Anterior Ischemic Optic Neuropathy Research Articles

How lesions at different locations along the visual pathway influence pupillary reactions to chromatic stimuli

PurposeTo examine systematically how prechiasmal, chiasmal, and postchiasmal lesions along the visual pathway affect the respective pupillary responses to specific local monochromatic stimuli.MethodsChromatic pupil campimetry (CPC) was performed in three patient groups (10 subjects with status after anterior ischemic optic neuropathy, 6 with chiasmal lesions, and 12 with optic tract or occipital lobe lesions (tumor, ischemia)) using red, low-intensity red, and blue local stimuli within the central 30° visual field. Affected areas - as determined by visual field defects revealed using conventional static perimetry - were compared with non-affected areas. Outcome parameters were the relative maximal constriction amplitude (relMCA) and the latency to constriction onset of the pupillary responses.ResultsA statistically significant relMCA reduction was observed in the affected areas of postchiasmal lesions with red (p = 0.004) and low-intensity red stimulation (p = 0.001). RelMCA reduction in the affected areas seemed more pronounced for low-intensity red stimulation (46.5% mean reduction compared to non-affected areas; 36% for red stimulation), however statistically not significant. In prechiasmal lesions, a statistically significant latency prolongation could be demonstrated in the affected areas with low-intensity red stimulation (p = 0.015).ConclusionOur results indicate that the choice of stimulus characteristics is relevant in detecting defects in the pupillary pathway of impairment along the visual pathway, favoring red stimuli of low intensity over blue stimuli. Such knowledge opens the door for further fundamental research in pupillary pathways and is important for future clinical application of pupillography in neuro-ophthalmologic patients.

Neuro-Ophthalmological Optic Nerve Cupping: An Overview

Optic nerve cupping or enlargement of the cup-to-disc ratio is widely recognized as a feature of glaucoma, however it may also occur in non-glaucomatous optic neuropathies. The most well-recognized non-glaucomatous optic neuropathies that cause cupping include compressive optic neuropathies, arteritic anterior ischemic optic neuropathies, hereditary optic neuropathies, and optic neuritis. Cupping is thought to consist of two main components: prelaminar and laminar thinning. The former is a shallow form of cupping and related to loss of retinal ganglion cells, whereas the latter involves damage to the lamina cribrosa and peripapillary scleral connective tissue. Differentiating glaucomatous and non-glaucomatous optic nerve cupping remains challenging even for experienced observers. Classically, the optic nerve in non-glaucomatous causes has pallor of the neuroretinal rim, but the optic nerve should not be examined in isolation. The patient’s medical history, history of presenting illness, visual function (visual acuity, color vision and visual field testing) and ocular examination also need to be considered. Ancillary testing such as optical coherence tomography of the retinal nerve fiber layer and ganglion cell layer-inner plexiform layer may also be helpful in localizing the disease. In this review, we review the non-glaucomatous causes of cupping and provide an approach to evaluating a patient that presents with an enlarged cup-to-disc ratio.

Ultrasound Technologies and the Diagnosis of Giant Cell Arteritis.

Giant cell arteritis (GCA) is a primary autoimmune vasculitis that specifically affects medium-sized extracranial arteries, like superficial temporal arteries (TAs). The most important data to be considered for the ultrasound (US) diagnosis of temporal arteritis are stenosis, acute occlusions and “dark halo” sign, which represent the edema of the vascular wall. The vessel wall thickening of large vessels in GCA can be recognized by the US, which has high sensitivity and is facile to use. Ocular complications of GCA are common and consist especially of anterior arterial ischemic optic neuropathies or central retinal artery occlusion with sudden, painless, and sharp loss of vision in the affected eye. Color Doppler imaging of the orbital vessels (showing low-end diastolic velocities and a high resistance index) is essential to quickly differentiate the mechanism of ocular involvement (arteritic versus non-arteritic), since the characteristics of TAs on US do not correspond with ocular involvement on GCA. GCA should be cured immediately with systemic corticosteroids to avoid further visual loss of the eyes.

Amiodarone-associated bilateral optic neuropathy: a case report

Purpose: Amiodarone is a commonly prescribed anti-arrhythmic drug; however, its use is limited by many adverse effects. Amiodarone causes lung, thyroid gland, skin, central nervous system, liver, and eye disorders. Corneal microdeposits are the most common ocular adverse effects, while more serious tissue damage such as optic neuropathy can also occur. The aim of this report was to describe a case of a toxic optic neuropathy, which is one of the adverse effects of amiodarone treatment.
 Case report: This is a case report of a 51-year-old patient hospitalized at the Department of Ophthalmology University Medical Center Maribor because of blurred vision, first in his right eye and later in his left eye. Three months before admission, the patient began treatment with amiodarone because of arrhythmia after acute pericarditis. The patient underwent a complete ophthalmic examination and other tests for all known optic neuropathy causes. The patient initially presented with blurred vision in his right eye, and also in his left eye after 7 days. Except for corneal micro-deposits and optic disc edema, the results of an ophthalmic exam were normal. Static and kinetic visual field examinations showed bilateral visual field defects. Fluorescein angiography showed bilateral fluorescein dye leakage from the optic disc. Amiodarone treatment was terminated on the 7th day of hospitalization, and the patient reported improvement of vision in subsequent weeks. The edema in his left optic disc resorbed at 3.5 weeks and in his right optic disc at 5 weeks after termination of amiodarone treatment. Kinetic and static perimetry showed improvement in the visual field 10 weeks after the termination of amiodarone treatment.
 Conclusions: Toxic optic neuropathy had a similar clinical course as non-arteritic anterior ischemic optic neuropathy. Prompt diagnosis is crucial because treatment with amiodarone can prevent irreversible visual impairment. Because of the frequent clinical use of amiodarone, and despite the low incidence of toxic optic neuropathy, regular annual follow-up examinations should be performed.

Parapapillary atrophy in optic neuropathies: Histology and clinical relevance.

Parapapillary atrophy is one of the parameters of the optic nerve head area which are assessed during the ophthalmoscopic examination particularly useful to characterize glaucomatous optic neuropathy. Optical coherence tomography evaluation provides high-resolution images of the optic nerve head and surrounding area, and can be used to study parapapillary atrophy. Different parapapillary atrophy zones were described depending on their histological features and research has been conducted to investigate the possible association between the presence and/ or size of parapapillary atrophy zones and several optic nerve disorders. In this review we discuss the histology and the clinical findings related to parapapillary atrophy in patients with glaucomatous optic neuropathy, non-glaucomatous optic neuropathies (e.g. arteritic and non-arteritic anterior ischemic optic neuropathies; suprasellar and parasellar tumors), and other ocular conditions (e.g. high myopia; age-related macular degeneration). Two different histologic classifications were identified. Parapapillary atrophy was demonstrated in glaucoma and glaucoma-like neuropathies, but not in other types of optic nerve disorders.

Dynamic volume-rendered optical coherence tomography pupillometry.

To assess intrapupillary space (IPS) changes in healthy subjects with regard to decreased iris motility in patients with pseudoexfoliation glaucoma (PEXG) or non-arteritic anterior ischaemic optic neuropathy (NAION) in a feasibility study in a clinical environment. Scotopic and photopic IPS measurements using three-dimensionally rendered swept-source optical coherence tomography (SS-OCT) data were obtained and compared for all subjects. Intrapupillary space (IPS) parameters were evaluated such as absolute volumetric differences, relative light response for volumetric ratios and pupillary ejection fraction (PEF) for functional contraction measurements. From a total of 122 IPS from 66 subjects, 106 IPS were eligible for comparison providing values for 72 normal, 30 PEXG and 4 NAION eyes. In healthy, PEXG and NAION subjects, scotopic overall mean IPS was 8.90, 3.45 and 4.16 mm3 , and photopic overall mean IPS was 0.87, 0.74 and 1.13 mm3 , respectively. Three-dimensional contractility showed a mean absolute difference of 8.03 mm3 for normals (defined as 100% contractility), 2.72 mm3 for PEXG (33.88% of normal) and 3.03 mm3 for NAION (38.50% of normal) with a relative light response ratio between scotopic and photopic volumes of 10.26 (100%), 4.69 (45.70%) and 3.67 (35.78%), respectively. Pupillary ejection fraction (PEF) showed a contractile pupillary emptying of 88.11% for normals, 76.92% for PEXG and 70.91% for NAION patients. This 3D pupillometry OCT assessment allows for quantitative measurements of pupil function, contractility and response to light. More specifically, PEF is presented as a potential (neuro)-pupillary outcome measure that could be useful in the monitoring of ophthalmic disorders that affect pupillary function.

Clinical characteristics of choroidal microvasculature dropout in normal-tension glaucoma versus nonarteritic anterior ischemic optic neuropathy: an optical coherence tomography angiography study

The present study investigated the characteristics of choroidal microvasculature dropout (CMvD) in eyes with nonarteritic anterior ischemic optic neuropathy (NAION) versus those in eyes with normal-tension glaucoma (NTG). This study included 27 NAION, 27 NTG, and 27 healthy control subjects. CMvD was observed in 15 eyes (55.6%) of the NAION group and 20 (74.1%) of the NTG group. The area and angular width of CMvD were significantly greater in eyes with NAION (0.278 ± 0.172 mm2 and 86.5 ± 42.3°) than in those with NTG (0.138 ± 0.068 mm2 and 35.1 ± 16.2°, p = 0.002 and p < 0.001, respectively). CMvD in eyes with NAION were distributed in 120–250° and most frequently located at the temporal region, while CMvD in eyes with NTG showed double peaks at 220–280° and 110–140° and most frequently located at the inferotemporal region. The factors associated with the discrimination of NAION from NTG were greater area of CMvD (OR, 1.181; 95% CI, 1.021–1.366; p = 0.025) and location closer to the temporal region of the CMvD (OR, 0.904; 95% CI, 0.838–0.975; p = 0.009). The clinical characteristics of CMvD differed between eyes with NAION and those with NTG. Optical coherence tomography angiography may provide an additional approach to differentiating glaucoma from NAION.

Ocular Implications in Patients with Sleep Apnea

Sleep apnea syndrome (SAS) is a condition characterized by recurrent episodes of total or partial collapse of the upper respiratory tract associated with daytime drowsiness that cannot be explained by other factors. SAS is a pathology that can cause ophthalmological damage both directly through the pathophysiological mechanism characteristic of the disease on the ocular system, and indirectly by promoting the development of other pathologies (cardiovascular, metabolic), which are a risk factor for ocular morbidity in the absence of sleep apnea syndrome. The aim of this paper is to highlight the ocular symptoms determined by sleep apnea syndrome (SAS), by analyzing literature over the past 20 years. Method: A mini-review that collected data from Pub Med Central, ResearchGate, GoogleScholar, DovePress, ScienceDirect, Elsevier, related to the ocular implications given by sleep apnea syndrome, with or without continuous positive airway pressure (CPAP) treatment. The study included articles that identified a number of eye conditions associated with sleep apnea, such as: dry eye syndrome and impaired ocular surface, glaucoma, non-arteritic anterior ischemic optic neuropathy, floppy eyelid syndrome, keratoconus, central serous chorioretinopathy, central vein occlusion, corneal neovascularization, and age-related macular degeneration. Sleep apnea syndrome is a pathology that can cause the onset or worsening of varying degrees of severity eye diseases by its pathophysiological mechanism, with a different impact on the quality of the individual’s life. On one hand, the purpose of this review is to identify studies in literature that associate sleep apnea syndrome with eye alterations; on the other hand, to inform the Romanian medical staff in different fields of the patients’ guidance diagnosed with SAS to an ophthalmology clinic since early and mild symptoms, so that these patients benefit from an ophthalmological approach and monitoring, in an attempt to diagnose and treat eye diseases in time and prevent their worsening.

A case of ocular neurosyphilis in a patient with HIV

A case of ocular neurosyphilis in a patient with HIV

O31 Giant cell arteritis - a rare ocular presentation

O31 Giant cell arteritis - a rare ocular presentation

Optical Coherence Tomography Angiography Acute of Non-Arteritic Anterior Ischemic Optic Neuropathy

Abstract Background Anterior ischemic optic neuropathy (AION) is divided into arteritic anterior ischemic optic neuropathy (AAION) which accounts for 15% and Nonarteritic anterior ischemic optic neuropathy (NAION) which accounts for 85% of cases. Non-arteritic anterior ischemic optic neuropathy (NAION) is an ischemic change involves the 1 mm thickness of the optic nerve head (optic disc). It affects around 10 cases per 100,000 per year in the age group over 50. Objective To assess the optical coherence tomography angiography peripapillary area pattern in diagnosed non-arteritic acute ischemic optic neuropathy patients within a period from one week to 3 weeks during (acute stage while the disc is still edematous) of acute painless diminution of vision. Patients and Methods We enrolled 20 patients in cases group and 10 patients in control group were enrolled to assess the OCTA peripapillary area pattern in diagnosed NAAION patients within a period from one week to 3 weeks during (acute stage while the disc is still edematous) of acute painless diminution of vision compared to the pattern seen in the normal control group OCTA, FFA and VF (centralized 30-2 SITA strategy) were done to the cases group. But FFA and VF were excluded in the control group. Results The results of our study show statistically significant difference found between the two studied groups regarding central circle perfusion density, middle circle perfusion density (superior, inferior and nasal) and outer circle perfusion density (superior and temporal) while no statistically significant difference found between them regarding middle circle (temporal) and outer circle (inferior and nasal). Conclusion So according to this study in cases of NAION (acute stage), we can depend on perfusion density within the middle and outer circle of Early Treatment Diabetic Retinopathy Study (ETDRS) grid put on the disc and peripapillary area. As, these are the areas affected by decreased perfusion density. While, there is increased perfusion density within the central and middle circles, which could be due to, diffuse disc edema.

Anterior ischemic optic neuropathy secondary to optic nerve head drusen - A case report and review of literature

Herein, we report a case of acute, unilateral, painless visual loss in a middle-aged female. A 43-year-old female presented with rapid painless diminution of vision in the left eye with no history of any systemic disease. Anterior segment findings were within the normal limit in both eyes. Fundus examination revealed hemorrhages at the disc with pale disc and disc edema in the left eye and no remarkable change in the right eye. Ultrasound B-scan (USG) and computed tomography (CT) scan revealed optic nerve head drusen (ONHD). Diagnosis of nonarteritic anterior ischemic optic neuropathy (NAION) secondary to ONHD of the left eye was made.

A study to evaluate ocular changes in patients undergoing spine surgery in the prone position.

Background and Aims:AA present prospective study was conducted to evaluate ocular changes occurring in patients undergoing spine surgery in the prone position.Material and Methods:A total of 44 patients of either sex, belonging to American society of Anaesthesiology I and II (aged 18-60 years) scheduled for elective spine surgery in prone position were enrolled in the study. Baseline IOP and MAP measurement were taken prior to induction. After induction of anaesthesia patients were intubated using flexo-metallic tube of appropriate size. IOP and MAP were recorded after induction of anaesthesia, following completion of surgery and immediately after turning the patient supine and 30 min following extubation. Blood loss and duration of surgery was also noted. The OPP was derived using the formula (OPP = MAP-IOP). Ophthalmic examination was also performed using direct and indirect ophthalmoscopy on the day prior to surgery and on first post-operative day to rule out anterior ischemic optic neuropathy (AION), posterior ischemic optic neuropathy (PION), and retinal ischemia.Results:Mean IOP significantly increased (18.91 ± 3.56 mm Hg) (P < 0.001) at the end of surgery as compared to baseline value 12.85 ± 3.07 mm Hg. As a result mean OPP significantly reduced (75.12 ± 16.45) (P = 0.0018) at the end of the procedure.Conclusion:In patient’s undergoing spine surgery in the prone position, careful patient positioning with no extrinsic pressure on the eyes, minimal surgical time and blood loss, and prevention of intraoperative hypotension, should be ensured to prevent the IOP rise and a reduction in OPP which can further prevent post-operative visual disturbance.

Altered Brain Functional Connectivity at Resting-State in Patients With Non-arteritic Anterior Ischemic Optic Neuropathy.

Purpose: To investigate the possible changes in functional connectivity (FC) in patients with non-arteritic anterior ischemic optic neuropathy (NAION) using resting-state functional MRI (fMRI).Methods: Thirty-one NAION patients and 31 healthy controls were recruited and underwent resting-state fMRI scans. Regions of interest (ROIs) were defined as bilateral Brodmann’s area 17 (BA17). FC analysis was performed between the ROIs and the rest of the brain regions, and the between group comparisons of FC were performed. We conducted correlation analysis between the FC changes and the clinical variables in NAION patients.Results: Compared with healthy controls, patients with NAION showed significantly decreased FC between the left BA17 and the right inferior frontal gyrus, left caudate nucleus. As for the right BA17, patients exhibited significantly increased FC with the left olfactory gyrus and decreased FC with the right superior frontal gyrus (SFG), right insula. Moreover, FC values between the right insula and the right BA17 were positively correlated with the right side of mean sensitivity in the central visual field (r = 0.52, P < 0.01) and negatively correlated with the right side of mean defect in the central visual field (r = −0.55, P < 0.01).Conclusion: Our study indicated that patients with NAION showed significantly abnormal functional reorganization between the primary visual cortex and several other brain regions not directly related to visual function, which supports that NAION may not only be an ophthalmic disease but also a neuro-ophthalmological disease.

Non-Arteritic Anterior Ischemic Optic Neuropathy

Purpose. The case report describes the clinical approach to a patient with optic neuropathy in an optometric practice by simple yet valid methods which can be used auxiliary to standard procedures. Material and Methods. Funduscopy was performed via Volk 90D lens and slitlamp. Functional tests, such as visual acuity, pupil reactions, visual field assessment, colour vision, red saturation test, Pulfrich phenomenon and pupil cycle time test, were employed for their differential diagnosis value. Results. The visual acuity and central colour vision were nor- mal; the other tests revealed abnormal state of the patient‘s right eye or visual pathway. Ophthalmoscopy revealed a disc oedema in one half of the optic nerve head. After urgent referral with tentative diagnosis of optic neuropathy of un- known aetiology, a diagnosis of non-arteritic anterior ischemic optic neuropathy (NA-AION) was made at the eye hospital. Conclusion. In patients with sudden onset of monocular visual disturbances where no obvious lesions in visual axis are found various types of optic neuropathies are a frequent finding. Some of these conditions include systemic diseases, such as multiple sclerosis, and some can be associated to life threatening diseases, such as giant cell arteritis. Keywords optic neuropathy, ischemic optic neuropathy, functional vision testing, visual field, giant cell arteritis

Neutrophil to Lymphocyte Ratio as a Marker in Patients with Non-Arteritic Anterior Ischemic Optic Neuropathy in HRH Princess Maha Chakri Sirindhorn Medical Center

Background: Non anterior ischemic optic neuropathy (NAION) is the most common form of ischemic optic neuropathy. usually associated with systemic vasculopathy disease and has variable visual outcomes. The mechanism of NAION is not fully understood and there is no treatment have been proven to be standard treatment. Objective: To evaluate Neutrophil to Lymphocyte Ratio in Non-arteritic Anterior Ischemic Optic Neuropathy patients in HRH Princess Maha Chakri Sirindhorn Medical Center. Design: Retrospective crossectional study. Materials and Methods: 90 patients in the present study were categorized equally into three groups. Group one was those who were diagnosed with NAION. Group two and three as control groups were those who were diagnosed with cataract with and without systemic diseases respectively. The complete blood count was examined at the first visit of NAION or at the pre-operative day. NLR in each group was calculated and compared. Results: The average of NLR in the group one was 2.25, in the group two and group three were 1.69 and 1.74 respectively. The comparison of mean continuous variable between 3 groups using Oneway ANOVA was analysed. NLR in group one was higher with statistical significance (p&lt;0.05) when compared with group two but there was no statistical significance between group one and group three or group two and group three. The level of NLR has the negative correlation with the improvement of BCVA at 3 months. Conclusion: NLR ratio is one of the marker that can be found elevated when there is an inflammatory reaction, in the present study there is a significant higher of NLR ratio in NAION group and has negative correlation with vision at three months, NLR could be used as a prognostic indicator for the prediction of Visual outcome. Keywords: Non arteritic anterior ischemic optic neuropathy; Neutrophil lymphocyte ratio (NLR); Prognostic indicator; Prediction; Visual outcome

Bilateral optic neuritis with macular edema in a young female: A case report

A 20 year old female, presented with history of swelling of right cheek since 2 weeks associated with fever and rash, blurring of vision in both eyes since 7 days which was sudden in onset and painless. Dilated fundoscopic examination of right eye showed disc edema with hyperemia with macular edema. Left eye showed disc edema with hyperemia, splinter hemorrhage on the disc and macular edema. This case posed a diagnostic challenge as clinically, it did not typically fit into the diagnosis of optic neuritis as the pupil reactions were normal, absence of afferent pupillary defect. However, there was rapid therapeutic response with intravenous injection of Dexamethasone, which improved the visual acuity from <1/60 to 6/6 in about a week. Keyword: Post viral optic neuritis, Macular edema, Anterior ischemic optic neuropathy

The Effects of Two Nrf2 Activators, Bardoxolone Methyl and Omaveloxolone, on Retinal Ganglion Cell Survival during Ischemic Optic Neuropathy.

Nonarteritic anterior ischemic optic neuropathy (NAION) is one of the most common acute optic neuropathies that affect the over 55-year-old population. NAION causes the loss of visual function, and it has no safe and effective therapy. Bardoxolone methyl (methyl 2-cyano-3,12-dioxooleana-1,9(11)-dien-28-oate; CDDO-Me; RTA 402) is a semisynthetic triterpenoid with effects against antioxidative stress and inflammation in neurodegeneration and kidney disease that activates the nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathway. Moreover, RTA 402 is an FDA-approved compound for the treatment of solid tumors, lymphoid malignancies, melanoma, and chronic kidney disease. Omaveloxolone (RTA 408) is an activator of Nrf2 and an inhibitor of NFκB, possessing antioxidative and anti-inflammatory activities in mitochondrial bioenergetics. RTA 408 is also under clinical investigation for Friedreich ataxia (FA). In this study, a rodent anterior ischemic optic neuropathy (rAION) model induced by photothrombosis was used to examine the therapeutic effects of RTA 402 and RTA 408. Treatment with RTA402 results in antiapoptotic, antioxidative stress, anti-inflammatory, and myelin-preserving effects on retinal ganglion cell (RGC) survival and visual function via regulation of NQO1 and HO-1, reduced IL-6 and Iba1 expression in macrophages, and promoted microglial expression of TGF-β and Ym1 + 2 in the retina and optic nerve. However, these effects were not observed after RTA 408 treatment. Our results provide explicit evidence that RTA 402 modulates the Nrf2 and NFκB signaling pathways to protect RGCs from apoptosis and maintain the visual function in an rAION model. These findings indicate that RTA 402 may a potential therapeutic agent for ischemic optic neuropathy.

Tocilizumab monotherapy after ultra-short glucocorticoid administration in giant cell arteritis: a single-arm, open-label, proof-of-concept study.

Two randomised controlled trials showed a glucocorticoid-sparing effect of tocilizumab in patients with giant cell arteritis. In the GUSTO trial we aimed to evaluate the efficacy and safety of tocilizumab monotherapy after ultra-short-term glucocorticoid treatment in patients with new-onset giant cell arteritis. This investigator-initiated, single-arm, single-centre, open-label, proof-of-concept trial with a Simon's two stage design was done at University Hospital Bern, Bern, Switzerland. We enrolled patients aged older than 50 years newly diagnosed with giant cell arteritis (within 4 weeks before the screening visit) satisfying the American College of Rheumatology criteria or with large vessel vasculitis-associated polymyalgia rheumatica. The participants received 500 mg methylprednisolone intravenously for 3 consecutive days. Thereafter, glucocorticoid treatment was discontinued and a single infusion of tocilizumab (8 mg/kg bodyweight) was administered intravenously, followed by weekly subcutaneous tocilizumab injections (162 mg) until week 52. The primary endpoint was the proportion of patients who had remission within 31 days and showed no relapse at week 24. The secondary endpoints were the proportion of patients with complete relapse-free remission of disease at weeks 24 and 52, and time to first remission, first relapse (after induction of remission), and first partial remission. This study is registered with ClinicalTrials.gov, NCT03745586. From Nov 23, 2018, to Sept 22, 2019, 18 patients were enrolled (12 of 18 were female, 18 of 18 were White) with a median age of 72 (IQR 67-75) years. Overall, 15 of 18 patients had cranial symptoms, ten of 18 had polymyalgia rheumatica symptoms, and 13 of 18 showed a positive histopathology. At the interim analysis, three (25%) of 12 patients were in remission. The null hypothesis could not be rejected, and the study was futile with respect to the primary endpoint. However, 14 (78%) of 18 patients had remission within 24 weeks (mean time to first remission 11·1 weeks, 95% CI 8·3-13·9) and 13 of 18 showed no relapses up to 52 weeks (72%, 47-90). Mean time to first partial remission was 6·2 [3·7-8·7] weeks. Time to first relapse (after induction of remission) could not be estimated as there was no relapse after induction of remission. Overall, three of 18 patients did not respond to treatment and two of 18 discontinued the study due to an adverse event (hepatopathy [one] and diverticulitis [one]). Anterior ischaemic optic neuropathy occurred in one patient. The data show a slow remission-inducing and a lasting remission-maintaining effect of tocilizumab after an ultra-short pulse of glucocorticoids in patients with newly diagnosed giant cell arteritis. As a proof-of-concept study, our data do not allow us to propose clinical recommendations. Bern University Hospital, University of Bern, and F Hoffmann-La Roche.

Implication of Retrobulbar and internal carotid artery blood-flow-volume alterations for the pathogenesis of non-arteritic anterior ischemic optic neuropathy

BackgroundTo analyze blood flow volume alteration that involved both retrobulbar artery and internal carotid artery (ICA) in patients with non-arteritic anterior ischemic optic neuropathy (NAION) and to assess their relevance for the pathogenesis of NAION.MethodsForty two patients with NAION (unilateral affected) and 42 age-matched controls participated in this study. By head-and-neck computed tomographic angiography (CTA), the diameter of ICA and ophthalmic artery (OA) were measured. By colour Doppler imaging (CDI), the mean blood flow velocity (Vm) and the blood flow volume of ICA and OA were measured or calculated. By optical coherence tomography angiography (OCTA), peripapillary and optic disc vessel density were measured. Data obtained from the affected side of the patients were compared to those of the contralateral healthy side and the control.ResultsCompared with the controls and the contralateral healthy side of the patients with NAION, the diameter of ICA, the blood flow volume of ICA and OA, the peripapillary and optic disc vessel density in the affected side decreased significantly (p < 0.05). However, there was no statistical difference in the diameter of OA (p = 0.179, 0.054 respectively), the Vm of OA (p = 0.052, 0.083 respectively), or the Vm of ICA (p = 0.364, 0.938 respectively) between groups. Peripapillary and optic disc vessel density were significantly positive correlated with the blood flow volume in ipsilateral ICA and OA in patients with NAION (all p < 0.01).ConclusionsThe reduction of blood flow volume was more prominent in OA and ICA than decrease of Vm, peripapillary and optic disc vessel density were significantly positive correlated with the blood flow volume of ipsilateral ICA and OA in patients with NAION.