visual acuity improved by 0.6 to 0.8, and critical frequency of phosphene disappearance (CFPD) improved by 35 to 45 Hz. Compared with combined or inverse form of TON, ischemic form of TON is seen in the earlier period after the traumatic event. Steroids plus EPS treatment effect was greater in the last form than in the two former forms.
Conclusion: Our steroids plus EPS treatment may be an alternative to conventional treatment (megadose steroid-only therapy) for TON in the clinical setting.
Keywords: traumatic optic neuropathy, neuroprotective therapy, electric phosphene stimulation
1.Ford RL, Lee V, Xing W, Bunce C. A 2-year prospective surveillance of pediatric traumatic optic neuropathy in the United Kingdom. J AAPOS. 2012 Oct;16(5):413-7.
2.Stunkel L, Van Stavern GP. Steroid Treatment of Optic Neuropathies. Asia-Pac J Ophthalmol (Phila). 2018 Jul-Aug;7(4):218-228.
3.Kumaran AM, Sundar G, Lim TC. Traumatic optic neuropathy: a review. Craniomaxillofac Trauma Reconstr. 2015 Mar;8(1):31-41.
4.Yu-Wai-Man P, Griffiths PG. Steroids for traumatic optic neuropathy. Cochrane Database Syst Rev. 2011 Jan 19;(1):CD006032.
5.Edwards P, Arango M, Balica L, et al. Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months. Lancet. 2005 Jun 4-10;365(9475):1957-9.
6.Steinsapir KD, Goldberg RA. Traumatic optic neuropathy: An evolving understanding. Am J Ophthalmol. 2011 Jun;151(6):928-933.e2.
7.Yu-Wai-Man P. Traumatic optic neuropathy – clinical features and management issues. Taiwan J Ophthalmol. 2015 Jan-Mar; 5(1): 3–8.
8.Bekhtereva NP. [Curative electric stimulation of the human brain and nerves]. Moscow: AST; 2008. Russian.
9.Drozhenko VS. [Effects of modified electric phosphene stimulation on the function of the visual system in patients with partial optic atrophy]. Thesis for the Degree of Cand Sc (Med). Odessa, 2002. Russian.
10.Eliseeva NM, Serova NK, Gnezditskiĭ VV, Eolchiian SA. [Transdermal electrostimulation of neurosurgical patients with vision disorders]. Vestn Oftalmol. 1997 Jan-Feb;113(1):19-22. Russian.
11.Ponomarchuk VS, Slobodianyk SB, Drozhenko VS. [Comparative analysis of the curative efficacy of electric phosphene stimulation in various eye disorders]. In: [Current issues of ophthalmology: Collection of science works]. Zaporizhzhia; 1997. p.17-21. Russian.
12.Gordon-Lipkin E, Chodkowski B, Reich DS, et al. Retinal nerve fiber layer is associated with brain atrophy in multiple sclerosis. Neurology. 2007 Oct 16;69(16):1603-9.
13.Moyseyenko NM. [Prognostic value of ophthalmoscopic symptoms of traumatic optic neuropathy]. International scientific-practical journal “Ophthalmology”. 2017; 1(6): 34-44.
14.Kerns Y, Fakhouri AJ, Weinrib HP, Freeman J.A. Electrical stimulation of nerve regeneration in the rat: the early effects evaluated by a vibrating probe and electron microscopy. Neuroscince. 1991;40(1):93-107.
15.Lee V, Ford RL, Xing W, et al. Surveillance of traumatic optic neuropathy in the UK. Eye (Lond). 2010 Feb;24(2):240-50. doi: 10.1038/eye.2009.79.
The author certifies that she has no conflicts of interest in the subject matter or materials discussed in this manuscript.