A prospective randomized trial of megadose methylprednisolone and high dose dexamethasone for traumatic optic neuropathy

Abstract

Purpose: To determine whether the improvement in visual acuity obtained when using high dose dexamethasone in the treatment of traumatic optic neuropathy was comparable to that of megadose methylprednisolone. Method: A total of forty-four patients with traumatic optic neuropathy were prospectively randomized and selected to receive intravenous high dose dexamethasone or megadose methylprednisolone within 2 weeks of injury. Age, gender, cause of injury, interval from injury to treatment, initial, post-pulse, and final visual acuity were analysed statistically to compare the dexamethasone and methylprednisolone groups. Results: The mean interval to treatment was not significantly different (p=0.28) for the dexamethasone group at 5.5 days compared to the methylprednisolone group at 4.1 days. Visual improvement of at least two lines of the Snellen chart or two levels of unmeasured visual acuity was shown in 9 patients (37.5%) of the dexamethasone group and 10 patients (50%) of the methylprednisolone group. There was no statistically significant difference between the initial and post-pulse visual acuity (p=1.0) and the initial and final visual outcome (p=0.60) in the dexamethasone group compared with the methylprednisolone group. Conclusion: There was no significant difference in the visual acuity obtained after treatment with intravenous dexamethasone or methylprednisolone for traumatic optic neuropathy.