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. 2007 Jan 24:(1):CD001430.
doi: 10.1002/14651858.CD001430.pub2.

Corticosteroids for treating optic neuritis

S S Vedula, S Brodney-Folse, R L Gal, R Beck

Corticosteroids for treating optic neuritis

S S Vedula et al. Cochrane Database Syst Rev. .

Update in

Abstract

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.

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Conflict of interest statement

Declarations of Interest: Roy Beck is the primary investigator for the Optic Neuritis Treatment Trial.

References

References to studies included in this review

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References to studies excluded from this review

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References to studies awaiting assessment

    1. Kommerell G. Treatment of optic neuritis with corticosteroids. Discussion at the 10th Meeting of the International Neuro-ophthalmological Society (Freiburg 5 to 9 June 1994) [Die Behandlung der Neuritis nervi optici mit Kortikosteroiden. Diskussion bei der 10. Tagung der International Neuro–ophthalmological Society (Freiburg, 5. bis 9.Juni 1994)] Klinische Monatsblatter Fur Augenheilkunde. 1994;205(3):126–27. - PubMed
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    1. Soderstrom M. Corticosteroids and acute optic nerve neuritis. A therapeutic method requiring further studies [Kortikosteroider och akut opticusneurit Behandlingsmetod kräver ytterligare studier] Lakartidningen. 1995;92(5):387–90. - PubMed

Additional references

    1. Beck RW. Optic Neuritis. In: Miller NR, Newman NJ, editors. Walsh and Hoyt's Neuro-ophthalmology. 5th. Baltimore: Williams and Wilkins; 1998. pp. 599–647.
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    1. Higgins JPT, Green S, editors. The Cochrane Library, Issue 3, 2005. Chichester, UK: John Wiley & Sons, Ltd; 2005. Locating and selecting studies. Cochrane Handbook for Systematic Reviews of Interventions 4.2.5. updated May 200, Section 55.

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