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Meta-Analysis
. 2012 Apr 18;4(4):CD001430.
doi: 10.1002/14651858.CD001430.pub3.

Corticosteroids for treating optic neuritis

Robin L Gal  1 , Satyanarayana S Vedula, Roy Beck
Affiliations
Meta-Analysis

Corticosteroids for treating optic neuritis

Robin L Gal et al. Cochrane Database Syst Rev. .

Update in

  • Corticosteroids for treating optic neuritis.
    Gal RL, Vedula SS, Beck R. Gal RL, et al. Cochrane Database Syst Rev. 2015 Aug 14;2015(8):CD001430. doi: 10.1002/14651858.CD001430.pub4. Cochrane Database Syst Rev. 2015. PMID: 26273799 Free PMC article.

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 methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 1), MEDLINE (January 1950 to February 2012), EMBASE (January 1980 to February 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to February 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 21 February 2012. We also searched reference lists of identified trial reports to find additional trials.

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 six randomized trials which included a total of 750 participants. Two trials evaluated low dose oral corticosteroids while one trial evaluated low dose intravenous corticosteroids across two treatment arms 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% confidence interval (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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Figures

Figure 1
Figure 1. Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Figure 2
Figure 2. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
See this image and copyright information in PMC

Update of

References

References to studies included in this review

    1. Hickman SJ, Kapoor R, Jones SJ, Altmann DR, Plant GT, Miller DH. Corticosteroids do not prevent optic nerve atrophy following optic neuritis. Journal of Neurology, Neurosurgery and Psychiatry. 2003;74(8):1139–41. - PMC - PubMed
    1. Jones SJ, Miller DH, Kapoor R, Brusa A, Plant G. Double-blind controlled trial of methylprednisolone treatment for acute optic neuritis: 6-month follow-up with visual evoked potential measurement. Multiple Sclerosis. 1996;2 Suppl:32–3.
    1. Kapoor R, Miller DH, Jones SJ, Plant GT, Brusa A, Gass A, et al. Effects of intravenous methylprednisolone on outcome in MRI-based prognostic subgroups in acute optic neuritis. Neurology. 1998;50(1):230–7. - PubMed
    1. Menon V, Mehrotra A, Saxena R, Jaffery NF. Comparative evaluation of megadose methylprednisolone with dexamethasone for treatment of primary typical optic neuritis. Indian Journal of Ophthalmology. 2007;55(5):355–9. - PMC - PubMed
    1. Tabuchi A, Kimura H, Inoue M. Optic neuritis treatment trial: Contrast sensitivity; assessment and results. Neuro-Ophthalmology Japan. 1998;15(1):30–6.

References to studies excluded from this review

    1. Alejandro PM, Castanon Gonzalez JA, Miranda Ruiz R, Edgar Echeverria R, Adriana Montano M. Comparative treatment of acute optic neuritis with “boluses” of intravenous methylprednisolone or oral prednisone [Tratamiento comparativo de la neuritis optica aguda con “bolos” de metilprednisolona endovenosa o prednisona oral.] Gaceta Medica de Mexico. 1994;130(4):227–30. - PubMed
    1. Beran V, Hradecka V, Kohoutova O. Comparison of stimulation therapy with glucocorticoid therapy in optic nerve inflammation [Porovnani popudove terapie s lecbou glukokortikoidy u zanetu zrakoveho nervu] Ceskoslovenska Oftalmologie. 1973;29(5):372–4. - PubMed
    1. Bhatti MT, Schmitt NJ, Beatty RL. Acute inflammatory demyelinating optic neuritis: current concepts in diagnosis and management. Optometry. 2005;76(9):526–35. - PubMed
    1. Bird AC. Treatment of acute optic neuritis. Transactions of the Ophthalmological Societies of the United Kingdom. 1976;96(3):412–4. - PubMed
    1. Bowden AN, Bowden PMA, Friedman AI, Perkin GD, Rose FC. A trial of corticotrophin gelatin injection in acute optic neuritis. Journal of Neurology, Neurosurgery and Psychiatry. 1974;37(8):869–73. - PMC - PubMed

References to ongoing studies

    1. [accessed 22 February 2012];Optic neuritis recovery after oral or IV corticosteroids. NCT01524250. http://clinicaltrials.gov/ct2/show/NCT01524250.

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.
    1. Ebers GC. Optic neuritis and multiple sclerosis. Archives of Neurology. 1985;42(7):702–4. - PubMed
    1. Fleishman JA, Beck RW, Linares OA, Klein JW. Deficits in visual function after resolution of optic neuritis. Ophthalmology. 1987;94(8):1029–35. - PubMed
    1. Glanville JM, Lefebvre C, Miles JN, Camosso-Stefinovic J. How to identify randomized controlled trials in MEDLINE: ten years on. Journal of the Medical Library Association. 2006;94(2):130–6. - PMC - PubMed
    1. Higgins JPT, Altman DG, Sterne JAC, Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration; Chichester, UK: John Wiley & Sons, Ltd; 2011. Chapter 8: Assessing risk of bias in included studies. updated March 2011. Available from www.cochrane-handbook.org.

References to other published versions of this review

    1. Vedula SS, Brodney Folse S, Gal RL, Beck R. Corticosteroids for treating optic neuritis. Cochrane Database of Systematic Reviews. 2007;(1) doi: 10.1002/14651858.CD001430.pub2. - DOI - PMC - PubMed

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