Masoud Soheilian, Shahin Yazdani, Liela Alizadeh-Ghavidel, Mohammad R. Mohebbi

Advantages:

Transvitreal optic neurotomy (TON) is effective in the management of recent-onset, non-arteritic anterior ischemic optic neuropathy (NAION) in terms of visual acuity (VA) and visual feild (VF) improvement.

Methods:

In this single masked clinical trial, sixteen eyes of 16 patients with recent onset (less than six weeks duration) NAION were randomized to TON (8 eyes), versus observation alone (8 eyes). The primary outcome measure was improvement in VA of at least 2 Snellen lines at final follow-up. Secondary outcome measures included time to achieve best-corrected VA, VF changes and complications.

Effectiveness / Safety:

After six months of follow-up, 6 eyes (75%) in the TON group and 2 eyes (25%) in the observation group had improved VA (P=0.04, OR=9, 95% CI, 1-82). Mean VA improvement was significantly greater in the TON versus the observation group at three months (0.8±0.49 versus 0.24±0.45 logMAR, p=0.03) and at six months (1.04±0.83 versus 0.24±0.45 logMAR, p=0.03). Time to achieve best-corrected visual acuity was not significantly different between the groups. VF improvement in the TON group was significantly greater than the observation group (P=0.01, OR=21, 95% CI, 1.5-293.2) at final follow up.