Application of HELP in nonarteritic anterior ischemic optic neuropathy: A prospective, randomized, controlled study

Haas, Anton; Walzl, Manfred; Jesenik, Friedrich; Walzl, B.; Berghold, Andrea; Berglöff, J.; Feigl, Beatrix; Faulborn, J.

doi:10.1007/bf01007832

Cited by 22 publications

(14 citation statements)

References 21 publications

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“…In a previous work, Haas et al [29] demonstrated that treatment with LDL apheresis (HELP system) can improve the visual parameters in patients affected by NAION, obtaining more significant results than in the control group treated with hemodilution. Instead, visual acuity, expressed in logMAR units, did not show significant differences between the group treated with apheresis and the control group.…”

Section: Discussionmentioning

confidence: 99%

Is the Efficacy of LDL Apheresis in Ischemic Optic Neuropathy Linked to a Reduction in Endothelial Activation Markers?

Ramunni¹,

Ranieri²,

Giancipoli³

et al. 2006

Blood Purif

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Endothelial dysfunction of the optic microcirculation is considered to be the main pathogenetic mechanism in nonarteritic ischemic optic neuropathy. The aim of the present work was to assess whether a clinical improvement is correlated with a reduction in the endothelial activation markers by means of LDL apheresis (LDLA). Three weekly sessions of LDLA were administered in 23 patients affected by nonarteritic ischemic optic neuropathy. Statistically significant reductions were achieved in all parameters: total cholesterol (44.6%), LDL cholesterol (54.6%), fibrinogen (60.9%), von Willebrand factor (38.6%), sE-Selectin (22.6%), sICAM-1 (14%) and sVCAM-1 (15.5%), each of which was correlated with an improvement in the mean deviation of the visual field, although statistical significance for the single parameters was not reached. However, analysis of variance between the mean deviation improvement and the set of parameters taken together yielded highly significant results (p < 0.0001). LDLA was effective in reducing the values of all evaluated endothelial activation markers, and this trend was correlated with an improvement in the visual field.

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Section: Discussionmentioning

confidence: 99%

Is the Efficacy of LDL Apheresis in Ischemic Optic Neuropathy Linked to a Reduction in Endothelial Activation Markers?

Ramunni¹,

Ranieri²,

Giancipoli³

et al. 2006

Blood Purif

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“…The only randomized control study for the treatment of NAION was the IONDT (Ischemic Optic Neuropathy Decompression Trial) [4] which suggested that optic nerve decompression surgery for NAION patients is ineffective, and may even be harmful. Other studies explored the role of aspirin [5-7], vasodilators [8], heparin-induced extracorporeal LDL/fibrinogen precipitation (HELP) [9], hyperbaric oxygen [10], diphenylhydantoin [11], norepinephrine [12], levodopa [13], topical brimonidine [14,15], intravitreal bevacizumab [16,17] and systemic corticosteroids [18-20]. Recently Prokosch et al showed that adding the corticosteroid floucortolone to their standard treatment (intravenous and per os pentoxifylline for one week and then per os for a further 6 months) slightly improves the short and long term visual acuity (VA) in some patients.…”

Section: Introductionmentioning

confidence: 99%

Visual outcome of mega-dose intravenous corticosteroid treatment in non-arteritic anterior ischemic optic neuropathy – retrospective analysis

et al. 2014

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BackgroundTo date, non arteritic anterior ischemic optic neuropathy (NAION) is still incurable. We wish to evaluate the effect of intravenous (IV) corticosteroids on the visual outcome of NAION patients.MethodsVisual parameters were retrospectively compared between NAION patients treated with IV corticosteroids and untreated NAION patients (control). Visual acuity (VA) and Humphrey automated static perimetry visual field (VF) defects of the affected eye were compared between groups at baseline, 1, 3, 6 months, and end of follow-up visits. The VF analysis consisted of number of quadrant involvements and mean deviation (MD).ResultsEach group comprised 23 patients (24 eyes). Mean initial VA was similar in the control and treatment groups (p = 0.8). VA at end of follow-up did not improve in either groups (p = 0.8 treated group, p = 0.1 control group). No improvement and no difference in VF defects were found by either quadrant analysis (p = 0.1 treated group, p = 0.5 control group) or MD analysis (p = 0.2, treated group, p = 0.9 control group). VA and VF parameters tended to be worse in the treated group, although without statistical significance.ConclusionsOur results suggest that IV corticosteroids may not improve the visual outcome of NAION patients. Since intravenous corticosteroids could potentially cause serious adverse effects, this treatment for NAION is questionable.

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“…In the hemodilution group, visual acuity increased in 33.4%, remained stable in 42.8% and worsened in 23.8%. There was mild, but statistically significant (p < 0.01) improvement in the mean sensitivity of visual fields in the HELP group that was not seen in the hemodilution group [39].…”

Section: Vasodilatorsmentioning

confidence: 95%

“…It is theorized that the precipitation of these substances may improve the circulatory milieu to which the optic nerve at risk for NAION is exposed. In a prospective, randomized, controlled study over a period of 3 months, 40 patients with acute NAION and symptom onset within 2 weeks were randomly assigned to either HELP or hemodilution therapy to determine the efficacy of these two treatments on visual acuity and fields [39]. There was no difference in visual acuity between the two groups (p = 0.48).…”

Section: Vasodilatorsmentioning

confidence: 98%

Nonarteritic anterior ischemic optic neuropathy: untreatable at present?

Mackay

Atkins

Newman

et al. 2013

Expert Review of Ophthalmology

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Application of HELP in nonarteritic anterior ischemic optic neuropathy: A prospective, randomized, controlled study

Abstract: The HELP system seems to be safe and more effective than hemodilution in improving the hemorheological and the functional situation in NAION and could be a promising regimen in the treatment of NAION.

Cited by 22 publications

References 21 publications

Is the Efficacy of LDL Apheresis in Ischemic Optic Neuropathy Linked to a Reduction in Endothelial Activation Markers?

Is the Efficacy of LDL Apheresis in Ischemic Optic Neuropathy Linked to a Reduction in Endothelial Activation Markers?

Visual outcome of mega-dose intravenous corticosteroid treatment in non-arteritic anterior ischemic optic neuropathy – retrospective analysis

Nonarteritic anterior ischemic optic neuropathy: untreatable at present?

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