The Efficacy and Safety of Prostaglandin E1 in the Management of Ischemic Retinal and Optic Nerve Diseases: A Systematic Review

To evaluate the efficacy and safety of intravenous prostaglandin E1 (PGE1) for the management of ischemic retinal and optic nerve diseases. Our protocol was registered prospectively on PROSPERO (CRD42024524166). We searched 4 electronic databases [PubMed, Scopus, Web of Science, and Google Scholar] to retrieve all studies reported using PGE1 for patients with including CRAO, BRAO, A-AION, A-PION, ischemia in high myopia, NA-PION, and PAMM. We conducted a Wilcoxon signed-rank test to assess the effect of PGE1 on the visual acuity (VA) of included subjects. VA change was utilized to assess the degree of VA improvement. We assessed the quality of the included studies using the JBI tool. We included a total of 12 studies with a total of 30 cases. Age ranged from 40 to 97years with a mean of 66.77years for 15 females and 15 males. The most presented disease was CRAO (60%), followed by BRAO (10%), ischemia with high myopia (10%), non-arteritic posterior ischemic optic neuropathy (10%), arteritic posterior ischemic optic neuropathy (3.3%), arteritic anterior ischemic optic neuropathy (3.3%) and PAMM (3.3%). Time from symptoms onset to presentation was reported only in 25 cases (83.3%) with a median of 8hours. Wilcoxon signed-rank test revealed significant improvement in visual acuity after IV PGE1 treatment (V = 465, p < .05). Our analysis revealed preliminary evidence suggesting that IV PGE1 May be a potentially safe and effective treatment for improving VA in patients with posterior segment ischemia.