Dickersin K, Manheimer E
Department of Community Health, New England Cochrane Center, Brown University Box G-S2, Providence, RI 02912, USA.
Cochrane Database Syst Rev. 2000(2):CD001538. doi: 10.1002/14651858.CD001538.
Nonarteritic ischemic optic neuropathy is characterized by sudden and painless loss of vision in one eye, accompanied by pallid swelling of the optic disc. Although various medical interventions, such as corticosteroids and phenytoin sodium, have been used to treat nonarteritic ischemic optic neuropathy, no therapy has been proven effective.
The objective of this review is to assess the safety and efficacy of surgical treatment compared with other treatment or usual care in people with nonarteritic ischemic optic neuropathy.
We searched the Cochrane Controlled Trials Register - Central and MEDLINE. The most recent searches were performed in December 1997.
We included randomized trials comparing surgery to no surgery in people with nonarteritic ischemic optic neuropathy.
We obtained full copies of all potentially relevant articles. Only one article described a randomized trial of surgery and it was eligible for inclusion. No formal assessment of quality was done. One reviewer extracted data. No synthesis was required, as there was only one trial.
The one trial identified randomized 258 patients. The only published report with outcomes data for that trial presents preliminary results from 244 patients who had achieved six months of follow-up at the time of the report. Participants assigned to surgery did no better than participants assigned to careful follow-up regarding improved visual acuity of three or more lines of vision at six months: 32.6% of the surgery group improved compared with 42.7% of the careful follow-up group. The adjusted odds ratio (OR), adjusted for baseline visual acuity and diabetes, comparing the two groups for three or more lines improvement was 0.74 (95% confidence interval (CI) 0.39 to 1. 38) (surgery group improvement was worse than careful follow-up). In addition, participants receiving surgery had a significantly greater risk of losing three or more lines of vision at six months: 23.9% in the surgery group worsened compared with 12.4% in the careful follow-up group. The six-month adjusted OR comparing the two groups for loss of three or more lines of vision was 1.96 (95% CI 0.87 to 4.41). Spontaneous improvement of three or more lines of vision was observed in 42.7% of participants in the careful follow-up group.
REVIEWER'S CONCLUSIONS: Results from the Ischemic Optic Neuropathy Decompression Trial indicate that optic nerve decompression surgery for nonarteritic ischemic optic neuropathy is not effective.
非动脉炎性缺血性视神经病变的特征是单眼突然无痛性视力丧失，伴有视盘苍白肿胀。尽管已使用多种医学干预措施，如皮质类固醇和苯妥英钠来治疗非动脉炎性缺血性视神经病变，但尚无疗法被证明有效。
本综述的目的是评估与其他治疗或常规护理相比，手术治疗对非动脉炎性缺血性视神经病变患者的安全性和有效性。
我们检索了Cochrane对照试验注册库 - 中心库和MEDLINE。最近一次检索于1997年12月进行。
我们纳入了比较非动脉炎性缺血性视神经病变患者手术与非手术治疗的随机试验。
我们获取了所有潜在相关文章的完整副本。只有一篇文章描述了手术的随机试验，且符合纳入标准。未进行正式的质量评估。由一名审阅者提取数据。由于只有一项试验，无需进行综合分析。
该试验纳入了258例随机分组的患者。该试验唯一发表的带有结果数据的报告展示了244例患者的初步结果，这些患者在报告时已进行了6个月的随访。在6个月时，接受手术治疗的参与者在视力提高3行或更多行方面并不比接受仔细随访的参与者表现更好：手术组有32.6%的患者视力改善，而仔细随访组为42.7%。在对基线视力和糖尿病进行校正后，两组在视力提高3行或更多行方面的调整比值比（OR）为0.74（95%置信区间（CI）0.39至1.38）（手术组改善情况比仔细随访组差）。此外，接受手术治疗的参与者在6个月时视力下降3行或更多行的风险显著更高：手术组有23.9%的患者视力恶化，而仔细随访组为12.4%。两组在视力下降3行或更多行方面的6个月调整OR为1.96（95%CI 0.87至4.41）。在仔细随访组中，42.7%的参与者视力自发提高了3行或更多行。
缺血性视神经病变减压试验的结果表明，非动脉炎性缺血性视神经病变的视神经减压手术无效。
