Bilateral Anterior Ischemic Optic Neuropathy Research Articles

Œdèmes papillaires bilatéraux : étude prospective de 50 patients

In this prospective study, we report fifty consecutive cases of bilateral papilledema without neurosurgical or obvious ophthalmologic etiology, referred to our institution between January 2005 and March 2007. Lumbar puncture with opening CSF pressure measurement distinguished two groups of patients: Group 1 ( n = 39) with and Group 2 ( n = 11) without intracranial hypertension. In Group 1, 9/39 patients presented secondary intracranial hypertension mainly due to cerebral venous thrombosis. In 30 patients, after complete investigations, a diagnosis of idiopathic intracranial hypertension was made: as commonly reported, patients were predominantly overweight (96.7% with body mass index > 25 kg/m 2) young (mean age = 27.6 years) and women (96.7%). Eleven patients with intracranial hypertension had no headaches. In Group 2, the most common diagnosis was bilateral non-arteritic anterior ischemic optic neuropathy, but rare causes have been identified.

Bilateral ocular ischemic syndrome as an initial manifestation of Takayasu’s arteritis associated with carotid steal syndrome

Bilateral anterior ischemic optic neuropathy and bilateral ocular ischemic syndrome have been rarely reported as initial manifestations of Takayasu's arteritis (TA). Appearance of ocular symptoms in TA is closely related to extension and severity of involvement of the aorta and its major branches. Here we reported a case of 'carotid steal syndrome' secondary to TA in a 45 year old Turkish man, who had severe ocular and brain ischemia, presented initially with symptoms of ocular ischemic syndrome.

Bilateral, Nearly Simultaneous Anterior Ischemic Optic Neuropathy Complicated by Diabetes and Bilateral, Small, Crowded Optic Discs

Bilateral simultaneous anterior ischemic optic neuropathy (AION) is uncommon. We report a case of bilateral and nearly simultaneously occurring AION. A 61-year-old man was referred to our hospital with bilateral optic disc edema. Visual field testing demonstrated inferior nasal defect OD and inferior defect OS. Fluorescein angiography showed a delay of dye filling in the superior part of the optic disc in both eyes. The patient had poorly controlled diabetes. A mild increase in erythrocyte sedimentation rates and creactive protein was observed, but the results of temporal artery biopsy were negative. His optic discs were small and lacked biological cups, which has been identified as a risk factor for developing AION. The complications of the structural anomaly, also known as "disc at risk," and diabetes might have caused the bilateral and nearly simultaneously occurring AION.

Suspected Simultaneous Bilateral Anterior Ischemic Optic Neuropathy in a Patient with Behçet's Disease

Aim: To report a 47-year-old Japanese woman with a one-year history of Behçet's disease who complained of sudden bilateral visual loss with concurrent anterior ischemic optic neuropathy (AION). Case Report: The patient's Snellen visual acuity was 0.1 (OD) and 0.3 (OS) of onset. There was bilateral mild anterior chamber inflammation. Bilateral optic disc pale swelling was observed without retinal exudates and edema. Fluorescein angiography demonstrated bilateral hypofluorescence of the optic disc in early frames but with no distinct retinal vasculitis. Visual field showed bilateral relative central scotoma and right altitudinal hemianopsia. Laboratory examination revealed an ESR of 26 mm in the first hour with a C-reactive protein level of < 0.3 mg/dl. Periocular injection of triamcinolone acetonide in both eyes without systemic corticosteroid administration improved her visual acuity to 0.7 (OD) and 1.2 (OS) within 45 days of onset. Bilateral optic disc swelling gradually resolved. In the early stages, fluorescein angiography demonstrated normal optic disc filling in both eyes. There was a residual right central scotoma on visual field. Conclusion: We observed an extremely rare case of simultaneous bilateral AION with Behçet's disease with marked visual recovery within 45days of onset.

Bilateral Anterior Ischaemic Neuropathy Complicating Ruptured Abdominal Aortic Aneurysm

Introduction normal. Duplex ultrasound identified extensive atheromatous disease in both common carotid arteries; there Anterior ischaemic optic neuropathy (AION) is usually was a 60% stenosis on the left and a 40% stenosis on the right. A diagnosis of non-arteritic bilateral AION caused by temporal arteritis or emboli. In this article, we report the occurrence of bilateral AION following was made. Four months after his operation the patient remains haemorrhagic shock. blind but has otherwise made a good recovery.

Anterior ischemic optic neuropathy following the use of a nasal decongestant

PURPOSE: To report a case of sequential anterior ischemic optic neuropathy temporally related to the sequential use of a decongestant nasal spray. METHODS: A 43-year-old woman was evaluated for sequential bilateral vision loss following the use of oxymetazoline nasal spray. RESULTS: Thorough investigation of possible etiologies causing the bilateral anterior ischemic optic neuropathy was negative. Our patient had several predisposing risk factors for ischemic optic neuropathy, including diabetes mellitus, hypertension, and crowded optic nerve heads. Before each acute optic neuropathy, the patient used two to three puffs of oxymetazoline nasal spray. CONCLUSION: Decongestants have been associated with ischemic and hemorrhagic vascular events. Vasoconstriction secondary to oxymetazoline use may precipitate anterior ischemic optic neuropathy.

Postural Vision Loss in Giant Cell Arteritis

Two patients with biopsy-proven giant cell arteritis experienced bilateral transient vision loss after bending over and after getting up from a supine position. One patient had no demonstrable signs of carotid, ophthalmic, or anterior ciliary vascular disease, suggesting that his episodes of transient vision loss were due to vertebrobasilar insufficiency. The other patient experienced bilateral postural vision loss in the context of impending bilateral anterior ischemic optic neuropathy. Bilateral transient postural vision loss is an uncommon manifestation of giant cell arteritis that could reflect either severe bilateral vascular compromise of the anterior circulation or severe vertebrobasilar insufficiency. In either situation, prompt evaluation and treatment is indicated to prevent the irreversible sequelae of the disease.

Bilateral Anterior Ischemic Optic Neuropathy as a Presentation of Takayasu??s Disease

Takayasu's disease is an arteritis with a predilection for the proximal branches of the aortic arch. Chronic retinal hypoxic changes and ischemic ocular inflammation, resulting from cervical vascular occlusion, have been described extensively. Anterior ischemic optic neuropathy has rarely been reported in this condition, and only in conjunction with other ophthalmic findings. Here we present the case of a patient who developed bilateral anterior ischemic optic neuropathy in the absence of other eye findings, and was subsequently found to have an aortic arch syndrome compatible with Takayasu's disease.

Comparison of Visual Function in Fellow Eyes after Bilateral Nonarteritic Anterior Ischemic Optic Neuropathy

Although previous studies have examined the risk of bilaterality of nonarteritic ischemic optic neuropathy (NAION), none have compared extensively the extent of visual loss between fellow eyes. The authors examined cases of bilateral NAION to determine the extent of vision loss in the second eye compared with that in the first eye. Thirty-one cases of bilateral NAION were reviewed. Variables included age, gender, and the presence of comorbid disease. Visual function was assessed by Snellen visual acuity, color vision, and pattern and mean deviation of the visual fields. No correlation was detected between the extent or pattern of visual loss in fellow eyes. No significant difference in visual function existed between first and second eyes for the patients overall. Patients who retained better visual function in the second eye were significantly older than those who retained better visual function in the first eye (visual acuity, P = 0.0005; color vision, P = 0.07; mean deviation, P = 0.02). In patients older than 50 years of age (25 of 31 cases), the second eye had significantly better visual acuity (P = 0.04) and less Humphrey visual field mean deviation (P = 0.04) than the first eye. Visual function in the second eye correlated poorly with that of the first eye. Older patients with bilateral NAION retained better visual function in the second eye than in the first eye. For younger patients, the extent of visual loss in the second eye could not be predicted based on the visual loss in the first eye.

Anterior ischemic optic neuropathy in patients undergoing hemodialysis

Four patients are discussed who underwent hemodialysis and developed anterior ischemic optic neuropathy (AION). Three patients had been treated by hemodialysis for several years. One patient developed bilateral optic neuropathy after the first hemodialysis session, So far, only four hemodialysis patients with bilateral AION have been reported in the literature. One of these reported patients had optic disc drusen; another suffered from severe blood loss. It is suggested that the ischemic optic neuropathy in our four patients may have been caused by low blood pressure, which was very difficult to regulate in these patients, Three of our patients developed bilateral optic neuropathy, the second eye shortly after the first. One patient had unilateral AION, which remained unilateral for four years.

Nonarteritic Anterior Ischemic Optic Neuropathy and Intraocular Pressure

Several reports have suggested that nonarteritic anterior ischemic optic neuropathy (AION) may be related to increased intraocular pressure. We reviewed the records of 45 patients aged 48 through 86 years with nonarteritic AION (10 patients had bilateral AION) for intraocular pressure measurements and the diagnosis of glaucoma or suspected glaucoma. This group was compared with 45 age- and sex-matched patients with normal eye examination results. The mean +/- SD intraocular pressures were 16.3 +/- 3.3 mm Hg for 45 eyes of the 45 patients with AION and 16.1 +/- 2.8 mm Hg for 45 eyes of the 45 control patients (paired t test, P = .70). Among patients with unilateral AION, intraocular pressure was not greater in the involved eye than in the uninvolved eye. Three patients with AION had a previous diagnosis of glaucoma, while three of the control patients were being followed up with suspected glaucoma. We found no evidence in our series to support the hypothesis that AION is associated with increased intraocular pressure.

Bilateral blindness in cavernous sinus thrombosis

An unusual case of bilateral blindness secondary to a cavernous sinus thrombosis is reported. A woman who had undergone reconstructive surgery after tumor resection of the floor of the mouth, was readmitted 1 month later with bilateral proptosis and signs of sepsis. There were no complaints of blurred vision. A CT-scan of the orbits demonstrated a bilateral cavernous sinus thrombosis (CST) secondary to an infection at the skull base behind the myocutaneous flap. A few days later she became blind, due to bilateral central retinal artery occlusion and anterior ischemic optic neuropathy. The general critical condition improved with intensive AB treatment. The patient recovered well without neurological defects apart from her permanent bilateral blindness. There were no signs of tumor recurrence. To our knowledge, this is the first documented case of bilateral blindness in a patient suffering from CST.

Anterior Ischemic Optic Neuropathy: VII. Incidence of Bilaterality and Various Influencing Factors

A prospective study was conducted in 438 patients with anterior ischemic optic neuropathy (AION). There were 388 patients with nonarteritic AION and 50 with arteritic AION. The risk of bilaterality in patients with arteritic AION was found to be 1.9 times the risk in patients with nonarteritic AION (P = 0.0118). The cumulative incidence curve, considering the time taken to develop bilateral AION for nonarteritic cases was significantly (P = 0.0103) different from that for arteritic cases. The estimated 25th-percentile time to development of bilateral AION was much shorter in patients with arteritic AION (0.4 month) than in those with nonarteritic AION (32.4 months). In arteritic AION, unilateral as well as bilateral AION had almost invariably developed before systemic steroid therapy was started and not after, indicating that this therapy is effective in preventing the development of AION in giant cell arteritis. In nonarteritic AION, the risk of bilaterality was significantly greater in men (P = 0.0113) and in young (<45 years old) patients with diabetes (P = 0.0245), with no significant difference attributable to the other age groups or other associated systemic diseases. In this study, it was found that young diabetic men have a risk of AION developing in the second eye that is 1.56 times the risk in young diabetic women, 2.56 times the risk in women who either are nondiabetic or are not young, and 1.64 times the risk in both older men and nondiabetic men.

Bilateral third nerve palsy and anterior ischemic optic neuropathy

An elderly woman with arterial hypertension and a monoclonal gammapathy (MGUS) suffered non-simultaneous bilateral third nerve palsy and simultaneous bilateral anterior ischemic optic neuropathy, with very poor recovery. Extensive investigations and clinical course did not show evidence for a tumoral cause or temporal arteritis. In the absence of other associated disease, vascular changes related to hypertension and MGUS may have caused acute ischemia in the third nerves and optic nerves.

Bilateral Anterior Ischemic Optic Neuropathy, Pseudoxanthoma Elasticum and Platelet Hyperaggregability

Pseudoxanthoma elasticum (PXE) is a systemic disease that affects the elastic fibers of the arterial walls producing dilatation, occlusion and eventually rupture of arteries. The lowering of visual acuity in patients harboring PXE is currently thought to account for the presence of fibrovascular ingrowth into the angioid streaks. The authors saw a 46-year-old patient with bilateral lowering of visual acuity due to bilateral anterior ischemic optic neuropathy (AION) but in whom uncomplicated angioid streaks, PXE and an increased platelet agglutination were found.

Anterior Ischemic Optic Neuropathy

Four unusual patients had bilateral anterior ischemic optic neuropathy (AION). In all four cases, AION developed in the first eye with the classic presentation. The fellow eye had symptomless optic disc edema (ODE) with no subjective or objective visual loss initially, but the classic AION clinical picture developed later on. The findings indicate that symptomless ODE may precede the visual loss in AION and could constitute the earliest sign of this disease. Since ODE in AION is due to axoplasmic flow stasis that, by itself, does not produce visual loss (this is produced by disruption of visual impulse transmission), this would suggest that mild optic nerve head ischemia interferes with axoplasmic flow without disrupting the visual impulse; however, more severe ischemia would disrupt both. Possible effects of various grades of acute optic nerve head ischemia are discussed.