Treatment of nonarteritic anterior ischemic optic neuropathy.
Treatment of nonarteritic anterior ischemic optic neuropathy.
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DOI：
10.1016/j.survophthal.2009.06.008
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发表时间：
2010-01
影响因子：
5.1
通讯作者：
Biousse V
中科院分区：
文献类型：
--
作者：
Atkins EJ;Bruce BB;Newman NJ;Biousse V
非动脉炎性前部缺血性视神经病变（NAION）是视神经急性缺血性损伤的最常见临床表现。大多数针对 NAION 的治疗方法都是经验性的，包括多种被认为可作用于血栓形成、血管或椎间盘水肿本身的药物。其他的则被认为具有神经保护作用。尽管已经尝试了多种疗法，但大多数疗法尚未得到充分研究，并且 NAION 动物模型最近才出现。缺血性视神经病变减压试验 (IONDT) 是唯一针对 NAION 的 I 类大型多中心前瞻性治疗试验，发现手术干预没有任何益处。最近的一项大型非随机对照研究表明，口服类固醇可能对急性 NAION 有帮助。最近提出的其他干预措施是玻璃体内注射类固醇或抗血管内皮生长因子（抗 VEGF）药物。没有 I 类研究显示药物或手术治疗有益。大多数关于 NAION 治疗的文献由回顾性或前瞻性病例系列和轶事病例报告组成。同样，旨在二级预防 NAION 中同眼受累的治疗方法的益处尚未得到证实。
Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common clinical presentation of acute ischemic damage to the optic nerve. Most treatments proposed for NAION are empirical and include a wide range of agents presumed to act on thrombosis, on the blood vessels, or on the disc edema itself. Others are presumed to have a neuroprotective effect. Although there have been multiple therapies attempted, most have not been adequately studied, and animal models of NAION have only recently emerged. The Ischemic Optic Neuropathy Decompression Trial (IONDT), the only class I large multicenter prospective treatment trial for NAION, found no benefit from surgical intervention. One recent large, nonrandomized controlled study suggested that oral steroids might be helpful for acute NAION. Others recently proposed interventions are intravitreal injections of steroids or anti-vascular endothelial growth factor (anti-VEGF) agents. There are no class I studies showing benefit from either medical or surgical treatments. Most of the literature on the treatment of NAION consists of retrospective or prospective case series and anecdotal case reports. Similarly, therapies aimed at secondary prevention of fellow eye involvement in NAION remain of unproven benefit.
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