Department of Neuro Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India.
Indian J Ophthalmol. 2023 Jan;71(1):235-240. doi: 10.4103/ijo.IJO_945_22.
Our study aims to evaluate the effectiveness of intravenous erythropoietin (EPO) in patients with indirect traumatic optic neuropathy (TON), assess the side effects, and compare the visual function results among three groups of patients who had received different treatment options - EPO, steroids, and observation.
: Patients with indirect TON presenting to the neuro-ophthalmology clinic from August 2019 to March 2020, were assigned to three groups, with six patients in each group. In group 1, patients were recruited prospectively and received recombinant human erythropoietin, whereas, in groups 2 and 3, patients were recruited retrospectively and received intravenous methylprednisolone followed by oral steroids and multivitamins, respectively. Groups 1 and 2 included patients presenting within 2 weeks of trauma, whereas group 3 included those presenting beyond that. Best-corrected visual acuity, pupillary reaction, color vision, and visual fields following treatment were measured.
Initial visual acuity in the EPO group ranged from 20/80 to no perception of light (No PL). The mean initial BCVA (1.82 logMAR, standard deviation [SD] = 0.847) improved to 1.32, SD = 0.93 logMAR after treatment recorded at the third month (P = 0.0375), with no significant adverse effects. The initial BCVA of group 2 ranged from 20/120 to No PL. The mean initial BCVA (1.95, SD = 0.77 logMAR) improved to 1.45 logMAR, SD = 0.97 after treatment (P = 0.0435) but three patients had side effects of steroids. Initial visual acuity in Group 3 ranged from 20/40 to no PL. The mean initial BCVA (1.09 logMAR, SD = 1.10) worsened to 1.19 logMAR, SD = 1.06 after treatment after treatment (P = 0.0193). The improvement in BCVA when compared between the three groups was not significant.
Both erythropoietin and steroids are effective in the management of traumatic optic neuropathy. However, erythropoietin shows lesser or no side effects when compared to steroids.
本研究旨在评估静脉内促红细胞生成素（EPO）治疗间接外伤性视神经病变（TON）的疗效，评估其副作用，并比较三组患者的视力结果，三组患者分别接受了不同的治疗方案：EPO、类固醇和观察。
2019 年 8 月至 2020 年 3 月间，在神经眼科诊所就诊的间接 TON 患者被分配到三组，每组 6 例。在第 1 组中，前瞻性招募患者并接受重组人促红细胞生成素治疗，而在第 2 组和第 3 组中，回顾性招募患者并接受静脉内甲基强的松龙治疗，随后分别接受口服类固醇和多种维生素治疗。第 1 组和第 2 组包括创伤后 2 周内就诊的患者，而第 3 组包括创伤后超过 2 周就诊的患者。治疗后测量最佳矫正视力、瞳孔反应、色觉和视野。
EPO 组的初始视力范围为 20/80 至无光感（No PL）。第 3 个月记录的治疗后平均初始 BCVA（1.82 logMAR，标准差 [SD] = 0.847）提高至 1.32，SD = 0.93 logMAR（P = 0.0375），无明显不良反应。第 2 组的初始 BCVA 范围为 20/120 至 No PL。初始平均 BCVA（1.95，SD = 0.77 logMAR）提高至 1.45 logMAR，SD = 0.97 （P = 0.0435），但有 3 例患者出现类固醇副作用。第 3 组的初始视力范围为 20/40 至无光感。治疗后平均初始 BCVA（1.09 logMAR，SD = 1.10）恶化至 1.19 logMAR，SD = 1.06（P = 0.0193）。三组间 BCVA 的改善无显著差异。
EPO 和类固醇在治疗外伤性视神经病变方面均有效。然而，与类固醇相比，EPO 的副作用较小或没有。
