Despite its side effects, intravenous methylprednisolone is still used by many ophthalmologists and neurologists to treat multiple sclerosis (MS) -related demyelinating optic neuritis, according to researchers. However, the results published in Clinical Ophthalmology suggest that steroid therapy should only be considered on an individual basis and not as a routine treatment for each patient.
Demyelinating retrobulbar optic neuritis is closely related to MS and can be the first sign of the disease. Currently, treatment with 1 g intravenous methylprednisolone for 3 days is recommended only for patients with severe or bilateral vision loss, or those with 2 or more white matter lesions seen on MRI, but is more commonly prescribed.
The researchers compared the structure and function of the retina and optic nerve in patients with a history of MS-related demyelinating retrobulbar optic neuritis. The 32 eyes of 32 patients with a previous single episode of MS-related demyelinating retrobulbar optic neuritis were divided into 2 groups: S (+) consisting of 16 patients treated with intravenous methylprednisolone at a dose of 1 g / day for 3 days were the acute stage of optic neuritis and S (-) consisting of 16 patients who received no treatment.
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The researchers performed the best corrected distance visual acuity (DBCVA), the slit lamp examination of the anterior and posterior segment, the visual field analysis, the macular thickness in the foveal (RT1) and parafoveal region (RT2), the peripapillary retinal nerve fiber layer through thickness (RNFL) in the temporal, superior, nasal and inferior quadrants, assessment of the bioelectrical function of the visual pathway with focus on the optic nerve – pattern of visual evoked potentials (PVEP) and of macular ganglion cells and cone photoreceptors – pattern electroretinogram (PERG)
They found no statistically significant differences between the groups with regard to DBCVA, mean visual field deviation of the macula (RT1, RT2), RNFL thickness in the temporal, superior, nasal and inferior quadrants and bioelectrical function (PVEP, PERG).
“The results of our study show that there is no statistically significant difference in the function and structure of the retina and optic nerve in long-term observation of eyes with a history of demyelinating ON that have or have not been treated with intravenous steroids,” explains the study. “Therefore, the use of steroid therapy should be considered individually and not as a routine treatment for all patients.”
reference
Nowacka B, Lubiński W. Comparison of the structure and function of the retina and optic nerve in patients with a history of demyelinating retrobulbar optic neuritis associated with multiple sclerosis who were and not treated with systemic steroid therapy. Clin Ophthalmol. 2021; 15: 2253-2261. doi: 10.2147 / OPTH.S309975
This article originally appeared on Ophthalmology Advisor
