Transvitreal Optic Neurotomy for Non-arteritic Anterior Ischemic Optic Neuropathy

To evaluate the role of transvitreal optic neurotomy (TON) in the management of non-arteritic anterior ischemic optic neurotomy (NAION). Sixteen eyes of 16 patients with recent onset NAION (less than six weeks duration) were included in this single-masked randomized controlled trial. The patients were randomized to TON (8 eyes) versus observation alone (8 eyes). Pre- and postoperative visual acuity and visual field as well as complications of the procedure were evaluated. After six months of follow up, six eyes in the TON group and two eyes in the observation group had improvement in visual acuity (P=0.04). Mean visual improvement was significantly better in the TON versus the observation group three (0.8±0.49 vs 0.24±0.45 logMAR, P=0.03) and six (1.04±0.83 vs 0.24±0.45 logMAR, P=0.03) months postoperatively. Time to achieve best-corrected visual acuity was not significantly different between the groups. Visual field improvement in the TON group was significantly better than the observation group at final follow up. TON is effective in the management of recent onset NAION in terms of visual acuity and visual field improvement. A multicenter randomized clinical trial with larger sample size is needed to confirm these findings.