NAION Treatment With Oral Prednisolone and Erythropoietin Injection

Study Overview
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Brief Summary
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This randomized double-blind clinical trial is performed on all recent (within the last 5 days) NAION patients referred to hospitals affiliated to the Shahid Beheshti University of Medical Sciences, Iran. The patients will be equally and randomly assigned into two experimental groups and a control group. The first experimental group will receive 1000 units of erythropoietin every 12 hours for three days. The second experimental group will receive 50 mg of oral prednisolone from the onset of the disease for 1 week, with the dose gradually reduced within 2 weeks and then discontinued. In addition, the subjects in the second experimental group will receive 300 mg of ranitidine daily. The third group will receive placebo. Eye examination with color vision, perimetry, and peripapillary optical coherence tomography (to measure the thickness of the retinal nerve fiber layer) will be performed before the intervention, and 1, 3 and 6 months after the intervention. SITA standard visual field testing will be done using the Visual Field Analyzer Humphrey 750 Field (Carl Zeiss, USA). The thickness of the retinal nerve fiber layer will be measured by optical coherence tomography (Cirrus Zeiss Cirrus HD-OCT, Carl Zeiss, USA). The q-q plot and Kolmogorov-Smirnov tests will be performed to test normal distribution of data. Descriptive statistics including frequency, percentages, standard deviation, median and range will be used. Other statistical test including ANOVA, Kruskal-Wallis, Chi-Square, and Fischer's exact tests will be performed. All statistical analyses will be performed in SPSS (version 20) at significance level of 0.05.

Official Title
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Scientific Title: Efficacy of Oral Prednisolone and Erythropoietin Injection in Treatment of Acute Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION)

Conditions
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Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION)

Intervention / Treatment
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* Drug: Oral prednisolone administration 50 mg
* Drug: Intravenous Erythropoietin injection


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: - All NAION patients (maximum time of disease occurrence: 5 days) referred to emergency department of Labbafinejad, Torfeh and Imam Hossein hospitals Exclusion criteria: Glaucoma or any ocular, neurologic or systemic disease affecting the vision Abnormal laboratory test results such as ESR and CRP History of ocular surgery History of receiving medication for NAION Uncontrolled systemic disease such as diabetes or hypertension Contraindications of systemic steroids including active infection, active gastric ulcer, immunosuppression Contraindications of erythropoietin administration, such as polycythemia Unwillingness to participate in the study
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Oral prednisolone administration<br>50 mg oral prednisolone from the onset of the disease for 1 week, with the dose gradually reduced within 2 weeks and then discontinued | Drug: Oral prednisolone administration 50 mg<br>* 50 mg oral prednisolone from the onset of the disease for 1 week, with the dose gradually reduced within 2 weeks and then discontinued<br>|
| Active Comparator: Intravenous Erythropoietin injection<br>2. 1000 units of erythropoietin every 12 hours for three days | Drug: Intravenous Erythropoietin injection<br>* 1000 units of erythropoietin every 12 hours for three days<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improvement in indices visual acuity compared to normal course of the disease | Snellen visual acuity chart | 6 months after the intervention | 
| Improvement in indices visual field | Mean deviation and pattern standard deviation | 6 months after the intervention | 
| Improvement in indices retinal nerve fiber thickness | peripapillary Optical Coherence Tomography | 6 months after the intervention |