High Dose Intravenous Corticosteroid Versus Placebo in Recent Traumatic Optic Neuropathy

To compare the effect of high dose intravenous corticosteroid therapy with placebo in the treatment of recent traumatic optic neuropathy (TON). In a double masked-placebo controlled clinical trial, 31 eyes of 31 patients were randomly assigned into two groups. Only patients with history of ophthalmic or head trauma within the past 7 days were included. Unconscious patients, those with penetrating ocular injury, and candidates for decompression surgery were excluded. The treatment group (16 eyes) received 1 gr methylprednisolone intravenously for 3 days followed by 1 mg/kg prednisolone orally for 11 days. The placebo group (15 eyes) received 50 ml normal saline intravenously every 6 hours for 3 days. Visual improvement was defined as increase of at least 0.3 LogMAR visual acuity after 3 months. Visual improvement was achieved in 68.8% of the treatment group and 53.3% of the placebo group (P=0.1). Visual improvement in the first 48 hours was correlated with final visual acuity (P=0.03) but final visual acuity was not significantly correlated with age (P=0.06), interval from trauma to treatment (P=0.5), and initial visual acuity (P=0.06). In patients with recent TON, high-dose intravenous corticosteroids and placebo are comparable in terms of improvement in visual acuity.