Nonarteritic Anterior Ischemic Optic Neuropathy Research Articles

Macular and Optic Disc Head Morphology on OCT and Visual Prognosis in Non-Arteritic Anterior Ischemic Optic Neuropathy

Introduction: Non-arteritic anterior ischemic optic neuropathy (NAION) shows an acute painless unilateral visual loss due to a reduced perfusion of the optic nerve head (ONH). Aim of this study was to analyse ONH respective macula morphology after NAION by optical coherence tomography and the correlation to visual acuity.

Clinical and Demographic Characteristics of Patients with Neuro-ophthalmological Disorders Starting Later in Life

Objectives: To determine the demographic, etiological and clinical features as well as treatment modalities of patients with neuro-ophthalmological disorders starting at a later age. Materials and Methods: We retrospectively reviewed the clinical data related to the neuro-ophthalmology patients who presented at the age of ≥ 65 years at two tertiary eye care referral centers from 2004 to 2022. Results: Of the 2,127 patients who applied to the Neuro-Ophthalmology Department during this period, 162 (7.6%) were ≥ 65 years old at the time of diagnosis and their data were analyzed. The mean age at the onset of disease was 73.2 ± 6.7 (65–95) years, and mean follow-up time was 1.1±0.4 (1-3) years. Non-arteritic anterior ischemic optic neuropathy (NAAION) (n=85, 52.5%), isolated cranial nerve palsies (n=28, 17.3%), and cerebral vascular disorders (CVD) (n=14, 8.6%) were the most frequent diagnosis. The most common symptoms were as follows: sudden visual loss in 79 (48.8%), diplopia in 31 (19.1%), and blurred vision in 21 (13%) cases. The most common accompanying systemic disease was hypertension (HT) and diabetes mellitus (DM) in 31 (27.4%), followed by HT in 29 (25.7%) cases. There was no accompanying systemic disease in 49 (30.2%) patients. The diagnosis of NAAION and AAION resulted in poor visual outcomes, while CVD presented with homonymous hemianopsia. Conclusion: NAAION and CVD were the most common age-related neuro-ophthalmological disorders that cause visual acuity loss and a visual field defect at an advanced age. Identifying these disorders and managing the visual problems are essential to preserve the protection of the patient's quality of life.

Isolated ocular motor nerve palsy associated with raised homocysteine

Ocular motor mono-neuropathies frequently occur from micro-vascular ischemia to the nerve in the presence of atherosclerotic risk factors such as old age, diabetes mellitus, hypertension, and dyslipidemia. Other possible causes include trauma, intra-cranial neoplasm, aneurysm, inflammation, infection, and brainstem infarction. Recently, hyper-homocysteinemia has emerged as an independent risk factor for systemic and ocular vaso-occlusive disorders. Ocular pathologies such as retinal vascular occlusion and non-arteritic anterior ischemic optic neuropathy have been found to be associated with mild hyper-homocysteinemia. This case series describes four patients with isolated third and sixth cranial nerve palsy where hyper-homosysteinemia was the only risk factor.

Retracted: The Efficacy of Glucocorticoids in the Treatment of Nonarteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis.

[This retracts the article DOI: 10.1155/2022/2935992.].

Evaluation of the Choroid in Patients with Non Proliferative Diabetic Retinopathy by Optical Coherence Tomography Angiography (OCTA)

Background: Diabetes may cause a wide range of eye disorders, including cataracts, glaucoma and other ocular abnormalities, recurrent styes, non-arteritic anterior ischemic optic neuropathy and diabetic papillopathy.

A Taiwan Nationwide Population-Based Study of Socio-Demographic Factors and Comorbid Conditions Associated with Non-Arteritic Anterior Ischaemic Optic Neuropathy

Aims: The aim of the study was to investigate the socio-demographic factors and systemic conditions associated with non-arteritic anterior ischaemic optic neuropathy (NAION). Methods: This was a nationwide population-based retrospective case-controlled study that recruited 9,261 NAION patients selected from the Taiwan National Health Insurance Research Database. The control group consisted of 9,261 age-, sex-, and index date-matched non-NAION patients recruited from the Taiwan Longitudinal Health Insurance Database, 2000. NAION was designated in the database by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) as “code 377.41: ischaemic optic neuropathy without ICD-9-CM code 446.5: giant cell arteritis.” Associated socio-demographic factors and systemic medical conditions were analysed using the McNemar’s test, and continuous variables were analysed using the paired t test. The odds ratio (OR) and adjusted OR of developing NAION were compared using univariate logistic regression and multivariable logistic regression analyses, respectively. Results: Patients with systemic conditions such as diabetes mellitus, hypertension, hyperlipidaemia, chronic kidney disease, and hypotension were more likely to develop NAION than controls (adjusted OR = 1.81, 95% confidence interval [CI] = 1.67–1.97, p < 0.0001; adjusted OR = 1.46, 95% CI = 1.36–1.57, p < 0.0001; adjusted OR = 1.44, 95% CI = 1.33–1.57, p < 0.0001; adjusted OR = 3.26, 95% CI = 2.65–4.01, p < 0.0001; adjusted OR = 2.32, 95% CI = 1.31–4.10, p = 0.0039, respectively). Conclusions: NAION is strongly associated with diabetes mellitus, hypertension, hyperlipidaemia, chronic kidney disease, and hypotension.

Characteristics of macrophage-like cells in acute nonarteritic anterior ischemic optic neuropathy and the normal fellow eyes on en face optical coherence tomography.

To quantitatively analyze macrophage-like cells (MLCs) at the vitreoretinal interface (VRI) in acute nonarteritic anterior ischemic optic neuropathy (NAION) using en face swept-source optical coherence tomography (OCT). Twenty-five acute NAION eyes and 25 normal fellow eyes from 25 patients were included in the study. MLCs were visualized in a 3 μm 6 mm×6 mm en face OCT slab above the VRI centered on the optic nerve head (ONH). After semiautomatic binarization and quantification, we evaluated the MLC density between the two groups. We also investigated the relationship between MLC density and other OCT parameters, including the increase in peripapillary retinal nerve fiber layer (RNFL) thickness and loss of vessel density (VD) in radical peripapillary capillary (RPC). The MLC density in the affected eye of the ONH was highly correlated with that in the fellow eye (r=0.612, p=0.001). The MLC density significantly increased in acute NAION eyes (NAION vs. normal, 11.97 ± 6.66 vs. 9.31 ± 6.10 cell/mm2, p=0.028). In sectorial analysis, the increase in MLCs was mainly in the superior regions (4.13 ± 7.49 vs. 0.94 ± 5.21 cell/mm2, p=0.001). The VD of RPC decreased significantly in the affected eyes (NAION vs. normal, 37.54 ± 5.25 vs. 40.56 ± 4.25, p=0.016), and the loss of RPC was predominantly in the superior sectors and the temporal sectors when compared to the inferior sectors and the nasal sectors, respectively (superior vs. inferior, -3.54 ± 6.71 vs. -0.37 ± 8.07, p=0.004; temporal vs. nasal, -2.69 ± 8.72 vs. -1.22 ± 6.06, p=0.005). The loss of RPC and the increase in MLC density were greater in affected sector corresponding to the visual field (VF) defect. MLCs located above the VRI increased significantly in acute NAION eyes, especially in subregions corresponding to VF defect, which provides clinical evidence supporting that the inflammatory response participates in the pathological process of NAION. The magnitude of the increase in MLCs corresponds to the RPC loss in the quadrant analysis.

Analysis of Vessel Density Using OCTA in Nonarteritic Anterior Ischemic Optic Neuropathy

Purpose: To investigate the intraocular vessel density in patients with nonarteritic anterior ischemic optic neuropathy (NAION) using optical coherence tomography angiography (OCTA).Methods: Medical records of patients with NAION were retrospectively analyzed. Their age, sex, best corrected visual acuity, color vision results, mean deviation of visual field test were analyzed. Using results of OCT and OCTA that was performed at first visit within 3 weeks of symptom onset, vessel densities in eyes with NAION were evaluated by comparing contralateral unaffected eyes. Furthermore, in only affected eyes, the correlation between visual acuity at the time of diagnosis and anatomical factors such as mean vessel density and retinal nerve fiber layer (RNFL) thickness was investigated.Results: Twenty-five patients (11 males and 14 females) were enrolled in this study and the mean age was 65.92 ± 9.37 years. Whole RNFL thickness in affected eye was significantly lower than that in unaffected eye (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). The average peripapillary vessel density was also significantly lower in affected eyes, 45.63% ± 7.60% compared to that in the contralateral eyes, 51.44% ± 3.40% (&lt;i&gt;p&lt;/i&gt; = 0.004). In analysis of only 25 affected eyes, there was no significant correlation between each sectoral peripapillary RNFL thickness and vessel density. There was also no significant correlation between the visual acuity and the vessel density and retinal nerve fiber layer thickness in the ischemic peripapillary hemisphere. However, there was a significant negative correlation between the visual acuity and the un-ischemic peripapillary hemisphere with a coefficient of -0.608 (&lt;i&gt;p&lt;/i&gt; = 0.001).Conclusions: The higher vessel density of nonaffected sector, the better visual acuity at the time of diagnosis in patients with NAION. Patency of blood supply in the preserved peripapillary intraretinal vessel density sector may affect the visual function.

Optic neuropathies post-Covid 19 - review.

The Corona virus infection started at the end of 2019 in Wuhan - China and spread rapidly throughout the world, generating the Covid 19 pandemic. The manifestations of the Covid disease were extremely varied, from a simple flu, with fever, cough, weakness, headache, joint pain, up to severe pneumonia, with severe acute respiratory syndrome (SARS-Cov2) and even death. The symptomatology of the disease, the evolution and the complications that appeared varied, depending on the associated pathology - diabetes mellitus (DM), hypertension (HT), the age and the immune status of the patient. Aim: The ocular manifestations related to Covid 19 were mostly represented by conjunctivitis, but the neurotropic character of Corona virus could justify the appearance of certain neuro-ophthalmological manifestations, such as: optic neuritis (ON), cranial nerve palsies, visual field (VF) anomalies. The aim of this paper was to research the cases of optic neuropathy post-Covid 19, published in the specialty literature between 2020 and 2022. The following were evaluated: risk factors, distribution by age group and gender, evolution and complications, as well as the clinical forms of optic neuropathies. Materials and methods: We used Google Scholar and PubMed databases to find articles on optic neuropathies related to the Covid-19 infection. We followed the articles published during the pandemic and selected 21 cases, belonging to 17 authors, irrespective of their origin and the language in which they were written. Results: 21 patients affected by ON in the Covid-19 disease, 11 women and 10 men, were mentioned. The optic neuropathies described by the authors were: retrobulbar optic neuropathy, only one associated with myelin oligodendrocyte glycoprotein (MOG), papillitis, neuroretinitis, anterior ischemic optic neuropathy (AION), out of which one arteritic anterior ischemic optic neuropathy (AAION) and the others non-arteritic anterior ischemic optic neuropathy (NAAION), one being related to pronation in an oro-tracheal intubated (OTI) patient with acute respiratory distress syndrome (ARDS). Discussions: The neuro-ophthalmological complications associated with Covid 19 disease can be severe, so the patients should be monitored continuously. Many investigations (serological, immunological and imaging exams) are necessary to exclude other etiologies of ON. Conclusions: A complete ophthalmological exam is mandatory for each patient diagnosed with Covid 19 disease, even if they have ocular manifestations or not. Abbreviations: SARS-Cov2 = severe acute respiratory syndrome; DM = Diabetes mellitus; HT = Hypertension; ON = Optic neuritis; VF = Visual field ; NS = Nervous system; CRP = C-reactive Protein; CL = cytokines; IL = interleukins; TNFɑ = tumor necrosis factor; CNS = central nervous system; ACE = angiotensin-converting enzyme; CRVO = central retinal vein occlusion; MOG = myelin oligodendrocyte glycoprotein; MOG-AD = myelin oligodendrocyte glycoprotein antibody disease; BBB = blood-brain barrier; ARDS = acute respiratory distress syndrome; IOP = intraocular pressure; CVP = central venous pressure; MSOF = multiple systems organ failure; AAION = arteritic anterior ischemic optic neuropathy; NAION = non-arteritic anterior ischemic optic neuropathy; AION = anterior ischemic optic neuropathy; OCT = optical coherence tomography; CT = computer tomography; AFG = angiofluorography; MRI = magnetic resonance imaging; ESR = erythrocyte sedimentation rate; RF = rheumatoid factor; ANA = antinuclear antibodies; ANCA = antineutrophil cytoplasmic antibodies; AQP4 = anti aquaporin 4; NMO = neuromyelitis optica; CSF = cerebrospinal fluid; OTI = oro-tracheal intubated; VA = visual acuity; ONTT = optic neuritis treatment trial; RNFL = retinal nerve fiber layer; ICU = intensive care unit; LE = left eye; RE = right eye; MS = multiple sclerosis; ICH = intracranial hypertension; BCVA = best correction visual acuity; LP = light perception; APD = afferent pupillary defect; BM = biomicroscopy; PDN = prednisone; MTX = methotrexate; MTPN = methylprednisolone; NSAID = non-steroidal anti-inflammatory drugs; CGL = cells ganglion layer; VEP = visual evoked potential; CF = counting fingers.

Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) Induced by Selective Agonist of Serotonin 5-HT1 Receptor – A Case Report

Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) Induced by Selective Agonist of Serotonin 5-HT1 Receptor – A Case Report

Risk Factors for Fellow Eye Involvement in Patients with Nonarteritic Anterior Ischemic Optic Neuropathy

Introduction: The aim of the study was to investigate the possible risk factors for fellow eye involvement in patients with nonarteritic anterior ischemic optic neuropathy (NAION). Methods: A total of 113 patients with unilateral NAION attack were included and divided into two groups according to whether fellow eye involvement was present over a mean follow-up period of 2.70 years (P25–P75: 0.77–3.54 years). General characteristics (including age, sex, diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea syndrome [OSAS]) and ocular characteristics (including initial best-corrected visual acuity, initial visual field damage of the first eye, and the presence/absence of a crowded disc) were analyzed and compared between the two groups. Cox regression was used to assess the risk factors for fellow eye involvement. Results: During the follow-up period, 40 patients developed fellow eye involvement. The initial best-corrected visual acuity (p = 0.048) and mean deviation of the visual field (VF) (p = 0.039) of the first eye in patients with fellow eye involvement were worse than those in patients without it. Diabetes (HR = 3.06, 95% CI: 1.50, 6.26, p = 0.002) and increased VF damage (moderate vs. mild, HR = 2.92, 95% CI: 1.03, 8.25, p = 0.043; severe vs. mild, HR = 5.01, 95% CI: 1.65, 15.20, p = 0.004) were associated with a significantly increased risk of fellow eye involvement. In 57 patients with apnea-hypopnea index (AHI) data for further study, an AHI score ≥23.2 was also found to be a risk factor (HR = 3.36, 95% CI: 1.17, 9.69, p = 0.025). Conclusion: Diabetes, severer initial VF damage, and more severe OSAS were risk factors for fellow eye involvement in NAION. For patients with these risk factors, more intensive follow-ups might be warranted.

Neuroprotection and Neuroregeneration Strategies Using the rNAION Model: Theory, Histology, Problems, Results and Analytical Approaches

Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common cause of sudden optic nerve (ON)-related vision loss in humans. Study of this disease has been limited by the lack of available tissue and difficulties in evaluating both treatments and the window of effectiveness after symptom onset. The rodent nonarteritic anterior ischemic optic neuropathy model (rNAION) closely resembles clinical NAION in its pathophysiological changes and physiological responses. The rNAION model enables analysis of the specific responses to sudden ischemic axonopathy and effectiveness of potential treatments. However, there are anatomic and genetic differences between human and rodent ON, and the inducing factors for the disease and the model are different. These variables can result in marked differences in lesion development between the two species, as well as in the possible responses to various treatments. These caveats are discussed in the current article, as well as some of the species-associated differences that may be related to ischemic lesion severity and responses.

Upregulation of retinal VEGF and connexin 43 in murine nonarteritic anterior ischemic optic neuropathy induced with 577 nm laser.

Nonarteritic anterior ischemic optic neuropathy (NAION) is a common acute optic neuropathy and cause of irreversible vision loss in those older than 50 years of age. There is currently no effective treatment for NAION and the biological mechanisms leading to neuronal loss are not fully understood. Promising novel targets include glial cells activation and intercellular communication mediated by molecules such as gap junction protein Connexin 43 (Cx43), which modulate neuronal fate in central nervous system disorders. In this study, we investigated retinal glial changes and neuronal loss following a novel NAION animal model using a 577 nm yellow laser. We induced unilateral photochemical thrombosis using rose bengal at the optic nerve head vasculature in adult C57BL/6 mice using a 577 nm laser and performed morphometric analysis of the retinal structure using serial invivo optical coherence tomography (OCT) and histology for glial and neuronal markers. One day after experimental NAION, in acute phase, OCT imaging revealed peripapillary thickening of the retinal ganglion cell complex (GCC, baseline: 79.5 ± 1.0 μm, n = 8; NAION: 93.0 ± 2.5 μm, n = 8, P < 0.01) and total retina (baseline: 202.9 ± 2.4 μm, n = 8; NAION: 228.1 ± 6.8 μm, n = 8, P < 0.01). Twenty-one days after ischemia, at a chronic phase, there was significant GCC thinning (baseline 78.3 ± 2.1 μm, n = 6; NAION: 72.2 ± 1.9 μm, n = 5, P < 0.05), mimicking human disease. Examination of molecular changes in the retina one day after ischemia revealed that NAION induced a significant increase in retinal VEGF levels (control: 2319 ± 195, n = 5; NAION: 4549 ± 683 gray mean value, n = 5, P < 0.05), which highly correlated with retinal thickness (r = 0.89, P < 0.05). NAION also led to significant increase in mRNA level for Cx43 (Gj1a) at day 1 (control: 1.291 ± 0.38; NAION: 3.360 ± 0.58 puncta/mm2, n = 5, P < 0.05), but not of glial fibrillary acidic protein (Gfap) at the same time (control: 2,800 ± 0.59; NAION: 4,690 ± 0.90 puncta/mm2 n = 5, P = 0.19). Retinal ganglion cell loss at day 21 was confirmed by a 30% decrease in Brn3a+ cells (control: 2,844 ± 235; NAION: 2,001 ± 264 cells/mm2, n=4, P<0.05). We described a novel protocol of NAION induction by photochemical thrombosis using a 577nm laser, leading to retinal edema and VEGF increase at day 1 and RGCs loss at day 21 after injury, consistent with the pathophysiology of human NAION. Early changes in glial cells intercommunication revealed by increased Cx43+ gap junctions are consistent with a retinal glial role in mediating cell-to-cell signaling after an ischemic insult. Our study demonstrates an early glial response in a novel NAION animal model and reveals glial intercommunication molecules such as Cx43 as a promising therapeutic target in acute NAION.

Clinical, demographic characteristics, and treatment protocols of optic neuropathies: Three-year follow-up experiences from a tertiary hospital in Turkey.

Background: This study was conducted to review the demographic and clinical characteristics, treatment protocols, and visual outcomes of patients with optic neuropathy. Methods: This historical cohort study analyzed the clinical features of 91 patients with optic neuropathy followed up for three years at a university hospital in Turkey. Results: Non-arteritic anterior ischemic optic neuropathy (NA-AION) was the most common group among the optic neuropathy subgroups (47.2%), and optic neuritis (ON) was the second most common group (38.5%). The mean age of symptom onset for NA-AION was 64.97 ± 12.15 years, significantly higher than the mean age of onset for ON (40.28 ± 15.52 years). Most of the patients with NA-AION had at least one systemic disease causing microangiopathy [51.1% had diabetes mellitus (DM), 33.3% had hypertension (HTN)]. Among the patients with ON, 51.4% were idiopathic, and 25.7% were multiple sclerosis (MS)-related ON cases. Patients with ischemic optic neuropathy (ION), ON, and traumatic optic neuropathy received pulse intravenous (IV) corticosteroids, and eleven patients with NA-AION received acetylsalicylic acid (ASA) therapy in addition to corticosteroids. There was a statistically significant increase in visual acuity in NA-AION and ON groups (P = 0.019). It was observed that the cases of ON peaked in the winter months in Turkey. Conclusion: In the differential diagnosis between NA-AION and idiopathic ON, the presence of one or more vascular systemic diseases and mean age may be the main factors. IV steroid treatment given to patients with NA-AION in the acute phase may significantly improve visual acuity.

Construction and functional enrichment analysis of the competitive endogenous RNA regulatory network for nonarteritic anterior ischemic optic neuropathy based on high-throughput sequencing.

Based on the transcriptome high-throughput sequencing of nonarteritic anterior ischemic optic neuropathy (NAION), this study constructed a competitive endogenous RNA (ceRNA) network, enriched and analyzed it, screened long noncoding (lnc)RNAs and circular (circ)RNAs that may participate in the competitive endogenous mechanism in NAION, and inferred its function. Four milliliters of peripheral blood from NAION patients and the control group was extracted from clinical samples, transcriptome high-throughput sequencing was performed, and the sequencing data were visualized. Based on the principle of the ceRNA network, the lncRNA-micro (mi)RNA-messenger (m)RNA interaction axis and circRNA-miRNA‒mRNA interaction axes were constructed. The differentially expressed genes (DEGs) in the interaction axis were enriched and analyzed by Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG), and the functions and signalling pathways of lncRNAs and circRNAs in the interaction network were speculated. Fifty-one circRNAs were differentially expressed in the sequencing data: 25 were upregulated, and 26 were downregulated. For 996 differentially expressed lncRNAs, 317 were upregulated and 679 were downregulated, and for 1161 differentially expressed mRNAs, 698 were upregulated and 463 were downregulated. Thirty-three differentially expressed miRNAs, upregulated miRNA 18 and downregulated miRNA 15 were identified. After screening, 13 coexpressed mRNAs, 15 lncRNAs, and 3 miRNAs were finally constructed in the lncRNA-miRNA-mRNA network, and the circRNA-miRNA-mRNA network was constructed by 159 mRNAs, 26 miRNAs, and 34 circRNAs. In the lncRNA network, GO enrichment analysis obtained 182 biological processes, 12 cell components and 38 molecular functions, which are related mainly to the regulation of the activity of proteins and enzymes such as cyclic nucleotide-dependent protein kinase activity and magnesium ion-dependent protein serine/threonine phosphatase activity. KEGG analysis involved mainly the forkhead box O (FoxO) signalling pathway, apelin signalling pathway, etc. In the circRNA enrichment results, 353 biological processes, 52 cell components, and 45 molecular functions were obtained, involving mainly calcium channel regulation, neutrophil activation, mRNA transport, and metabolism. KEGG mainly involved the Wnt signalling pathway, apelin signalling pathway, Hippo signalling pathway, oxytocin signalling pathway, etc. This paper provides a new idea for lncRNAs and circRNAs to mediate the occurrence and development of NAION through the ceRNA mechanism. This study lays a foundation for the in-depth study of the pathogenesis of NAION.

Influence of obstructive sleep apnea syndrome on the contralateral optic nerve in patients with unilateral nonarteritic anterior ischemic optic neuropathy.

The aim was to quantitatively evaluate the influence of obstructive sleep apnea syndrome (OSAS) on the morphology and function of the contralateral optic nerve in patients with unilateral nonarteritic anterior ischemic optic neuropathy (NAION). Fifty patients with unilateral NAION were divided into non-OSAS (n = 16), mild OSAS (n = 15), and moderate-severe OSAS (n = 19) groups based on their apnea-hypopnea index (AHI) scores. Systemic and ocular characteristics were compared between these groups. Spearman correlation and multiple linear regression analyses were used to determine the independent factors that most influenced the thickness of the peripapillary retinal nerve fiber layer (pRNFL). Body mass index and hypertension occurrence were higher in the moderate-severe OSAS group than in the non-OSAS group. Temporal pRNFL was thinner in the moderate-severe group than in the mild and non-OSAS groups, whereas no difference was found between the mild and non-OSAS groups. Spearman correlation showed that the AHI (r = -.469, P = .001) and the percentage of total sleep time with oxygen saturation < 90% (T90%; r = -.477, P = .001) correlated with temporal pRNFL thickness. Multiple linear regression showed that the AHI was negatively associated with temporal pRNFL thickness (β = -0.573, P = .003). OSAS may cause subclinical temporal pRNFL thinning in the contralateral optic nerve among patients with unilateral NAION without any significant change in visual function. Advanced optic nerve observation and intervention may be warranted in patients with moderate-severe OSAS. Li X, Zhang Y, Guo T, etal. Influence of obstructive sleep apnea syndrome on the contralateral optic nerve in patients with unilateral nonarteritic anterior ischemic optic neuropathy. J Clin Sleep Med. 2023;19(2):347-353.

Unilateral asymptomatic optic disc edema: do not forget sinusitis

Background: Optic disc edema is a pathological condition with various causes. Cases of optic disc swelling should be dealt with a multidisciplinary approach to rule out those causes. Unilateral optic disc edema is seen in papillitis, non-arteritic anterior ischemic optic neuropathy, retinal vein occlusion, and infection or inflammation of the contiguous sinus or orbit. Here, we report a rare case of unilateral asymptomatic optic disc edema due to posterior ethmoid sinusitis. &#x0D; Case Presentation: A 53-year-old man presented for a routine 3-monthly follow-up after an uneventful cataract surgery of the right eye. All examinations were unremarkable, except for the right eye optic disc edema on fundus examination, consistent with an enlarged blind spot in the visual field test. Contrast-enhanced magnetic resonance imaging revealed mucosal thickening with muco-inflammatory exudates of the posterior ethmoidal sinus overriding the optic disc on the right side, leading to optic disc edema of the right eye. The patient was diagnosed with unilateral asymptomatic optic disc edema in the right eye due to posterior ethmoid sinusitis and referred to an otorhinolaryngologist for the management. The otorhinolaryngologist performed functional endoscopic sinus surgery and prescribed antibiotics and anti-histamines for 6 weeks. At the final examination, his visual acuity was 6/6, and the fundus examination revealed no optic disc edema.&#x0D; Conclusions: We reported a rare case of unilateral optic nerve edema and visual field loss with a treatable cause. Contemporary imaging provided the accurate diagnosis. Therefore, in cases of disc edema, sinusitis of the adjacent paranasal sinuses should be ruled out as a possible cause of compressive optic neuropathy or inflammation overriding the optic nerve.

The Clinical Profile of Unilateral and Bilateral Optic Disc Swelling in a Tertiary Center in Northern Malaysia.

Background Optic disc swelling (ODS) is a pathological condition with a variety of causes, including optic neuritis (ON), anterior ischemic optic neuropathy, and papilledema. Determining the causes of ODS is critical due to the possibilities of vision- or life-threatening diseases, such as space-occupying lesions. This study aimed to investigate the clinical profile of unilateral and bilateral ODS in Penang Hospital, Malaysia. Methodology This retrospective, descriptive study was conducted in Penang Hospital. Medical records of patients who were diagnosed with ODS from June 2018 until June 2020 in Penang Hospital Eye Emergency Clinic were reviewed. We excluded patients who defaulted on subsequent three months of follow up and those with pseudo-ODS. Results ODS was diagnosed in 43 patients who were all included in the study. Majority were females 55.8% (n = 24), with age ranging from 16 to 78 years. ON contributed most (41.9%, n = 18), followed by non-arteritic anterior ischemic optic neuropathy (NA-AION) (34.9%, n = 15), and papilledema (9.3%, n = 4). Other causes (14%, n = 6) included diabetic papillitis (n = 1), hypertensive retinopathy (n = 1), and central retinal vein occlusion (n = 4). Poor mean initial visual acuity was seen in patients with ON (1.07 ± 0.68) and NA-AION (1.33 ± 0.67). ON showed better final visual outcomes compared to NA-AION at the one-year follow-up. Conclusions ON and NA-AION were identified as the two most common causes of ODS in Penang Hospital for both unilateral and bilateral presentations. Most cases presented with poor initial visual acuity. After one year of follow-up, good visual recovery was seen in ON cases compared to other cases.These results were comparable with studies conducted in other Asian counties.

A Case of Nonarteritic Anterior Ischemic Optic Neuropathy after Intravitreal Aflibercept Injection

Purpose: To report a case of nonarteritic anterior ischemic optic neuropathy (NAION) development after intravitreal injection of aflibercept.Case summary: A 71-year-old female presented with decreased visual acuity and was diagnosed with wet macular degeneration in the right eye. She received two intravitreal aflibercept injections. After 1 month, the best-corrected visual acuity (BCVA) had improved. However, the inferior rim of the optic disc was blurred and an inferior retinal nerve fiber layer (RNFL) swelling was observed. The patient received one more intravitreal aflibercept injection (a loading dose). After 2 weeks, the patient presented with sudden vision loss and the BCVA was finger-counting at 50 cm. Fundus examination revealed that the total optic disc rim was blurred and optical coherence tomography demonstrated diffuse RNFL swelling. The patient was diagnosed with NAION. After 2 months, the optic disc appeared pale but without blurring of the rim, and diffuse thinning of the RNFL was observed. Her BCVA had not improved up to 6 months of follow-up.Conclusions: Although NAION after intravitreal injection is uncommon, physicians should not only examine the macula but also comprehensively assess the intraocular pressure, the RNFL profile, and the optic disc head, especially in patients with NAION risk factors.

Diabetic Papillopathy and Nonarteritic Anterior Ischemic Optic Neuropathy Presenting as Pseudo-Pseudo-Foster Kennedy Syndrome.

Diabetic Papillopathy and Nonarteritic Anterior Ischemic Optic Neuropathy Presenting as Pseudo-Pseudo-Foster Kennedy Syndrome.