The Effect of Systemic Erythropoietin and Oral prednisolone on Recent-Onset Non-Arteritic Anterior Ischemic Optic Neuropathy: a Randomized Clinical Trial

Purpose: To evaluate the effect of systemic erythropoietin and oral steroids in the management of recent onset non-arteritic anterior ischemic optic neuropathy (NAION).Methods: Ninety-nine eyes of 99 patients diagnosed with NAION within 5 days of onset were included in this randomized clinical trial. Thirty-three patients were randomized into group 1 (systemic erythropoietin), group 2 (oral steroids), and group 3 (control). Group A received 10,000 units of erythropoietin twice a day for three days. Group B received oral prednisone 75 mg daily for two weeks followed by a tapering dose. Best corrected visual acuity (BCVA) was the main outcome, and mean deviation (MD) of visual field test and peripapillary retinal nerve fiber layer thickness (PRNFLT) were secondary outcomes. Results: The mean BCVA (±SD) at the time of presentation was 1 ± 0.56, 1.01 ± 0.6, and 0.94 ± 0.47 logMAR in groups A, B, and C, respectively (P = 0.140); corresponding values were 0.70 ± 0.44, 0.73 ± 0.35, and 0.75 ± 0.39 logMAR, respectively (P = 0.597) at 6-month follow-up. Fifty-five percent of patients in group A versus 34.3% in group B, and 31.2% in group C had an improvement of at least 3 lines in the BCVA values at the 6th-month followup visit. (P= 0.04) The mean deviation (MD) at the time of presentation was 19.67±6.2, 20.83±4.83, and 18.94±6.92 decibels (db), respectively (P= 0.483). The corresponding values at month 6 were 16.56±7.08, 18.15±6.57, and 15.9±5.97 db, respectively (P = 0.699). PRNFLT at presentation was 189 ± 58, 193 ± 64, and 199 ± 62 micrometers, respectively (P = 0.779), which decreased to 88 ± 12, 74 ± 25, and 71 ± 18, respectively (P = 0.041) at 6-month visit. Conclusion: This study indicates the beneficial effects of systemic erythropoietin in preserving the function and structure of the optic nerve in recent onset NAION.