The Efficacy of Progesterone in Treatment of Traumatic Optic Neuropathy (Proton Study)

Abstract

To evaluate the visual function improvement for treatment of indirect traumatic optic neuropathy Study design was comparative historical controlled trial. Seven patients newly diagnosed with indirect traumatic optic neuropathy Study design was comparative historical controlled trial. Seven newly diagnosed with indirect traumatic optic neuropathy (TON) were enrolled for progesterone group. Nineteen indirect Ton patients were reviewed medical records for steroid group (N= 12) and observation group (N= 7). Patients in progesterone group were given Depot medroxyprogesterone acetate (DMPA) 1 mg/kg. intramuscular injection every 12 hrs. for 5 days and observed for side effects. All patients were examined and reviewed for visual acuity by ETDRS chart, color vision test by Ishihara test, visual field testing by Humphrey automated perimetry, fundus and optic disc examination at baseline, follow-up 1 week, 1 month and 3 months. Demographic and clinical characteristic of patients in 3 groups were not different in terms of age, sex, underlying disease, side of eye, type of injury, baseline visual acuity, associated orbital fracture, history of amnesia, time to visit hospital and time to start treatment. Improvement in best-corrected visual acuity (BCVA) compared at 3 months from baseline showed no difference between 3 groups (p= 0.891). Analysis within steroid group showed statistically significant improvement of BCVA at 1 and 3 months (p= 0.015, 0.028 respectively). No improvement was shown in color vision and visual field in progesterone group. Only better baseline BCVA was the protective factor for better visual outcome (p= 0.027, Odds ratio = 0.004, 95%CI = 0.000 - 0.537). No side effects of progesterone were found in this study. Progesterone is a safe and promising neuroprotective agent that could be adjunctive or alternative to steroid in case of contraindication to corticosteroid treatment. This study showed no difference among choices of treatment therefor study in larger population is required. Steroid remains an effective option contrast with recent studies.