Objective:

We aimed to investigate if 3-day, 5-day, and 7-day schedules of IVMP could lead to different recovery of visual outcomes in optic neuritis.

Background:

Intravenous methylprednisolone (IVMP) is the main therapy for optic neuritis to accelerate and improve final visual outcomes. However, systematic reviews demonstrated studies used different schedules of IVMP 1 g/day and optimal duration of IVMP is unknown.

Design/Methods:

We performed a case-control study in a tertiary center in São Paulo, Brazil. We selected patients with optic neuritis that received 7-day and 3-day schedules of IVMP 1 g/day. We chose controls with 5-day schedules of IVMP, matching the groups with a propensity score for significant prognostic variables in optic neuritis. Our outcomes were the percentage of patients with incomplete recovery of the visual acuity using the Rosembaum Chart and visual acuity comparison in an estimated LogMAR scale at discharge, 1 month and 6-12 months.

Results:

We screened 109 patients for eligibility. We found 26 patients that received 7-day schedule of IVMP and 11 patients that received 3-day schedule of IVMP. After exclusion of patients due to missing data, we matched 22 patients with 7-day with 22 patients with 5-day IVMP and 11 patients with 3-day with 11 patients with 5-day IVMP schedules. We found that the percentage of patients with incomplete visual acuity recovery, adjusted by prognostic variables, was similar at discharge, 1 month and 6-12 months when comparing 3-day versus 5-day and 7-day versus 5-day schedules. Our results remained in different scale (LogMAR).

Conclusions:

Shorter IVMP 1 g/day schedules appears to be as effective as longer schedules in the recovery of visual acuity in patients with optic neuritis. We should consider 3-day instead of 5-day schedules for mild cases and 5-day instead of 7-day schedules for severe cases.