Bilateral Anterior Ischemic Optic Neuropathy Research Articles

1002 Bilateral Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) in a Patient with Obstructive Sleep Apnea (OSA)

Abstract Introduction Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) is an ischemic insult to the anterior portion of the optic nerve with unclear etiology. Several small sized studies and case reports have demonstrated association between OSA and NAION. In this case, we present a patient with bilateral NAION who was later diagnosed with OSA which may signify this important clinical association. Report of case(s) A 57-year-old man with history of hypertension, presented to the ophthalmology clinic for sudden painless decreased visual acuity of the right eye for one-month duration. He had no history of head trauma or other neurological deficits on his initial presentation. He reported having “bad vision” in his left eye for the entire of his life. Funduscopic evaluation revealed bilateral optic disc edema more in the left eye. Laboratory workup including CBC, CMP and HbA1C were within normal limits. Brain MRI showed only mild nonspecific scattered subcortical and deep periventricular hyperintensities suggestive of chronic small vessel ischemic disease and no acute infarct or masses. MRI of the orbits was normal. A diagnosis of bilateral Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) was highly suggested based on the clinical history and examination findings. A referral to a sleep clinic was made to evaluate for possible sleep apnea. A polysomnogram confirmed obstructive sleep apnea with AHI of 7.2/h, REM AHI of 7.7/h and supine AHI 14.9/h. Nocturnal hypoxemia associated with the respiratory events with time of O2 saturation < 88% for 29 minutes. Patient was referred for a titration study to determine the appropriate PAP pressure to treat his sleep disordered breathing. Conclusion This case adds to the current evolving evidence of the link between OSA with NAION. It signifies the importance of having an index of suspicion, among both sleep specialists and ophthalmologists, to recognize patients who may have one of the conditions and consider screening for the other, which may lead to earlier diagnosis and improved outcomes. Support (if any)

Bilateral Anterior Ischemic Optic Neuropathy Accompanied with Unilateral Central Retinal Artery Occlusion in a Biopsy-proven Case of Giant Cell Arteritis

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A case of ocular neurosyphilis in a patient with HIV

A case of ocular neurosyphilis in a patient with HIV

Bilateral Anterior Ischemic Optic Neuropathy Due to Giant Cell Arteritis With Preservation of Central Visual Acuity.

Bilateral Anterior Ischemic Optic Neuropathy Due to Giant Cell Arteritis With Preservation of Central Visual Acuity.

Bilateral non-arteritic anterior ischemic optic neuropathy with idiopathic intracranial hypertension secondary to attempted abortion related hemorrhage

We report a unique case of bilateral non-arteritic anterior ischemic optic neuropathy with co-existing idiopathic intracranial hypertension (IIH) in a young female following severe blood loss from abortion. At presentation, she had bilateral gross diminution of vision (hand movements and light perception in right & left eyes respectively) and bilateral pallid disc edema. Lumbar puncture and brain imaging were suggestive of IIH. Temporal association of vision loss with acute blood loss as well as fluorescein angiography were suggestive of bilateral NAION. Patient was treated with intravenous (IV) mannitol, IV methylprednisolone followed by oral steroids, oral acetazolamide, repeat lumbar punctures, and blood transfusion. Vision in right eye improved to 20/40 & left eye 20/500 at sixth month. Multidisciplinary approach is, thus, needed in management of such a case.

Bilateral Anterior Ischaemic Optic Neuropathy as First Manifestation of Henoch-Schönlein Purpura (IgA Vasculitis).

A 46-year-old man was referred to our department complaining of a bilateral progressive decrease in his visual acuity. Fundus examination revealed bilateral optic disc oedema, indicative of anterior ischaemic neuropathy (AION), and a macular star in the right eye. Laboratory analysis showed low haematocrit and haemoglobin, elevated creatinine, and increased erythrocyte segmentation rate and C-reactive protein level. Physical examination revealed the presence of purpuric rash on the trunk and the extremities. During the investigation we performed a complete laboratory and imaging examination for autoimmune collagen diseases, vasculitides and infectious diseases, which were all negative. Histologic findings of renal biopsy were compatible with IgA glomerulonephritis and thus Henoch-Schönlein purpura (HSP) diagnosis was established. The patient was treated with methylprednisolone and cyclophosphamide. Six months later, his renal function and his visual acuity had improved, and the rash had subsided. This is a rare case of AION in a patient with HSP.

Bilateral optic disc edema with preserved visual function not related to papilledema

Bilateral optic disc edema (ODE) with preserved visual function is typically a result of papilledema, but the causes of this finding in the absence of raised intracranial pressure have not been systematically evaluated. The goal of this study was to determine the causes of bilateral ODE with preserved visual function not related to intracranial hypertension to help in developing a differential diagnosis for this finding. We retrospectively reviewed 221 consecutive patients presenting to a tertiary neuro-ophthalmology practice over a period of 2 years. Four patients met the inclusion criteria with a mean age of 53 years (range 43 to 63), 2 patients were men and 2 were women. The final diagnoses were bilateral optic perineuritis secondary to p-ANCA vasculitis, bilateral incipient non-arteritic anterior ischemic optic neuropathy (NAION), hypertensive emergency, and intermediate uveitis. The patient with NAION developed an inferior altitudinal defect 4 months after presentation, but all other patients maintained normal visual function. The ODE resolved in all cases at a mean follow-up of 4.5 months (range 3 to 6 months). Optic disc edema with preserved visual function may not be related to papilledema, and this series indicates that optic perineuritis, incipient NAION, hypertensive emergency, and intermediate uveitis be considered in the differential diagnosis of these cases.

Bilateral anterior ischaemic optic neuropathy with macular star as first manifestation of Henoch‐Schönlein purpura (IgA vasculitis)

AbstractPurposeTo report a case of bilateral anterior ischaemic optic neuropathy with macular star in a patient with Henoch–Schönlein purpura (HSP).MethodsA 46‐year‐old man was referred to our clinic complaining of progressive decrease in visual acuity of the right eye (OD) since the last 10 days, and since 3 days in his left eye (OS). His visual acuity was ‘hand motion’ OD and 4/10 OS. Anterior segment examination was insignificant, while fundus examination revealed optic disc edema, and bilateral macular star. A relative afferent pupillary defect was present in his right eye with normal pupillary reflexes in the left eye. Laboratory analysis showed: Hematocrit: 22.1%, ESR: 140 mm/hr, CRP: 64.80 mg/dl, Creatinine: 4.4 mg/dl. Physical examination revealed presence of erythematous rash on the trunk and the extremities. The patient was admitted to the Nephrology department for treatment of his azotemia.ResultsDuring his hospital course we performed complete laboratory and imaging examinations for autoimmune diseases, vasculitis and infectious diseases, which were negative. Histologic findings of renal biopsy were compatible with IgA glomerulonephritis and thus HSP was diagnosed. The patient received oral methylprednisolone and intravenous cyclophosphamide therapy. Six months later his renal function had improved, the rash had subsided and his visual acuity was ‘counting fingers’ OD and 10/10 OS. Standard automated perimetry showed peripheral visual field depression bilaterally.ConclusionsHenoch–Schönlein purpura (HSP) is a small vessel vasculitis which is more common in children. Based on literature, ophthalmic manifestations of HSP usually involve the anterior segment and less frequently the posterior segment. Systemic vasculitis should be included in the differential diagnosis of bilateral optic disc edema.

Bilateral Non-Arteritic Anterior Ischemic Optic Neuropathy in a Young Male

A 43 year old diabetic male presented with complaints of blurring of peripheral vision, in the left more than right eye, since a couple of months. Best corrected visual acuity was 6/9 in the right eye and 6/24 in the left eye. Dilated fundus examination showed a slightly edematous disc superiorly with a cup:disc ratio of 0.1:1 in the right eye and nasal disc pallor with a cup:disc ratio of 0.1:1 in the left eye. Visual fields examination was suggestive of a partial inferior altitudinal defect in the left eye. OCT showed nerve fibre layer thinning and cup:disc ratio of 0.14:1 in the left eye. A diagnosis of bilateral NAION was made. Serum cholesterol levels were raised. VEP was advised which was suggestive of bilateral axonopathic optic neuropathy. The patient was started on a combination of Syndopa-Carbidopa, Aspirin and Atorvastatin. On follow-up, visual acuity improved to 6/12 in the left eye. Field defect was reduced slightly compared to the previous examination. The pathogenesis of NAION remains unclear but may involve ischemia to the optic nerve head from insufficient perfusion of the short posterior ciliary arteries. The most important structural risk factor is a small and crowded disc. The presentation in young patients is similar to elderly patients having classical AION. Prompt diagnosis and management gives a better chance of visual improvement in younger patients.

Non artheritic bilateral anterior ischaemic optic neuropathy (NAION) as devastating complication following Total Hip Arthroplasty: a case report.

Introduction: Postoperative vision loss (PVL) is an extremely rare complication following major surgical procedures. Patients with systemic hypertension, diabetes, coronary diseases and smokers are generally predisposed to this complication. More frequently, it is caused by ischemic optic neuropathy (ION), central retinal artery occlusion or retinal vein occlusion. Rare cases of unilateral PVL following total joint arthroplasty surgery have been recently described in literature. Case report: This case report describes the first reported bilateral non-arteritic anterior ischemic optic neuropathy (NAION), which occurred 3 days following a total hip arthroplasty with a consequent post-operative hypotension. Conclusions: Orthopedic surgeons should be aware that in hip joint replacement procedures, selected patients present an higher risk of ION following intra/postoperative hypotension and prolonged surgical times. (www.actabiomedica.it)

Giant cell arteritis presenting as bilateral anterior ischemic optic neuropathy: a biopsy-proven case report in Chinese patient

BackgroundGiant cell arteritis (GCA) is a systemic vasculitis of medium and large-size vessels and can led to permanent visual loss in elderly patients. GCA is very rare among Asians. We report a Chinese patient presenting with acute bilateral anterior ischemic optic neuropathy, and the temporal artery biopsy proved the diagnose of GCA.Case presentationA 77-year-old Chinese man presented with sudden bilateral blindness for 5 days with a severe headache. Funduscopic examination revealed bilateral optic disc swollen with “chalky white” pallid appearance. The blood tests showed the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) elevated dramatically. The color duplex ultrasonography (CDUS) of the superficial temporal artery revealed the inflammation of the vessel wall as a “halo sign”. The temporal artery biopsy was perfumed and the pathology revealed luminal occlusion with multinuclear giant cell infiltration. The patient was treated with intravenous methylprednisolone for 3 days and oral prednisone weaning for 12 months. The visual acuity remained no light perception at one year follow-up.ConclusionsAlthough very rare in Asian, GCA can led to permanent blindness in elderly Chinese caused by anterior ischemic optic neuropathy. The noninvasive CDUS might be a promising technique for diagnose GCA in highly suspected patients.

Hyperhomocysteinemia in bilateral anterior ischemic optic neuropathy after conventional coronary artery bypass graft: a case report

BackgroundThe incidence of anterior ischemic optic neuropathy after coronary artery bypass graft procedures ranges from 1.3 to 0.25%. The mechanisms of anterior ischemic optic neuropathy after cardiovascular procedures remain undefined but many systemic and related-to-surgery risk factors could underlie anterior ischemic optic neuropathy. In this case, we report a rare presentation of a bilateral anterior ischemic optic neuropathy after coronary artery bypass graft and speculate on the preoperative hyperhomocysteinemia as an independent risk factor for anterior ischemic optic neuropathy.Case presentationA 56-year-old white man, a tobacco smoker with type 2 diabetes and coronary artery disease, underwent a conventional coronary artery bypass graft with extracorporeal circulation. In spite of ongoing anti-aggregation, antithrombotic, and vasodilator therapy, 10 days after the surgery he complained of severe bilateral visual loss. Funduscopy and fluorescein angiography revealed a bilateral anterior ischemic optic neuropathy. Analysis of preoperative laboratory tests revealed hyperhomocysteinemia.ConclusionHyperhomocysteinemia could increase the risk of ocular vascular damage and bilateral ocular involvement in patients who have undergone conventional coronary artery bypass graft.

Bilateral Anterior Ischaemic Optic Neuropathy in a Child on Continuous Peritoneal Dialysis: Case report and literature review

Non-arteritic anterior ischaemic optic neuropathy (NAION) is a serious complication of continuous peritoneal dialysis (CPD) which can lead to poor vision and blindness. We report a five-year-old girl who had undergone a bilateral nephrectomy at the age of one year and was on home CPD. She was referred to the Paediatric Ophthalmology Unit of Sultan Qaboos University Hospital, Muscat, Oman, in 2013 with acute bilateral vision loss, preceded by a three-day history of poor oral intake. At presentation, the patient had severe systemic hypotension. An ophthalmological examination revealed severe bilateral visual impairment and NAION. She was treated with intravenous methylprednisolone and normal saline boluses. At a five-month follow-up, the visual acuity of the right eye had improved but vision in the left eye remained the same. Acute bilateral blindness due to NAION while on CPD is a rare condition in childhood. Paediatricians should be aware of this complication in order to ensure prompt management.

Bilateral Anterior Ischemic Optic Neuropathy During Treatment with Pegylated Interferon and Ribavirin

Hepatitis C virus (HCV) is a blood-borne pathogen that often results in chronic liver infection leaving patients at risk for cirrhosis, liver decompensation and hepatocellular carcinoma. The goal of therapy is to eliminate the virus in order to minimize morbidity and mortality from HCV infection. Traditional treatment has utilized a combination of pegylated-interferon (IFN) and ribavirin that often causes both systemic and ocular side effects. The most common ocular side effects are retinal hemorrhages and cotton wool spots, although in rare circumstances more significant ophthalmic adverse events have been attributed to IFN therapy.
 Here we discuss a case of bilateral anterior ischemic optic neuropathy (AION) that occurred during treatment with IFN and ribavirin for HCV genotype 1. We review the proposed pathogenesis of ocular side effects associated with this regimen, as well as the pathogenesis and risk factors associated with AION itself. Finally, we will offer clinical recommendations for screening for more than retinopathy should a patient present with ophthalmic complications.

Papillary tumor of the pineal region presenting with Foster Kennedy sign

Foster Kennedy syndrome is defined as unilateral optic nerve atrophy, contralateral disc edema and anosmia. It was originally thought to be pathognomonic of space occupying lesions in the anterior fossa causing direct compression of the optic and olfactory nerves and later intracranial hypertension and contralateral disc edema. Subsequent reports of non-tumor and non-anterior fossa causes, most commonly bilateral sequential anterior ischemic optic neuropathy, have been described. We report a 29 year old man who presented with unsteady gait and diminution of vision over 2 months. He displayed findings typical of Parinaud’s syndrome, right disc edema and left optic atrophy. MRI revealed a large pineal tumor associated with hydrocephalus and evidence of increased intracranial pressure. Papillary tumor of the pineal region (PTPR) was diagnosed on histopathology. To our knowledge, this is the first report of this very rare tumor, occurring in association with the Foster Kennedy sign.

Visual Loss after Cardiopulmonary Bypass (CABG) for Coronary Artery Disease: A Report of Case

We are reporting a 59-year-old male who presented with features of bilateral anterior ischaemic optic neuropathy after coronary artery bypass grafting. Postoperative vision loss after major nonocular surgery is a very rare but devastating complication since it has the potential to cause bilateral, severe and permanent loss of vision.

Ischemic Optic Neuropathy Following Cardiopulmonary Bypass Surgery: A Case Report

Postoperative visual dysfunction following major surgeries is still a significant clinical problem. Especially, ischemic optic neuropathy (ION) after cardiac surgery is a devastating complication that is known as a source of permanent visual loss. In this case study, a patient who presented with features of bilateral anterior ION after cardiopulmonary bypass surgery (CPBS) was reported. J Med Cases. 2015;6(1):20-23 doi: http://dx.doi.org/10.14740/jmc2016w

Neuropathie optique ischémique non artéritique bilatérale au cours du traitement de l’hépatite virale C par l’association interféron pégylé et Ribavirine®

Hepatitis C is a serious viral infection, for which the current treatment is based on the combination of pegylated interferon (IFN) and Ribavirin(®). Ophthalmic complications observed with PEG-IFN are infrequent and of variable prognosis. They often include an ischemic retinopathy with typical cotton-wool spots, hemorrhage and retinal edema, and rarely acute non-arteritic anterior ischemic optic neuropathy as illustrated by our report. We report the case of a 51-year-old man followed for chronic active hepatitis C, who presented in the fourth month of treatment with pegylated interferon and vidarabine with a sharp decline in visual acuity secondary to acute bilateral non-arteritic anterior ischemic optic neuropathy. The hepatitis C treatment was discontinued. His course was notable by the third week for a significant regression of papilledema with improvement in visual acuity in the right eye and no change in the left eye, remaining at counting fingers. After regressing for four years, the disease progressed to bilateral temporal optic atrophy without change in visual acuity. Pegylated interferon and Ribavirin(®) are commonly used in the treatment of chronic hepatitis C. They are the source of various ophthalmologic complications of varied severity. The pathophysiology of this ocular toxicity currently remains hypothetical. Non-arteritic ischemic optic neuropathy is still a relatively rare complication with a poor functional prognosis, often requiring discontinuation of treatment. Thus, careful ophthalmologic monitoring before and during antiviral treatment of patients with hepatitis C appears necessary.

Comparison of Peripapillary Retinal Nerve Fiber Layer Loss and Visual Outcome in Fellow Eyes Following Sequential Bilateral Non-Arteritic Anterior Ischemic Optic Neuropathy

ABSTRACTAim: To report on the correlation of structural damage to the axons of the optic nerve and visual outcome following bilateral non-arteritic anterior ischemic optic neuropathy.Methods: A retrospective review of the medical records of 25 patients with bilateral sequential non-arteritic anterior ischemic optic neuropathy was performed. Outcome measures were peripapillary retinal nerve fiber layer thickness measured with the Stratus optical coherence tomography scanner, visual acuity and visual field loss.Results: Median peripapillary retinal nerve fiber layer (RNFL) thickness, mean deviation (MD) of visual field, and visual acuity of initially involved NAION eyes (54.00 µm, −17.77 decibels (dB), 0.4, respectively) were comparable to the same parameters measured following development of second NAION event in the other eye (53.70 µm, p = 0.740; −16.83 dB, p = 0.692; 0.4, p = 0.942, respectively). In patients with bilateral NAION, there was a significant correlation of peripapillary RNFL thickness (r = 0.583, p = 0.002) and MD of the visual field (r = 0.457, p = 0.042) for the pairs of affected eyes, whereas a poor correlation was found in visual acuity of these eyes (r = 0.279, p = 0.176). Peripapillary RNFL thickness following NAION was positively correlated with MD of visual field (r = 0.312, p = 0.043) and negatively correlated with logMAR visual acuity (r = −0.365, p = 0.009).Conclusion: In patients who experience bilateral NAION, the magnitude of RNFL loss is similar in each eye. There is a greater similarity in visual field loss than in visual acuity between the two affected eyes with NAION of the same individual.

The eye: a window on kidney diseases.

The eye: a window on kidney diseases.