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


  • Saran Jiranansiri Department of Opthalmology, Phramongkutklao College of Medicine
  • Somboon Panyakorn Department of Opthalmology, Phramongkutklao College of Medicine
  • Kreaingsak Sirisakpanich Department of Obstetrics and Gynecology, Phramongkutklao College of Medicine
  • Raveewan Choontanom Department of Opthalmology, Phramongkutklao College of Medicine



Visual function, Optic neuropathy


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.


Metrics Loading ...


Pirouzmand F. Epidemiological trends of traumatic optic nerve injuries in the Largest Canadian adult trauma center. J Craniofac Surg. 2012 Mar;23(2):516-20. DOI:

Anderson RL, Panje WR, Gross CE. Optic nerve blindness following blunt forehead trauma. Ophthalmology 1982; 89(5):445– 455. DOI:

Walsh FB. Pathological-clinical correlations: I. Indirect trauma to the optic nerves and chiasm. II. Certain cerebral involvements associated with defective blood supply. Invest Ophthalmol 1966;5(5):433– 449.

Carta A. Ferrigno L, Salvo M, Bianchi-Marzoli S, Boschi A, Carta F. Visual prognosis after indirect traumatic optic neuropathy. J Neurol Neurosurg Psychiatry. 2003;74(2):246-248. DOI:

Bracken MB, Shepard MJ, Hellenbrand KG, et al. Methylprednisolone and neurological function, 1 year after spinal cord injury. Results of the National Acute Spinal Cord Injury Study. J Neurosurg 1985;63:704–713. DOI:

Young W, Bracken MB. The Second National Acute Spinal Cord Injury Study. J Neurotrauma. 1992 Mar;9 Suppl 1:S397-405. DOI:

Leonard A. Levin, Roy W. Beck, Michael P. Joseph,Stuart Seiff, Raymond Kraker. The Treatment of Traumatic Optic Neuropathy:The International Optic Nerve Trauma Study. Ophthalmology 1999;106:1268-77. DOI:

Baulieu E, Robel P. Neurosteroids:a new brain function? Journal of Steroid Biochemistry and Molecular Biology 1990; 37:395–403. DOI:

Stein DG. Progesterone exerts neuroprotective effects after brain injury. Brain Res Rev. 2008:386-97. DOI:

Schumacher M, Robel P, Baulieu EE. Development and regeneration of the nervous system: a role for neurosteroids. Dev Neurosci. 1996;18:6-21. DOI:

Roof RL, Duvdevani R, Braswell L, et al. Progesterone facilitates cognitive recovery and reduces secondary neuronal loss caused by cortical contusion injury in male rats. Exp Neurol. 1994;129:64-69. DOI:

Roof RL, Duvdevani R, Heyburn JW, et al. Progesterone rapidly decreases brain edema: treatment delayed up to 24 hours is still effective. Exp Neurol. 1996;138:246-251. DOI:

Roof RL, Duvdevani R, Stein DG. Progesterone treatment attenuates brain edema following contusion injury in male and female rats. Restor Neurol Neurosci. 1992;4:425-427. DOI:

Roof RL, Hoffman SW, Stein DG. Progesterone protects against lipid peroxidation following traumatic brain injury in rats.Mol Chem Neuropathol.1997;31:1-11. DOI:

Wright DW, Bauer ME, Hoffman SW, et al. Serum progesterone levels correlate with decreased cerebral edema after traumatic brain injury in male rats. J Neurotrauma. 2001;18:901-909. DOI:

Schumacher M, Baulieu EE. Neurosteroids: synthesis and functions in the central and peripheral nervous systems. Ciba Found Symp. 1995;191:90-106. DOI:

Stein DG. Brain damage, sex hormones and recovery: a new role for progesterone and estrogen? Trends Neurosci. 2001;24:386-391. DOI:

Stein DG, Roof RL, Fulop ZL. Brain damage, sex hormones and recovery. In: Stuss DT, Winocur G, Robertson IH, eds. Cognitive Neurorehabilitation: A Comprehensive Approach. Cambridge: Cambridge University Press; 1999:73-93.

Baulieu EE. Neurosteroids: a new function in the brain. Biol Cell. 1991;71:3 10. DOI:

Koenig HL, Schumacher M, Ferzaz B, et al. Progesterone synthesis and myelin formation by Schwann cells. Science. 1995; 268:1500-1503. DOI:

Behl C, Trapp T, Skutella T, et al. Protection against oxidative stress-induced neuronal cell death: a novel role for RU486. Eur J Neurosci. 1997;9:912-920. DOI:

Mayo W, Dellu F, Robel P, et al. Infusion of neurosteroids into the nucleus basalis magnocellularis affects cognitive processes in the rat. Brain Res. 1993;607:324-328. DOI:

Jiang N, Chopp M, Stein D, et al. Progesterone is neuroprotective after transient middle cerebral artery occlusion in male rats. Brain Res. 1996;735:101-107. DOI:

Betz AL, Coester HC. Effect of steroid therapy on ischaemic brain oedema and blood to brain sodium transport. Acta Neurochir Suppl (Wien). 1990;51:256-258. DOI:

McEwen BS, Coirini H, Westlind-Danielsson A, et al. Steroid hormones as mediators of neural plasticity. J Steroid Biochem Mol Biol. 1991;39:223-232. DOI:

Sugino N, Shimamura K, Tamura H, et al. Progesterone inhibits superoxide radical production by mononuclear phagocytes in pseudopregnant rats. Endocrinology. 1996;137:749-754. DOI:

Duvdevani R, Roof RL, Fulop Z, et al. Blood-brain barrier breakdown and edema formation following frontal cortical contusion: does hormonal status play a role? J Neurotrauma. 1995;12:65-75. DOI:

Attella MJ, Nattinville A, Stein DG. Hormonal state affects recovery from frontal cortex lesions in adult female rats. Behav Neural Biol. 1987;48:352-367. DOI:

Hunt JS, Miller L, Roby KF, et al. Female steroid hormones regulate production of pro-inflammatory molecules in uterine leukocytes. J Reprod Immunol. 1997;35:87-99. DOI:

Gonzalez-Vidal MD, Cervera-Gaviria M, Ruelas R, et al.Progesterone: protective effects on the cat hippocampal neuronal damage due to acute global cerebral ischemia. Arch Med Res. 1998;29:117-124.

Asbury ET, Fritts ME, Horton JE, et al. Progesterone facilitates the acquisition of avoidance learning and protects against subcortical neuronal death following prefrontal cortex ablation in the rat. Behav Brain Res. 1998;97:99-106. DOI:

Thomas AJ, Nockels RP, Pan HQ, et al. Progesterone is neuroprotective after acute experimental spinal cord trauma in rats. Spine. 1999;24:2134-2138. DOI:

Djebaili M, Guo Q, Pettus EH, et al. The neurosteroids progesterone and allopregnanolone reduce cell death, gliosis, and functional deficits after traumatic brain injury in rats. J Neurotrauma. 2005;22:106-118. DOI:

Djebaili M, Hoffman SW, Stein DG. Allopregnanolone and progesterone decrease cell death and cognitive deficits after a contusion of the rat pre-frontal cortex. Neuroscience. 2004;123: 349-359. DOI:

Pettus EH, Wright DW, Stein DG, et al. Progesterone treatment inhibits the inflammatory agents that accompany traumatic brain injury. Brain Res. 2005;1049:112-119. DOI:

Wright DW, Kellermann AL, Hertzberg VS, et al. ProTECT: a randomized clinical trial of progesterone for acute traumatic brain injury. Ann Emerg Med. 2007 Apr;49(4):391-402, 402.e1-2. Epub 2006 Sep 29. DOI:

Xiao GM, Wei J, Wu ZH, et al.Clinical study on the therapeutic effects and mechanism of progesterone in the treatment for acute severe head injury.Zhonghua Wai Ke Za Zhi. 2007 Jan 15;45(2):106-8.

Guomin Xiao, Jing Wei, Weiqi Yan, Weimin Wang and Zhenhui Lu. Improved outcomes from the administration of progesterone for patients with acute severe traumatic brain injury: a randomized controlled trial. Critical care 2008;12:R61. DOI:

Alford MA, Jeffery A, Carter KD (2001) Predictive value of the initial quantified RAPD in 19 consecutive patients with traumatic optic neuropathy. Ophthalmic Plastic Reconstr Surg 17:323–327 DOI:

Entezari M, Rajavi Z, Sedighi N, Daftarian N, Sanagoo M. High-dose intravenous methylprednisolone in recent traumatic optic neuropathy; a randomized double-masked placebo-controlled clinical trialGraefes Arch Clin Exp Ophthalmol. 2007 Sep;245(9):1267-71. Epub 2007 Jan 31. DOI:

Steinsapir KD, Goldberg RA, Sinha S, Hovda DA (2000) Methylprednisolone exacerbates axonal loss following optic nerve trauma in rats. Restor Neurol Neurosci 17(4):157–163

Mauriello J, Deluca J, Krieger A, Schulder M, Frohman L (1992) Management of traumatic optic neuropathy, a study of 23 patients Br J Ophthalmol 76(6):349–352 DOI:

Rajinganth MG, Gupta AK, Gupta A, Bapuraj JR (2003) Traumatic optic neuropathy visual outcome following combined therapy protocol. Arch Otolaryngol Head Neck Surg 129:1203–1206 DOI:




How to Cite

Jiranansiri S, Panyakorn S, Sirisakpanich K, Choontanom R. The Efficacy of Progesterone in Treatment of Traumatic Optic Neuropathy (Proton Study). J Southeast Asian Med Res [Internet]. 2017 Jun. 27 [cited 2024 Jul. 17];1(1):12-9. Available from:



Original Articles

Similar Articles

1 2 > >> 

You may also start an advanced similarity search for this article.