Visual-Evoked-Response-Supported Outcome of Intravitreal Erythropoietin in Management of Indirect Traumatic Optic Neuropathy

Abstract

Purpose Investigating the efficacy of intravitreal injection of erythropoietin (EPO) in managing indirect traumatic optic neuropathy (ITON) of different durations. Methods A case series that included two groups of ITON patients: recent ITON group (<3 months trauma duration; 7 eyes) and old duration ITON group (3–36 months; 7 eyes). Diagnostic computerized tomography (CT) and baseline flash visual evoked response (VER) were performed at the presentation time. At the initial visit and each follow-up, all patients had undergone assessment of best-corrected visual acuity (BCVA), pupil reaction, and anterior and posterior segments. VER was repeated 1 and 3 months after injection. All patients received an intravitreal injection of 2000 IU EPO in 0.2 ml of commercially available sterile EPREX 4000 solution, Jansen Cilag, Zug, Switzerland. Five patients had received a second injection 3 months later. Results Significant improvement was found in BCVA, VER amplitude, and latency (P < 0.0001, 0.0154, and 0.0291, respectively). Initial values of BCVA, VER amplitude, and latency correlated significantly to the final values. Differences between recent and old trauma groups were insignificant in the three parameters. In patients who received second injection, further clinical but statistically insignificant improvement was noted in BCVA in 60% of patients, VER amplitude in 50% of patients, and in VER latency in 100% of patients. No complications were recorded. Conclusion Intravitreal injection of EPO may be effective and safe in treatment of recent and old indirect traumatic optic neuropathy.

Reversal of optic nerve function and visual outcome in traumatic optic neuropathy

“…In present study, mean VEP amplitude as well as latency significantly improved following treatment (p<0.05). These findings were similar to study by Rashad et al, 9 in which significant improvement was found in BCVA, VER amplitude, and latency (P < 0.0001, 0.0154, and 0.0291, respectively) even after 1 injection of steroid.…”

Evaluation of Subcutaneous Injection of Erythropoietin on Visual Functions in Patients with Late Onset Optic Neuropathy: A Pilot Clinical Study

“…These promising results of our study are in accordance with previously published studies. For instance, some studies have successfully used EPO in the treatment of indirect traumatic ON at such doses, ranging from 2000 IU (intravitreal) to 10000 IU (intravenous) twice daily for 3 days or even higher doses [23,24]. In a prospective and noncomparative study, 16 cases with methanol ON were included.…”

Subcutaneous Erythropoietin Reverses Optic Neuropathy Induced by Methanol Poisoning: Three Case Reports

“…A number of studies have successfully used erythropoietin in the management of optic neuropathy due to methanol poisoning [11][12][13][14][15][16] at such doses, ranging from 2000 IU (intravitreal) to 10000 IU (intravenous) twice daily for three days [15,21]. Conversely, in most previous studies, erythropoietin were injected (intravenous or intravitreal) with or without corticosteroid in the management of optic neuropathy due to methanol poisoning and also, erythropoietin were injected at high dosages but in fewer repeats [17,20].…”