Korean J Ophthalmol.  2009 Mar;23(1):59-61. 10.3341/kjo.2009.23.1.59.

The Effect of an Intravitreal Triamcinolone Acetonide Injection for Acute Nonarteritic Anterior Ischemic Optic Neuropathy

• Sohn BJ
• Chun BY
• Kwon JY

• KMID: 1115656
• DOI: http://doi.org/10.3341/kjo.2009.23.1.59

Abstract

The purpose of this case report is to evaluate the visual outcome of an intravitreal triamcinolone acetonide injection (IVTA) as a treatment for a patient with acute nonarteritic anterior ischemic optic neuropathy (NAION). A 65-year-old male patient with severe visual loss due to acute NAION was treated with 4 mg/0.1mL IVTA. Fundus examination and measurements of the patient's best-corrected visual acuity and visual field were performed before and after the injection at 2 weeks, 1 month, 3 months, and 6 months. The best-corrected visual acuity changed from 0.05 before the injection to 0.16 at 2 weeks, 0.3 at 1 month, and 0.4 at 3 months and at the final visit. Optic disc swelling had markedly decreased at 1 week postoperatively and disappeared at 2 weeks after the injection. The clinical course of this patient suggests that an IVTA may be effective in increasing visual acuity following an acute NAION. A large randomized controlled trial is needed to assess the efficacy of IVTA as a treatment for NAION.

Keyword

Best-corrected visual acuity; Intravitreal triamcinolone acetonide injection (IVTA); Nonarteritic anterior ischemic optic neuropathy (NAION); Optic disc edema

MeSH Terms

Acute Disease
Aged
Diagnosis, Differential
Fluorescein Angiography
Follow-Up Studies
Fundus Oculi
Glucocorticoids/*administration & dosage
Humans
Injections
Male
Ophthalmic Solutions
Optic Neuropathy, Ischemic/*drug therapy/pathology/physiopathology
Triamcinolone Acetonide/*administration & dosage
Visual Acuity
Visual Fields
Vitreous Body

Figure

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  Fig. 1 A fundus photograph at the time of diagnosis demonstrates optic disc swelling with a flame-shaped hemorrhage. The optic disc swelling involved the whole disc, with the exception of the superior zone.

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  Fig. 2 Intravenous fluorescein angiogram. The early phase of an intravenous fluorescein angiogram showed a segmental perfusion delay in the optic disc.

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  Fig. 3 Visual field plotted by Goldmann perimeter at the time of diagnosis. A diffuse cecocentral scotoma was observed.

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  Fig. 4 A fundus photograph at 3 months after the IVTA injection demonstrates a segmental pale neuroretinal rim (5 o'clock-11 o'clock) which corresponds with the previous segmental perfusion delay seen with the fluorescein angiogram.

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