Corticosteroids for treating optic neuritis

Vedula SS, Brodney Folse S, Gal RL, Beck R

Published Online:

January 21, 2009

Optic neuritis is an acute demyelinating disease of the optic nerve, which typically presents with sudden loss of vision. Visual deficit varies in severity and generally improves spontaneously over several months. This review included five trials evaluating corticosteroids given either orally or by intravenous route in patients with optic neuritis. There is no evidence of benefit with either oral or intravenous corticosteroids in terms of improvement of vision. However, one trial reported quicker recovery of vision with intravenous corticosteroid therapy.

Abstract (click to read)

Background:

Optic neuritis is an inflammatory disease of the optic nerve. It occurs more commonly in women than in men. Usually presenting with an abrupt loss of vision, recovery of vision is almost never complete. Closely linked in pathogenesis to multiple sclerosis, it may be the initial manifestation for this condition. In certain patients, no underlying cause can be found.

Objectives:

To assess the effects of corticosteroids on visual recovery of patients with acute optic neuritis.

Search strategy:

We searched the Cochrane Controlled Trials Register (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (issue 4, 2005), MEDLINE (1966 to December 2005), EMBASE (1980 to January 2006), NNR (issue 4, 2006), LILACS and reference lists of identified trial reports.

Selection criteria:

We included randomized trials that evaluated corticosteroids, in any form, dose or route of administration, in people with acute optic neuritis.

Data collection and analysis:

Two authors independently extracted the data on methodological quality and outcomes for analysis.

Main results:

We included five randomized trials which included a total of 729 participants. Two trials evaluated low dose oral corticosteroids and two trials evaluated a higher dose of intravenous corticosteroids. One three-arm trial evaluated low-dose oral corticosteroids and high-dose intravenous corticosteroids against placebo. Trials evaluating oral corticosteroids compared varying doses of corticosteroids with placebo. Hence, we did not conduct a meta-analysis of such trials. In a meta-analysis of trials evaluating corticosteroids with total dose greater than 3000 mg administered intravenously, the relative risk of normal visual acuity with intravenous corticosteroids compared with placebo was 1.06 (95% CI 0.89 to 1.27) at six months and 1.06 (95% CI 0.92 to 1.22) at one year. The risk ratio of normal contrast sensitivity for the same comparison was 1.10 (95% CI 0.92 to 1.32) at six months follow up. We did not conduct a meta-analysis for this outcome at one year follow up since there was substantial statistical heterogeneity. The risk ratio of normal visual field for this comparison was 1.08 (95% CI 0.96 to 1.22) at six months and 1.02 (95% CI 0.86 to 1.20) at one year. Quality of life was assessed and reported in one trial.

Authors' conclusions:

There is no conclusive evidence of benefit in terms of recovery to normal visual acuity, visual field or contrast sensitivity with either intravenous or oral corticosteroids at the doses evaluated in trials included in this review.

This record should be cited as:

Vedula SS, Brodney Folse S, Gal RL, Beck R. Corticosteroids for treating optic neuritis. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD001430. DOI: 10.1002/14651858.CD001430.pub2

Assessed as up to date:

January 9, 2006

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Primary Review Group:

Eyes and Vision Group

Health topics:

Eyes & vision > Optic nerve disease

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Corticosteroids for treating optic neuritis

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