Portal de Periódicos da CAPES

Optic nerve decompression surgery for nonarteritic anterior ischemic optic neuropathy (NAION) is not effective and may be harmful. The Ischemic Optic Neuropathy Decompression Trial Research Group

1995; American Medical Association; Volume: 273; Issue: 8 Linguagem: Inglês

10.1001/jama.273.8.625

1538-3598

Kay Dickersin, Donald F. Everett, Steven E. Feldon, Frank J. Hooper, David W. Kaufman, Michael J. Elman, Patricia Langenberg, Nancy J. Newman, P. David Wilson, Z. Suzanne Zam, John S. Kennerdell, Anna Tyutyunikov, Russell Edwards, Todd Goodglick, Deborah Lang, Kimberly A. Peele, Sophia M. Chung, Diana Mekelburg, John B. Holds, John B. Selhorst, Mark L. Malton, Sonia Armstrong, Yvonne McCracken, Eugene Benjamin, C Dellinger, Traci Hunter Medlin, Barbara Kinsler, Mike McOwen, Donna Russell, Timothy Saunders, Gregory S. Kosmorsky, Tina Kiss, Cate Reinhard, Laura De Venne, Janet Edgerton, Tami Fecko, Susannah Hanson, Brian Kraus, D.A. Ross, Nancy Tomsak, Pamela Vargo, Rufus Willis, Kerry Zimmerman, Kristin Anderson, Richard Cortez, Karen DeBlanc, J E Hulse, Ronald B. Morales, Tracy R. Nichols, Lillian Reyes, Nadine Rodarte-Ochoa, Daniel Romo, Alfredo A. Sadun, Mary Steber, Frances Walonker, Donna N. Loupe, Diana S. Coffman, Harvey Cole, Ted H. Wojno, Barry Skarf, Colleen Wojtala, Mark Croswell, Wendy Gilroy, Christian Mageli, Dena McDonald, George Ponka, Rosa A. Tang, Melissa Hamlin, Jewel Curtis, J Forman, Kenneth Hyde, Kirk Mack, Portia Tello, Anthony C. Arnold, Berniee Cibener, Melody Acero, Bobbi Ballenberg, Anne Bolton, Robert A. Goldberg, Lynn K. Gordon, Michael A. Heneghan, Howard Krauss, Jackie Sanguinei, Robert Stalling, Jenja Yadegaran, Wayne T. Cornblath, Barbara Michael, Donna Campbell, Cheryl Caudill, Christine C. Nelson, Jonathan D. Trobe, Lenworth N. Johnson, G. Ross Baker, Coy Cobb, Philip L. Custer, S. Derek Turner, Roy Wilson, Brian R. Younge, Jacqueline A. Leavitt, Rebecca Nielsen, J.M. Allen, Barbara Eickhoff, James Garrity, Jacqueline Ladsten, Kathleen Lebarron, Thomas P. Link, Jay Rostvold, Karen Weber, Warren L. Felton, Tracy Boney, Danielle Gabriel, Daniel David, Lahn Fendelander, Daniel Geller, Timothy Jordan, Christian Kim, Craig E. Munger, Jo Anne Romandy, George E. Sanborn, Bradley F. Schwartz, Carl Sheusi, Constance M. Smith, Kathy Talley, S Thimmappa, Eric Eggenberger, Suzanne Bickert, Robert Granadier, Sandra Holliday, Thomas Moore, Jaya Varadarajan, Deborah Friedman, Patricia Jones, Haris Amin, Thomas A. Bersani, Cynthia Briglin, James Fooks, Michael M. Graham, Milton James, Gary Michalec, Hoang Nguyen, Jonathan C. Horton, Maeve Chang, Lou Anne Aber, Erik Lindstrom, Stuart R. Seiff, J. Guy, Z. Suzanne Zam, Amye Francis, Latif M. Hamed, Alan M. Lessner, Donna McDavid, Diana J. Shamis, James W. Goodwin, Martin E. Lindeman, Allen M. Putterman, Phyllis Bobak, Robert Horace Baker, Judy Beck, David Cowen, Avrom D. Epstein, Michael Hanson, Toni Scoggins, Ann Rodavitch, Brenda Gore, Andrea Blake, Michele Heroux, R Kalsi, Charlene Krauch, Mary Ann Millar, Mitchell J. Wolin, Rita Jean Brady, R.M. Hansen, Michael D. Briggs, K V Chalam, Barbara Danner, Beverly Simons, Anne Stewart, Kathleen B. Digre, Lizbeth Malmquist-Webb, Terrell Blackburn, Susan Baggaley, Richard D. Anderson, C. Peñas Juárez, Bonnie Kaye, Paul D. Langer, Aditya Mishra, Paula Morris, S. Osborn, Bhupendra C. Patel, Tessie Priskos, Sandra Staker, Judith E. A. Warner, Steven A. Newman, C. J. Evans, Allison Aylor, Carolyn Childress, Helen Dickerson, Jane Fleming, Nomine Harris, L. Sharon Hoyle, Ellen Murphy, James J. Scott, Karen Summerville, Mariann Terrell, Lillian Tyler, John V. Linberg, Lenore A. Breen, Michelle Michael, Charlene Campbell, Brian Ellis, Nancy Groves, Robert R. Hobson, G. McGregor, Laura Shepherd, Edward M. Cohn, Patricia Manatrey, Sara Casey, John Johnson, Coletti Kronner, Virginia R. Regan, Patricia Streasick, Michael J. Elman, Aim M. Rodavitch, Roberta W. Scherer, Barbara Crawley, Cheryl J. Hiner, Lucy Howard, Olga Lurye, Robert McCarter, Sara Riedel, Michelle Sotos, Laureen Spioch, Joann Starr, Judy Urban, Mark Waring, Danielle Gabriel, Stuart R. Seiff,

Intracranial Aneurysms: Treatment and Complications

Objective. —To assess the safety and efficacy of optic nerve decompression surgery compared with careful follow-up alone in patients with nonarteritic anterior ischemic optic neuropathy (NAION). Design. —The Ischemic Optic Neuropathy Decompression Trial (IONDT) is a randomized, single-masked, multicenter trial. Setting. —Twenty-five US clinical centers. Participants. —The IONDT ceased recruitment on October 20, 1994, on the recommendation of its Data and Safety Monitoring Committee. The preliminary results presented herein are based on data as of September 8,1994, from 244 patients with NAION and visual acuity of 20/64 or worse. One hundred twenty-five patients had been randomized to careful follow-up, and 119 had been randomized to surgery, with 91 and 95, respectively, having completed 6 months of follow-up. Intervention. —Patients in the surgery group received optic nerve decompression surgery and follow-up ophthalmologic examinations; those in the careful follow-up group received ophthalmologic examinations at the same times as the surgery group. Main Outcome Measures. —Gain or loss of three or more lines of visual acuity on the New York Lighthouse chart at 6 months after randomization, as measured by a technician masked to treatment assignment. Results. —Patients assigned to surgery did no better when compared with patients assigned to careful follow-up regarding improved visual acuity of three or more lines at 6 months: 32.6% of the surgery group improved compared with 42.7% of the careful follow-up group. The odds ratio (OR) for three or more lines better, adjusted for baseline visual acuity and diabetes, was 0.74 (95% confidence interval [CI], 0.39 to 1.38). Patients receiving surgery had a significantly greater risk of losing three or more lines of vision at 6 months: 23.9% in the surgery group worsened compared with 12.4% in the careful follow-up group. The 6-month adjusted OR for three or more lines worse was 1.96 (95% CI, 0.87 to 4.41). No difference in treatment effect was observed between patients with progressive NAION and all others. Conclusion. —Results from the IONDT indicate that optic nerve decompression surgery for NAION is not effective, may be harmful, and should be abandoned. The spontaneous improvement rate is better than previously reported. ( JAMA . 1995;273:625-632)