Is Intravitreal Bevacizumab an Effective Treatment Option for Nonarteritic Anterior Ischemic Optic Neuropathy?

Abstract

Nonarteritic anterior ischemic optic neuropathy (NAION) causes sudden profound loss of vision with no known cause or cure. Various treatment modalities, both surgical and pharmacologic, have been tried without success. The purpose of our retrospective study was to evaluate the effect of intravitreal bevacizumab (Avastin) as a treatment option for NAION. We evaluated demographics of 5 patients and compared visual acuity and automated visual fields prior to and following intravitreal bevacizumab injection. Visual acuity at presentation was 20/20 in 4 of 5 patients and 20/150 in 1. Visual acuity improved to 20/40 in the patient who presented with decreased acuity and decreased slowly in 3 patients and rapidly in 1. All patients presented with variable visual field defects: 1 improved slightly, 3 progressed, and 1 remained stable. One patient subsequently developed NAION in the fellow eye. These results are consistent with the natural course of the disease, and bevacizumab did not appear to have a dramatic effect on the clinical outcome in this small series of patients with NAION.

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

“…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.…”

Nonarteritic anterior ischemic optic neuropathy: untreatable at present?

“…In a retrospective case series, five patients with NAION received the injection between 1 and 39 days after the onset of visual loss [52]. In follow up ranging from 2 months to 3 years, only the patient treated within one day of symptom onset had improved vision, three had no change and one had worsening of vision.…”

“…Two subsequent studies evaluated intravitreal bevacizumab (1.25 mg) in NAION [52,53]. In a retrospective case series, five patients with NAION received the injection between 1 and 39 days after the onset of visual loss [52].…”

Nonarteritic Anterior Ischemic Optic Neuropathy: An Update on Demographics, Clinical Presentation, Pathophysiology, Animal Models, Prognosis, and Treatment

“…However, the literature thus far suggests that intravitreal injection of bevacizumab does not have a beneficial effect when compared with the natural history of NAION [64,65].…”