Bilateral Simultaneous Nonarteritic Anterior Ischaemic Optic Neuropathy: Case Report

Abstract

Bilateral simultaneous nonarteritic anterior ischaemic optic neuropathy (NAION) is extremely rare. A 57-year-old woman presented with bilateral optic disc oedema and peripapillary splinter haemorrhages. Initial visual acuities were hand movements in the right eye and light perception in the left eye. The patient had a mildly elevated diastolic blood pressure and glucose intolerance. Erythrocyte sedimentation rate and C-reactive protein levels were within normal limits. Temporal artery biopsy was negative for temporal arteritis. Marked visual improvement occurred in both eyes (0.8 in the right eye, 0.6 in the left eye) after systemic steroid therapy in the 16th month of follow-up.     

Giant cell arteritis

Giant cell arteritis has been considered an enigmatic disease. It is characterised by chronic granulomatous inflammation of the walls of large and medium‐sized arteries. The process has a predilection for the extradural cranial arteries, which include the ophthalmic and the posterior ciliary arteries. It is a multi‐symptom disease of older individuals and patients often present with challenging issues and diagnostic dilemmas. We review the literature and latest protocols for the diagnosis and management of giant cell arteritis.     

Amiodarone-associated Optic Neuropathy—A Clinical Criteria–based Diagnosis?

Amiodarone-associated optic neuropathy (AAON) is a controversial diagnosis with possible impact on vital cardiac therapy decisions. This retrospective case series aims for application of distinguishing features of AAON versus non-arteritic ischaemic optic neuropathy (NAION): Bilaterality, mode of onset, degree of optic nerve dysfunction, structure of uninvolved disc (unilateral cases), and systemic toxic effects. Applying these criteria to patients with disc swelling under amiodarone, the authors identified four unilateral disc swellings, one with NAION-typical features only and three with one or more NAION-atypical features. All three sequential and six bilateral cases showed one or more NAION-atypical features. The 12 cases highlight the persisting diagnostic dilemma arising from diversity of presentation, lack of plausible pathomechanism, and controversial existence of the entity itself.     

Shock-induced anterior ischaemic optic neuropathy after radical prostatectomy

The case is reported of a 61-year-old man who developed shock-induced anterior ischaemic optic neuropathy (SIAION) after undergoing radical prostatectomy. Visual loss began on the third postoperative day. Only one other patient with SIAION after prostatectomy has been reported in the past. SIAION may result in fixed visual loss after radical prostatectomy and ophthalmic evaluation should not be delayed in patients with postoperative visual loss.     

Nonarteritic ischemic optic neuropathy developed after capsular block syndrome

A 65-year-old man developed capsular block syndrome in the early postoperative period, following phacoemulsification surgery. After neodymium-doped yttrium aluminum garnet (Nd:YAG) laser anterior capsulotomy, the intraocular pressure remained elevated for 4 days despite antiglaucomatous medication. On the postoperative fifth day, nonarteritic ischemic optic neuropathy was diagnosed. To the best of our knowledge, this is the first report of a case with nonarteritic ischemic optic neuropathy associated with early postoperative capsular block syndrome after phacoemulsification surgery.     

Recovery of postoperative visual loss following treatment of severe anaemia

A 29-year-old pregnant woman noted acute visual loss following emergent Caesarean section complicated by excessive uterine bleeding. Postoperative visual acuity was count fingers in both eyes. Funduscopic changes were consistent with a diagnosis of anaemia-associated ischaemic optic neuropathy and retinopathy. One month later, because of persistent anaemia and poor visual recovery, blood transfusion was given. Following transfusion, the patient's vision improved over the next 6 months. In an otherwise healthy patient, visual loss associated with postoperative blood loss may still be partially reversible with correction of the anaemia, even after a delayed period of time.     

Bilateral anterior ischaemic optic neuropathy and acute renal failure: a case report

A patient who developed acute renal failure and subsequent bilateral non-arteritic anterior ischaemic optic neuropathy is described, The case was atypical in that the condition affected both eyes simultaneously, occurred in a young patient and was not associated with a recognised cause of renal failure or preexisting condition. Optic atrophy in the form of optic disc cupping, an unusual feature of non-arteritic optic neuropathy, was also present.     

Anterior ischaemic optic neuropathy in a patient with optic disc drusen

Background: Although visual field defects are well-known complications of optic disc drusen, reduction in visual acuity with this condition is rare. Method/Results: We report on a 68-year-old male with bilateral optic disc drusen who presented with monocular loss of vision in the right eye associated with an inferior altitudinal visual field defect and signs consistent with acute anterior ischaemic optic neuropathy, confirmed on fluorescein angiography. He also had a left inferior nasal step, but no evidence of glaucomatous cupping. The disc drusen were documented clinically and on B scan ultrasound and computed tomography. Conclusions: The diagnosis of acute anterior ischaemic optic neuropathy should be considered in patients with optic disc drusen who present with reduced visual acuity, particularly when the visual loss has been acute and non-progressive and is associated with altitudinal field loss and characteristic fluorescein angiography signs.     

Adalimumab and Non-Arteritic Anterior Ischaemic Optic Neuropathy: A Case Report

Sequential anterior ischaemic optic neuropathy was observed in a patient treated with a tumour necrosis factor α (TNF) inhibitor, adalimumab, for ankylosing spondylitis. He developed decreased visual acuity in the right eye after 17 months of treatment. Findings showed right optic disc oedema with haemorrhages and visual field defect. Adalimumab was discontinued and vision stabilised. After restarting adalimumab, he developed optic neuropathy in the left eye. Findings showed optic disc oedema, with haemorrhages and visual field changes in the left eye. Adalimumab may be associated with optic neuropathy; providers prescribing TNF inhibitors should be aware of optic neuropathy as a potential complication.     

Adalimumab and Non-Arteritic Anterior Ischaemic Optic Neuropathy: A Case Report

Abstract

Sequential anterior ischaemic optic neuropathy was observed in a patient treated with a tumour necrosis factor α (TNF) inhibitor, adalimumab, for ankylosing spondylitis. He developed decreased visual acuity in the right eye after 17 months of treatment. Findings showed right optic disc oedema with haemorrhages and visual field defect. Adalimumab was discontinued and vision stabilised. After restarting adalimumab, he developed optic neuropathy in the left eye. Findings showed optic disc oedema, with haemorrhages and visual field changes in the left eye. Adalimumab may be associated with optic neuropathy; providers prescribing TNF inhibitors should be aware of optic neuropathy as a potential complication.     

非动脉炎性前部缺血性视神经病变患者发病的相关因素研究

目的：：探讨非动脉炎性前部缺血性视神经病变患者发病的相关因素与长期改变。方法：选取我院2010-01/2015-06期间收治的非动脉炎性前部缺血性视神经病变患者360例为病变组,另外选取同期于我院体检的健康人群400例为对照组。统计患者临床资料,并行光学相干断层扫描。结果：病例组和对照组在性别比例、糖尿病史、高血压史、动脉硬化史、视盘面积、视杯面积、盘沿面积、杯/盘面积比、水平杯盘比、垂直杯盘比、空腹血糖( FBG)和甘油三酯(TG)比较差异有统计学意义(P<0.05)。男性、糖尿病史、高血压史、动脉硬化史、视盘面积、视杯面积、杯/盘面积比、水平杯盘比、垂直杯盘比、FBG和TG是非动脉炎性前部缺血性视神经病变的独立危险因素。病例组发病6、12、18 mo的上方、鼻侧、下方、颞侧和全周视网膜神经纤维层(RNFL)厚度均显著低于对照组(P<0.05),病例组不同病程患者之间各参数比较差异均无统计学意义(P>0.05)。结论：男性、糖尿病史、高血压史、动脉硬化史、视盘面积、视杯面积、杯/盘面积比、水平杯盘比、垂直杯盘比、FBG和TG是非动脉炎性前部缺血性视神经病变的独立危险因素,远期RNFL损害可能无进一步加重。     

非动脉炎性前部缺血性视神经病变的电生理及临床特征分析

目的：对NAION患者的电生理及临床特征进行分析。

方法：选取本院2015-06/2016-06收治的68例81眼非动脉炎性前部缺血性视神经病变(non-arteritic anterior ischaemic optic neuropathy,NAION)患者作为研究对象,按照年龄分为对照组36例39眼(平均年龄50岁以下),观察组32例42眼(平均年龄50岁以上)。对两组患者的人口学特点、临床特点、相关危险因素、图形视觉诱发电位、视力等方面进行对比分析。

结果：对照组患者临床症状中,发病时有遮挡感、对侧眼受累比例均明显低于观察组患者,组间差异有统计学意义(P<0.05)。对照组患者1°空间频率和15''空间频率均明显优于观察组,组间差异有统计学意义(P<0.05)。对照组与观察组患者初始视力比较,差异无统计学意义(P>0.05)。对照组患者最终视力明显优于观察组患者,组间差异有统计学意义(P<0.05)。

结论：患有NAION的患者,其临床病症受年龄较大、发病时有遮挡感、对侧眼受累等因素影响,1°空间频率和15''空间频率延迟相对较严重,且最终视力并不十分良好。由此可见,对NAION患者进行电生理检查有助于进行病情的诊断,临床亦应该加强对NAION患者的随访,减少其患眼对侧眼的发病几率。     

Fractal analysis of fluoroangiographic patterns in anterior ischaemic optic neuropathy and optic neuritis: a pilot study

Background:  To evaluate by means of fractal analysis the vascular pattern of the optic nerve head obtained by fluorescein angiogram, in non-arteritic anterior ischaemic optic neuropathy (NAION) and optic neuritis (ON).
Methods:  Twenty-nine patients at the Department of Ophthalmology of the University of Siena, diagnosed as having either NAION or ON by clinical and instrumental criteria, were prospectively subjected to fractal analysis: 11 patients with NAION and 18 patients with ON. In the ON group, 12 patients showed optic disc oedema, whereas six patients showed no optic disc oedema. The unaffected eyes of six patients with NAION and of seven patients with ON associated with optic disc oedema served as controls.
Results:  The mean fractal dimension D was 1.84 ± 0.09 in the NAION group, 1.92 ± 0.04 in the ON group with optic disc oedema, 1.86 ± 0.04 in the ON group without optic disc oedema and 1.63 ± 0.06 in the control group; all case groups showed significantly higher values than controls ( P  < 0.01). Among the case groups, the ON group with optic disc oedema showed a significantly higher mean fractal dimension value than the others ( P  < 0.01).
Conclusions:  Our data suggest that eyes with ON and NAION seem to have increased vascular complexity in the optic nerve head, manifested as an increase in fractal dimension.     

Invasive Fungal Sinusitis Presenting as Acute Posterior Ischemic Optic Neuropathy

Invasive fungal sinusitis causes painful orbital apex syndrome with ophthalmoplegia and visual loss; the mechanism is unclear. We report an immunocompromised patient with invasive fungal sinusitis in whom the visual loss was due to posterior ischaemic optic neuropathy, shown on diffusion-weighted MRI, presumably from fungal invasion of small meningeal-based arteries at the orbital apex. After intensive antifungal drugs, orbital exenteration and immune reconstitution, the patient survived, but we were uncertain if the exenteration helped. We suggest that evidence of acute posterior ischaemic optic neuropathy should be a contra-indication to the need for orbital exenteration in invasive fungal sinusitis.     

Decompensated Strabismus after Bilateral Perioperative Ischaemic Optic Neuropathy with Subsequent Recovery

Diplopia occurred in a patient who suffered peri-operative bilateral anterior ischaemic optic neuropathy. It is hypothesized that this occurred because of non-overlapping residual visual fields, as has been described in cases of bitemporal hemianopia. The symptom of diplopia resolved following some recovery of vision which resulted in a binocularly overlapping visual field region.