关键词: 缺血性视神经病变, 糖皮质激素, 视野

Abstract: Objective To investigate the short-term effect of systemic glucocorticoid therapy on visual field in patients with non-arteritic anterior ischemic optic neuropathy (NA-AION). Design Retrospective case series. Participants 56 patients (98 eyes) with NA-AION were enrolled from Renmin Hospital of Wuhan University from December 2016 to March 2021. Methods The patients were divided into glucocorticoid group (73 eyes) and control group (25 eyes) according to whether they agreed to treated with systemic glucocorticoid. The visual field was examined before and within 1 month after treatment. According to the improved glaucoma staging system (GSS2), the visual field defect degree of the affected eyes was divided into S0, border, S1, S2, S3, S4 and S5. All patients were given compound anisodine hydrobromide injection and mecobalamin tablets to improve circulation and cellular nutrition. At the same time, the glucocorticoid group was given glucocorticoid pulse therapy (intravenous methylprednisolone 500~1000 mg) once a day. After continuous use for 3 days, it was reduced as appropriate. After 5~7 days, it was changed to oral prednisolone (1 mg/kg/d), and gradually reduced (10 mg every 3 days) until the drug was stopped. After treatment, the patients whose visual field defect degree increased by stage and more than 1 stage were the patients with effective treatment, and the ratio of the patients with effective treatment to the total patients in the group was the effective rate. Visual field index (VFI), mean defect (MD), pattern standard deviation (PSD), visual field defect stage before and after treatment, and effective rate of treatment were compared between the two groups. Main Outcome Measures VEI, MD, PSD, visual field defect stage and effective rate of treatment. Results There was no significant difference in VFI and MD between glucocorticoid group and control group within 1 month after treatment [(57.62±24.40)% vs (60.28±28.67)%, t=0.450, P=0.654; (-14.70±7.21) dB vs (-14.20±9.06) dB, t=-0.280, P=0.780), while the difference of PSD was statistically significant [(9.19±3.87) dB vs (7.37±3.20) dB, t=2.112, P=0.037). The pre-posttreatment VFI difference, MD difference and PSD difference between glucocorticoid group and control group was not statistically significant [(8.38±15.976)% vs. (6.24±17.290)%, t=0.567, P=0.572; (2.04±4.71)dB vs (1.66±5.07) dB, t=0.338, P=0.736; (0.38±2.60) dB vs (-0.04±2.46) dB, t=0.713, P=0.736). After treatment, there was no significant difference in the staging of visual field defect between the glucocorticoid group and the control group (Z=-1.423, P=0.155), and there was no significant difference in the effective rate of treatment (27.40% vs 36.00%, χ2=0.724，P=0.696）. Conclusion Systemic glucocorticoid therapy can not improve the short-term visual field prognosis of NA-AION patients. (Ophthalmol CHN, 2021, 30: 430-434)

Key words: ischemic optic neuropathy, glucocorticoids, visual field