Bilateral anterior ischemic optical neuropathy against the background of newly diagnosed antiphospholipid syndrome in a young patient

Abstract

Introduction. Antiphospholipid syndrome (APS) is one of the leading causes of nonarteritic anterior ischemic opticoneuropathy (AION) in young patients. Ocular pathology, often being the earliest and the only manifestation of APS, explains possible difficulties in diagnosis of this thrombophilic condition. Objective – to present a clinical case of bilateral anterior ischemic opticoneuropathy against the background of newly diagnosed antiphospholipid syndrome in a young patient. Materials and Methods. At admission, the patient, born in 1988, was diagnosed with bilateral acute ischemic nonarteritic ION on the basis of visual acuity decrease to 0,7, narrowing of peripheral borders of visual fields concentrically by 10–15°, optic disc edema (ODE) of both eyes and macular edema of the right eye according to ophthalmoscopy and optical coherence tomography (OCT). Laboratory examination revealed thrombocytopenia, antibodies to DNA and cardiolipin in elevated titer, which allowed the diagnosis of primary antiphospholipid syndrome. Local anticoagulant and anticoagulant therapy, systemic administration of antioxidants, antiaggregants, vitamins, as well as preparations, improving microcirculation, were carried out. Results and Discussion. Against the background of treatment visual function restored to 1.0 in the right eye and 0.9 in the left eye, residual ODE edema was diagnosed in both eyes in the upper nasal sector. At follow-up in 2.5 months the morphological parameters of the retina and optic nerve were restored. Conclusion. Thromboocclusive lesions of retinal and optic nerve vessels are an early and sometimes the only manifestation of antiphospholipid syndrome. Their presence in young patients requires clinical and laboratory follow-up examination for timely diagnosis of concomitant thrombophilic condition. High risk of recurrent thrombosis of different localization makes it necessary to take antiplatelet agents for a long time.