LDL‐Apheresis Accelerates the Recovery of Nonarteritic Acute Anterior Ischemic Optic Neuropathy

Abstract

Nonarteritic acute anterior ischemic optic neuropathy (NAION) is a disabling disease which impairs visual function. It is presumed to result from disturbances of microcirculation in the anterior portion of the optic nerve head due to hemodynamic factors derived from excessive blood viscosity, or restriction of the vasal lumen in hypertensive, hypercholesterolemic, diabetic patients. We aimed to determine whether acute reduction of plasma fibrinogen and serum low-density lipoprotein (LDL) cholesterol is effective for treatment of NAION. We recruited 11 patients (7 females, 4 males) with a mean age of 57.2 +/- 19.6 years. All except one of them presented risk factors for atherosclerosis. The mean values of LDL-cholesterol and fibrinogen before treatment were 144 +/- 32 mg/dL and 341 +/- 80 mg/dL, respectively. All were treated with standard therapy (prednisone, salicylate, pentoxiphyllin) and underwent three sessions of LDL-apheresis (HELP system-B Braun) that can reduce plasma LDL-cholesterol and fibrinogen by more than 50% in a very short time. In all patients we observed a drastic reduction of LDL cholesterol and fibrinogen and a clear improvement in the visual functional data. In fact, mean values of corrected vision increased from 3.7/10 +/- 3/10 to 7.9/10 +/- 2.2/10 (P = 0.002) after the third session, while the scotomatous portion of the visual field regressed after the first session, and in 5 patients further regressed after the third session. This improvement had remained stable after 3 months. Thanks to it's effect of antagonizing hemorheologic disorders of the ocular microcirculation, fibrinogen/LDL-apheresis seems to be an efficacious treatment of NAION.

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

“…In AMD, the damage to the macula is slow, progressive, and sight loss is attributable to retinal pigment epithelium detachment and choroidal neovascularization. For these reasons, in our previous experience in the treatment of NAION [3,4] we used only three sessions of LDL apheresis, and the improvement in visual acuity was apparent already after the first session. Instead, in AMD, the treatment protocols involved 10 treatments over a period of 21 weeks [19] or 8 treatments over a period of 10 weeks [21] and improvements in the visual parameters were apparent only after several weeks.…”

“…Considering that the best results in terms of visual acuity were already evident after the first session [3,4] , and that in the same way the ability of apheresis to reduce the concentration of endothelial activation markers should be highest in the first session, we correlated only the parameters referring to the first session. We did not obtain substantial improvements in these first results for visual acuity in the later sessions in the few patients tested.…”

“…Traditional therapy based on anticoagulants, platelet antiaggregants and pentoxyphyllin does not significantly change the course of the disease, and the damage remains stable in most cases [1] . In recent experiences, we have demonstrated that treatment with LDL apheresis (HELP system, B. Braun, Melsungen, Germany) in association with the traditional therapy can foster an improvement in the visual field of subjects with NAION [3,4] . It is known that even a single session of LDL apheresis can sharply reduce plasma concentrations of total cholesterol, LDL cholesterol and fibrinogen [5] , as well as the von Willebrand factor [6] , considered to be a marker of endothelial activation [7] .…”

LDL apheresis in the treatment of non-arteritic ischaemic optic neuropathy: a 6-month follow-up study

“…5 Moreover, an improvement in the MD was also observed in our previous experiences 4,5 following treatment with LDL apheresis, but we did not prolong follow-up to 6 months. In this study, the return of the MD to the pretreatment values suggests that the temporary increase in MD could be sustained by reversible haemorheological improvements (reduced plasma and whole blood viscosity, reduced erythrocyte aggregability, and so on) obtained using LDL apheresis, that could have induced a short-term enhanced blood flow to the posterior ciliary arteries.…”

“…1,2 In previous experiences, we have associated treatment with LDL apheresis and traditional therapy in patients affected by NAION, obtaining convincing results in terms of the improvement of functional parameters. [3][4][5] In this study, 20 patients affected by NAION were randomly subdivided into two groups: a group of 10 patients treated with conventional therapy in combination with LDL apheresis (group 1) and a control group of 10 patients treated with conventional therapy only (group 2).…”