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. 2025 Apr 18;18(4):663-671.
doi: 10.18240/ijo.2025.04.13. eCollection 2025.

Intravitreal low-dose triamcinolone acetonide for nonarteritic anterior ischemic optic neuropathy

Zi-Jia Liu  1   2   3   4 , Xian Xu  1   2   3   4 , Ya-Nan Lyu  1   2   3   4 , Dong-Li Li  1   2   3   4 , Hao Zhou  1   2   3   4 , Yuan-Yuan Gong  1   2   3   4
Affiliations

Intravitreal low-dose triamcinolone acetonide for nonarteritic anterior ischemic optic neuropathy

Zi-Jia Liu et al. Int J Ophthalmol. .

Abstract

Aim: To evaluate the efficacy and safety of intravitreal low-dose (1 mg) triamcinolone acetonide (TA) in Chinese acute nonarteritic anterior ischemic optic neuropathy (NAION) patients.

Methods: Twenty-eight eyes of 28 patients with acute NAION (<30d of visual acuity loss) were enrolled and given intravitreal TA (IVTA) once. Visual field (VF), best corrected visual acuity (BCVA), retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, radial peripapillary capillary (RPC) density, and intraocular pressure (IOP) were evaluated at baseline and 7d, 1, 3, and 6mo after IVTA.

Results: VF and BCVA were significant improved during the follow-up according to the mean deviation (MD), visual field index (VFI), and Early Treatment Diabetic Retinopathy Study (ETDRS) scores (all P<0.001). There was no significant difference between the group that received an injection less than 14d after illness onset and the group that received an injection more than 14d after illness onset. The RNFL thickness, GCC thickness and RPC density were significantly decreased (all P<0.001). Temporary ocular hypertension was present in five eyes.

Conclusion: Low-dose IVTA may be an alternative safe treatment option for some NAION patients in the acute stage. However, optic nerve atrophy still existed.

Keywords: intravitreal injections; nonarteritic anterior ischemic optic neuropathy; triamcinolone acetonide; visual acuity; visual field.

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Conflict of interest statement

Conflicts of Interest: Liu ZJ, None; Xu X, None; Lyu YN, None; Li DL, None; Zhou H, None; Gong YY, None.

Figures

Figure 1
Figure 1. GCC report provided by AngioVue image system
GCC: Ganglion cell complex; FLV: Focal loss volume; GLV: Global loss volume; N: Nasal; T: Temporal.
Figure 2
Figure 2. RPC density graph provided by AngioVue image system
RPC: Radial peripapillary capillary; S: Superior; I: Inferior, N: Nasal; T: Temporal.
Figure 3
Figure 3. Trial profile.
Figure 4
Figure 4. Scatter plots of MD, PSD, and VFI of all cases (A), group 1 (B), and group 2 (C) at baseline and 1wk, 1, 3, and 6mo after injection
Red lines at means; aStatistically significant. BL: Baseline; MD: Mean deviation; PSD: Pattern standard deviation; VFI: Visual field index.
Figure 5
Figure 5. Scatter plots of BCVA ETDRS scores of all cases (A), group 1 (B), and group 2 (C) at baseline and 1wk, 1, 3, and 6mo after injection
Red lines at means; red scatter dots represent ETDRS scores of three extremely low vision eyes; aStatistically significant. BCVA: Best corrected visual acuity; BL: Baseline; ETDRS: Early Treatment Diabetic Retinopathy Study.
Figure 6
Figure 6. OCT scan of the left eye of a 75-year-old female patient with ETDRS scores below 5 at baseline (A) and 1mo (B) after IVTA
OCT: Optical coherence tomography; IVTA: Intravitreal low-dose triamcinolone acetonide; ETDRS: Early Treatment Diabetic Retinopathy Study.
Figure 7
Figure 7. Changes in the average RNFL thickness for the overall RNFL and each 90° quadrant
RNFL: Retinal nerve fiber layer; G: General; S: Superior; I: Inferior, N: Nasal; T: Temporal; SD: Standard deviation; BL: Baseline.
Figure 8
Figure 8. GCC thickness variation
GCC: Ganglion cell complex; SupGCC: Superior sector GCC thickness; InfGCC: Inferior sector GCC thickness; AvgGCC: Average thickness of both sectors; SD: Standard deviation; BL: Baseline.
Figure 9
Figure 9. Small vessel density variation
RPC: Radial peripapillary capillary; SD: Standard deviation; BL: Baseline.
Figure 10
Figure 10. Six months progression of the right eye of a 47-year-old male patient with acute NAION on multimodal analysis
A: Color fundus photographs; B, C: OCT scan of the peripapillary retina; D: OCTA vessel density in the peripapillary superficial retina in nerve head mode. NAION: Nonarteritic anterior ischemic optic neuropathy; OCT: Optical coherence tomography; OCTA: Optical coherence tomography angiography.
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