Steroids in the treatment of nonarteritic anterior ischemic optic neuropathy: A PRISMA-compliant meta-analysis

BACKGROUND: Non-arteritic anterior ischemic optic neuropathy (NAION) is the common cause of acute and subacute optic neuropathy in adults over the age of 50. Steroid administration in NAION seems to be in practice and is advised frequently by neurologists. The controversy regarding steroid usage in NAION is far from settled, with strong opinions on both sides. Despite a large amount of articles on this topic, but the results have not always been consistent. To address this gap, we decided to conduct a meta-analysis of all available published studies in order to better understand the effectiveness of steroids in treating NAION. OBJECTIVES: To identify the effectiveness of steroids in treating NAION. METHODS: We performed a meta-analysis using databases, including PUBMED EMBASE, and the Cochrane library, to find relevant studies. The weighted mean difference (WMD) was determined for BCVA in steroid and nonsteroid groups. RESULTS: Eight studies were included and summarized in this analysis. The studies included 720 eyes (392 NAION eyes and 328 eyes of normal controls). Heterogeneity among these studies was low (I(2) = 0%). Because of the presence of heterogeneity, we conducted a fixed effects model to assess the effect of steroids on visual acuity in patients with NAION. The meta-analysis clearly demonstrated that in NAION, steroids did not significantly improve visual acuity (WMD = −0.02 [95% CI: −0.10 to 0.06], Z = 0.40, P = .69). After sensitivity analysis via the leave-one-out method, WMD was not significantly changed. CONCLUSIONS: Our meta-analysis found that steroids do not significantly improve visual acuity in NAION. In view of their long list of side effects, attempts at reversing ischemia should not involve the use of steroids.