Visual Outcomes of Adding Erythropoietin to Methylprednisolone for Treatment of Retrobulbar Optic Neuritis

Abstract

Purpose: To compare the short-term visual function results and safety of erythropoietin as an add-on to the standard corticosteroid therapy in retrobulbar optic neuritis (RON).

Methods: In this prospective pilot study, adult patients with isolated RON with less than 10 days of onset were enrolled. Patients were consecutively assigned to standard intravenous methylprednisolone treatment either in combination with intravenous erythropoietin (20,000 units/day for three days) (group-1) or intravenous methylprednisolone alone (group-2). Primary outcome measure was best-corrected visual acuity (BCVA), which was assessed up to 120 days from the day the treatment was begun. Systemic evaluations were performed during and after treatment.

Results: Sixty-two patients with RON (mean age = 26.6 $\pm$ 5.77 years; range = 18-40 years) were enrolled into the study (group-1, $n$ = 35; group-2, $n$ = 27). BCVA three months after the treatment was 0.19 $\pm$ 0.55 logMAR and 0.11 $\pm$ 0.32 logMAR in group-1 and group-2, respectively (95% CI: $-$ 0.61 $-$ 0.16; $P$ = 0.62). Change in BCVA after three months was 2.84 $\pm$ 3.49 logMAR in group-1 and 2.46 $\pm$ 1.40 logMAR in group-2 (95% CI: $-$ 0.93 $-$ 1.91; $P$ = 0.57). Pace of recovery was not significantly different between the groups. No complications were detected among patients.

Conclusion: Intravenous erythropoietin as an add-on did not significantly improve the visual outcome in terms of visual acuity, visual field, and contrast sensitivity compared to traditional intravenous corticosteroid. This pilot study supports the safety profile of intravenous human recombinant erythropoietin, and it may help formulate future investigations with a larger sample size.

Keywords: Erythropoietin; Optic Nerve Regeneration; Optic Neuritis; Optic Neuroprotection; Visual Acuity; Visual Function; Contrast Sensitivity.

Figure 1

Best-corrected visual acuity (BCVA) at different time intervals among patients with retrobulbar optic neuritis in the two treatment groups. IV MP, intravenous methylprednisolone; IV MP + EPO, intravenous methylprednisolone in combination with intravenous erythropoietin.

Figure 2

Comparison of contrast sensitivity in patients with retrobulbar optic neuritis in the two treatment groups. IV MP, intravenous methylprednisolone; IV MP + EPO, intravenous methylprednisolone in combination with intravenous erythropoietin.

Figure 3

Mean deviation (MD) in patients with retrobulbar optic neuritis in the two treatment groups. IV MP, intravenous methylprednisolone; IV MP + EPO, intravenous methylprednisolone in combination with intravenous erythropoietin.