A trial of corticotrophin gelatin injection in acute optic neuritis

SYNOPSIS The effect of a 30 day course of corticotrophin gelatin injections on the natural history of acute unilateral optic neuritis in 27 patients is reported. A further 27 patients received inert injections in a double-blind control. Measurements were made on visual acuity, visual field, macular threshold, and colour vision, and the development of optic atrophy and other neurological episodes was recorded. No significant differences were found between treated and control groups at intervals up to two years from the start of the trial. The criteria for inclusion of patients are given and it is concluded that corticotrophin has no effect on the natural history of the condition as defined. The prognosis for vision in untreated acute optic neuritis is good. A recent survey found that by one and six months after the attack, 50%4 and 75%0 respectively ofpatients had regained normal vision (Bradley and Whitty, 1967). Cortico-trophin (ACTH) is widely used in the treatment of acute optic neuritis, though the evidence that it favourably affects the natural history comes from one trial in which (1) only patients present-ing within 10 days of the onset of visual blurring were included; (2) the only measure of visual function used was acuity for near vision; and (3) significant benefit was shown only in the first month of treatment with corticotrophin gel (Rawson et al., 1966, 1969). However, many patients with acute optic neuritis are not seen within 10 days of the onset of visual impairment, and, though their vision may be improving when they are first seen, it is important to know whether to use ACTH. Again, visual field defects and ab-normal colour vision may reduce the quality of vision irrespective of visual acuity. These are easily measured and should be considered when assessing improvement. In the present double-blind trial 54 consecu-tive patients presenting with acute optic neuritis were treated with either corticotrophin gel injec-tion or an inert control and several parameters of visual function were used to assess progress