Evaluation of enhanced external counterpulsation therapy for nonarteritic anterior ischemic optic neuropathy

Abstract

KEYWORDSnonarteritic anterior ischemic optic neuropathy, enhanced external counterpulsation, visual acuity, visual field 2 Abstract Background To explore the effects of enhanced external counterpulsation (EECP) and its underlying influencing factors in nonarteritic anterior ischemic optic neuropathy (NAION) patients. Methods Patients at Zhongshan Ophthalmic Center with recent-onset (<8 weeks) NAION were retrospectively recruited. The patients had decided whether or not they would undergo EECP treatment, and the patients who declined were included in the control group. The effectiveness of EECP was evaluated by comparing the visual function and fellow eye involvement in patients with and without EECP treatment. Results In total, 61 patients (76 eyes) were included. Twenty-nine patients (37 eyes) underwent EECP treatment, while 32 patients (39 eyes) were included in the control group. Mean time from NAION onset to EECP initiation was 27.59±16.70 days. In the EECP group, the mean EECP duration was 31.57±18.45 days. EECP was well tolerated by all patients. However, there was no significant difference in visual function between the EECP and control groups, regardless of time to treatment initiation. Furthermore, there was no evidence of the effectiveness of EECP in the subgroup analysis of patients with different systemic health conditions. Among the 42 patients with monocular NAION, the sequential attack rate was comparable between the EECP (27.78%) and control (25.00%) groups. Conclusion This study is the first nonrandomized controlled study to evaluate the effectiveness of EECP in NAION patients. Unfortunately, we failed to demonstrate the effectiveness of EECP in NAION at the 6-month follow-up. Any further application of EECP in NAION patients should be cautious. Background Nonarteritic anterior ischemic optic neuropathy (NAION) is an acute vision-threatening neurologic disorder commonly seen in elderly people[1]. Typically, the vision loss is usually monocular but, in some cases, binocular vision loss occurs in sequence or even simultaneously[2]. The precise pathogenesis of NAION is unclear. A variety of potential NAION risk factors can cause regional hypoxemia-related disc edema, resulting in axon death[3]. Some researchers have suggested that NAION is caused by circulatory insufficiency of the short posterior ciliary arteries, leading to laminar infarction of the optic nerve[4]. Several interventions have been proposed based on this theory[3-5]. Keren S, Zanolli M, Dotan G: Visual outcome following bilateral non-arteritic anterior ischemic optic neuropathy: a systematic review and meta-analysis. BMC Ophthalmol 2017, 17(1):155. 3. Hayreh SS: Ischemic optic neuropathies -where are we now? Graefes Arch Clin Exp Ophthalmol 2013, 251(8):1873-1884. 4. Biousse V, Newman NJ: Ischemic Optic Neuropathies. N Engl J Med 2015, 372(25):2428-2436. 5. Foroozan R: New Treatments for Nonarteritic Anterior Ischemic Optic Neuropathy. Neurol Clin 2017, 35(1):1-15. 6. Atkins EJ, Bruce BB, Newman NJ, Biousse V: Treatment of nonarteri...