The Effect of Intravitreal Injection of Erythropoietin in Treatment of Nonarteritic Anterior Ischemic Optic Neuropathy

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Ophthalmology, School of Medicine AND Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Resident, Department of Ophthalmology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Student, Department of Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Nonarteritic anterior ischemic optic neuropathy (NA-AION) is a disease with serious complications that already does not have any standard treatment. Some studies and experiences had shown that intravitreal erythropoietin injection has a neuroprotective effect. But there are some different and inconsistent results in those studies. So, the aim of this study was determining the effect of intravitreal injection of erythropoietin in treatment of the disease.Methods: In a clinical trial study, 40 eyes (from 38 patients) were selected and randomly divided in two groups. In the first group, 2000 IU erythropoietin was injected in vitreous and the second group did not receive erythropoietin. Visual acuity and visual field were measured before and three months after the treatment and compared between the two groups.Findings: The mean visual acuity was improved in the treatment group (P < 0.001) but did not differed in the control group (P = 0.270). In addition, the pattern standard deviation was improved in the treatment group (P = 0.047) but did not statistically change in the control group (P = 0.130).Conclusion: Intravitreal injection of erythropoietin in patients with nonarteritic anterior ischemic optic neuropathy leads to remarkable and significant improvement of visual acuity and field 3 months after the injection. So, this treatment strategy is advised in patients with suitable condition and without any contraindication by ophthalmologists. To evaluate the long-term effects, further studies are recommended.

Keywords

References

  1. Arnold AC. Ischemic optic neuropathy. In: Miller NR, Newman NJ, Biousse V, Kerrison JB. editors. Walsh and Hoyt's clinical neuro-ophthalmology. 6th ed. Philadelphia, PA; Lippincott, Williams and Wilkins; 2005. p. 349-84.
  2. Miller NR. Anterior ischemic optic neuropathy. In: Walsh FB, Hoyt WF, Miller NR. Walsh and Hoyt's clinical neuro-ophthalmology. Baltimore, MD: Williams and Wilkins; 1982. p. 212-26.
  3. Preechawat P, Bruce BB, Newman NJ, Biousse V. Anterior ischemic optic neuropathy in patients younger than 50 years. Am J Ophthalmol 2007; 144(6): 953-60.
  4. Johnson LN, Arnold AC. Incidence of nonarteritic and arteritic anterior ischemic optic neuropathy. Population-based study in the state of Missouri and Los Angeles County, California. J Neuroophthalmol 1994; 14(1): 38-44.
  5. Atkins EJ, Bruce BB, Newman NJ, Biousse V. Treatment of nonarteritic anterior ischemic optic neuropathy. Surv Ophthalmol 2010; 55(1): 47-63.
  6. Miller NR. Current concepts in the diagnosis, pathogenesis, and management of nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol 2011; 31(2): e1-e3.
  7. Hayreh SS. Management of non-arteritic anterior ischemic optic neuropathy. Graefes Arch Clin Exp Ophthalmol 2009; 247(12): 1595-600.
  8. Arnold AC. Pathogenesis of nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol 2003; 23(2): 157-63.
  9. Siren AL, Fratelli M, Brines M, Goemans C, Casagrande S, Lewczuk P, et al. Erythropoietin prevents neuronal apoptosis after cerebral ischemia and metabolic stress. Proc Natl Acad Sci USA 2001; 98(7): 4044-9.
  10. Lim JW, Han JR. Aqueous humour levels of vascular endothelial growth factor and erythropoietin in patients with diabetic macular oedema before and after intravitreal erythropoietin injection. Clin Exp Ophthalmol 2011; 39(6): 537-44.
  11. Li W, Sinclair SH, Xu GT. Effects of intravitreal erythropoietin therapy for patients with chronic and progressive diabetic macular edema. Ophthalmic Surg Lasers Imaging 2010; 41(1): 18-25.
  12. Zhang JF, Wu YL, Xu JY, Ye W, Zhang Y, Weng H, et al. Pharmacokinetic and toxicity study of intravitreal erythropoietin in rabbits. Acta Pharmacol Sin 2008; 29(11): 1383-90.
  13. Song BJ, Cai H, Tsai JC, Chang S, Forbes M, Del Priore LV. Intravitreal recombinant human erythropoietin: a safety study in rabbits. Curr Eye Res 2008; 33(9): 750-60.
  14. Tsai JC. Safety of intravitreally administered recombinant erythropoietin (an AOS thesis). Trans Am Ophthalmol Soc 2008; 106: 459-72.
  15. King CE, Rodger J, Bartlett C, Esmaili T, Dunlop SA, Beazley LD. Erythropoietin is both neuroprotective and neuroregenerative following optic nerve transection. Exp Neurol 2007; 205(1): 48-55.
  16. Levin LA. Axonal loss and neuroprotection in optic neuropathies. Can J Ophthalmol 2007; 42(3): 403-8.
  17. Ischemic Optic Neuropathy Decompression Trial: twenty-four-month update. Arch Ophthalmol 2000; 118(6): 793-8.
  18. Optic nerve decompression surgery for nonarteritic anterior ischemic optic neuropathy (NAION) is not effective and may be harmful. The Ischemic Optic Neuropathy Decompression Trial Research Group. JAMA 1995; 273(8): 625-32.
  19. Hayreh SS, Zimmerman MB. Non-arteritic anterior ischemic optic neuropathy: role of systemic corticosteroid therapy. Graefes Arch Clin Exp Ophthalmol 2008; 246(7): 1029-46.
  20. Lee AG, Biousse V. Should steroids be offered to patients with nonarteritic anterior ischemic optic neuropathy? J Neuroophthalmol 2010; 30(2): 193-8.
  21. Prescott CR, Sklar CA, Lesser RL, Adelman RA. Is intravitreal bevacizumab an effective treatment option for nonarteritic anterior ischemic optic neuropathy? J Neuroophthalmol 2012; 32(1): 51-3.
  22. Weishaupt JH, Rohde G, Polking E, Siren AL, Ehrenreich H, Bahr M. Effect of erythropoietin axotomy-induced apoptosis in rat retinal ganglion cells. Invest Ophthalmol Vis Sci 2004; 45(5): 1514-22.
  23. Diem R, Sattler MB, Merkler D, Demmer I, Maier K, Stadelmann C, et al. Combined therapy with methylprednisolone and erythropoietin in a model of multiple sclerosis. Brain 2005; 128(Pt 2): 375-85.
  24. Zhong L, Bradley J, Schubert W, Ahmed E, Adamis AP, Shima DT, et al. Erythropoietin promotes survival of retinal ganglion cells in DBA/2J glaucoma mice. Invest Ophthalmol Vis Sci 2007; 48(3): 1212-8.
  25. Zhang J, Wu Y, Jin Y, Ji F, Sinclair SH, Luo Y, et al. Intravitreal injection of erythropoietin protects both retinal vascular and neuronal cells in early diabetes. Invest Ophthalmol Vis Sci 2008; 49(2): 732-42.
  26. Pakdel F, Sanjari MS, Kashkouli MB, Pirmarzdashti N, Haghighi A, Moddareszade M. Erythropoietin in Recurrent Anterior Ischaemic Optic Neuropathy. Neuro-Ophthalmology 2012; 36(6): 249-52.
  27. Lagreze WA, Feltgen N, Bach M, Jehle T. Feasibility of intravitreal erythropoietin injections in humans. Br J Ophthalmol 2009; 93(12): 1667-71.
  28. Jehle T, Meschede W, Dersch R, Feltgen N, Bach M, Lagreze WA. Erythropoietin protects retinal ganglion cells and visual function after ocular ischemia and optic nerve compression. Ophthalmologe 2010; 107(4): 347-53. [In German].
  29. Modarres M, Falavarjani KG, Nazari H, Sanjari MS, Aghamohammadi F, Homaii M, et al. Intravitreal erythropoietin injection for the treatment of non-arteritic anterior ischaemic optic neuropathy. Br J Ophthalmol 2011; 95(7): 992-5.
Journal of Isfahan Medical School
Volume 34, Issue 416 - Serial Number 416
November and December 2017
Pages 1686-1692

Files

History

  • Receive Date: 11 April 2016
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics