Trial for a trial: Is there hope? – Optic neuritis treatment trial protocol in patients with traumatic optic neuropathy

Abstract

Aims: The aim of this study was to analyze the clinical profile, visual outcome, factors predicting the visual outcome, and response to systemic methylprednisolone as per the Optic Neuritis Treatment Trial (ONTT) protocol in patients with traumatic optic neuropathy (TON). Study Design: This was a prospective observational study. Subjects and Methods: All cases who had decreased visual acuity (VA) following impact head/orbital injury were evaluated with detailed history, and ophthalmic evaluation was done. Those who were diagnosed to have indirect TON were treated with intravenous methylprednisolone 500 mg twice daily for 3 days, followed by oral prednisolone 1 mg/kg for 11 days. Visual outcome was assessed at 1 week, 1 month, 3 months, and 6 months. The results were statistically analyzed. Results: 34.65% had severe loss of vision (<6/60 vision) at presentation. Twenty patients received early treatment (within 3 days) and six patients received treatment after 3 days. Fourteen eyes (53.84%) showed an improvement in VA at 1 month. Among those who had early treatment, 60% improved, but it was not statistically significant. An initial VA of <6/60 and the presence of brain contusions were significantly associated with poor visual outcomes. Conclusions: There is no statistically significant improvement in visual outcome with early initiation of therapy. Severe initial visual loss and presence of brain contusions predict poor visual outcomes. Selected patients will benefit with corticosteroids, and the ONTT protocol with minimal adverse reactions would be a safer choice in them.

Keywords

• methylprednisolone
• optic neuritis treatment trial
• traumatic optic neuropathy