Abstract
Herein, we report a case of nonarteritic anterior ischemic optic neuropathy (NAION) following uneventful pars plana vitrectomy for macular hole treatment. A 56-year-old previously healthy woman presented with a full-thickness macular hole in right eye (OD) and small cup-to-disc ratios in both eyes. Five days after surgery, she noticed sudden painless loss of vision in OD and was found to have an afferent pupillary defect and intraocular pressure of 29 mmHg. Fundus examination showed right optic disc edema and the resolution of a macular hole with an inferior altitudinal visual field defect. Erythrocyte sedimentation rate, C-reactive protein levels, and general physical examination findings were normal. She was treated with hypotensive eyedrops and oral prednisone, resulting in mild visual improvement and a pale optic disc. A combination of face-down position and increased intraocular pressure due to a small optic disc cup were considered as potential mechanisms underlying NAION in the present case. Vitreoretinal surgeons should be aware of NAION as a potentially serious complication and be able to recognize associated risk factors and clinical findings.
Highlights
Pars plana vitrectomy (PPV) with perimacular traction removal and facedown intraocular gas tamponade have demonstrated utility in treating idiopathic full-thickness macular holes (FTMH)
Visual field (VF) defects associated with peripapillary retinal nerve fiber layer (RNFL) thickness reduction, optic neuropathy, and optic disc pallor may occur after otherwise uncomplicated surgery for macular hole treatment
nonarteritic anterior ischemic optic neuropathy (NAION) is the most common optic neuropathy in patients >50 years old; it is thought to be a multifactorial disease involving an ischemic process resulting from microvascular occlusion or hypoperfusion of the blood supply to the optic nerve head, resulting in sudden visual loss associated with pale optic disc edema
Summary
Nonarteritic anterior ischemic optic neuropathy following pars plana vitrectomy for macular hole treatment: case report. Leonardo Provetti Cunha, Luciana Virgínia Ferreira Costa Cunha, Carolina Ferreira Costa, Mário Luiz Ribeiro Monteiro
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