Prognostic value of retinal nerve fiber layer thickness for postoperative peripheral visual field recovery in optic chiasm compression.

UNLABELLED: OBJECT.: The authors' objective was to evaluate the predictive value of preoperative axonal loss for peripheral visual field recovery after surgery for optic chiasm compression. METHODS: Consecutive patients with optic chiasm compression in the period from October 2010 through August 2012 were retrospectively studied. Time-domain optical coherence tomography (OCT) had been performed before surgery. Kinetic automated perimetry had been performed before and after surgical decompression. The area of the peripheral isopter (square degrees [deg(2)]) was assessed. Postoperative improvement was defined as an increase of 25 deg(2) or more. RESULTS: Sixty-eight eyes in 34 patients were included in the analysis. In 44 eyes the visual field improved after surgery, and in 24 eyes it was unchanged or worse. Nasal retinal nerve fiber layer (RNFL) thickness was a good prognostic factor for peripheral visual field recovery (OR 1.56 per 15 µm, p = 0.041). CONCLUSIONS: Peripheral visual field recovery after surgery for optic chiasm compression is predicted by nasal RNFL thickness, which is in accordance with the retinotopy of retinal ganglion cells, as nasal axons decussate at the optic chiasm.

Intravitreal triamcinolone injections in non-arteritic anterior ischemic optic neuropathy.

BACKGROUND: In non-arteritic anterior ischemic optic neuropathy (NA-AION), no treatments have demonstrated to be effective in recovering visual loss in randomized clinical trials. Oral steroids have been evaluated, and small series of intravitreal triamcinolone acetonide (IVTA) injection in NA-AION have been reported. The purpose of our study was to report the visual outcome and morphological changes in response to a single IVTA injection as a treatment for patients with NA-AION. PATIENTS AND METHODS: The charts of 36 patients with visual symptoms and optic disc swelling caused by NA-AION were evaluated. Twenty-one patients had received 4 mg IVTA and were compared with 15 non-treated patients. Visual acuity (VA), retinal nerve fiber layer thickness and static visual field were evaluated after 6 months. RESULTS: VA improvement at 6 months is statistically better in the treated group than in the non-treated group (p = 0.0035). In the treated group, there was a significant inverse correlation between the delay of the injection and the visual acuity achieved at 6 months (p < 0.0083**, r = -0.56). A significant improvement of the visual field was noted in the injected group when compared with the non-treated group at 6 months (p < 0.0028). DISCUSSION: In this retrospective study, patients receiving IVTA in the acute phase of NA-AION have better improvement of VA and visual field during the follow-up period of 6 months. However, only a large randomized controlled trial may enable to evaluate the benefits of IVTA Injections on visual outcome in NA-AION.