Bilateral simultaneous anterior ischemic optic neuropathy associated with sildenafil

We report a case of simultaneous bilateral nonarteritic anterior ischemic optic neuropathy (NAION) due to sildenafil use. A 55-year-old man with an unremarkable medical history presented simultaneous bilateral NAION 8 months after continuous use of sildenafil 4-5 times a month. At presentation, visual acuity (VA) was 0.7 in the right eye (RE) and 0.9 in the left eye (LE). The visual field showed an inferior altitudinal defect in both eyes and a fundus examination revealed prominent optic disc edema in the RE and a crowded optic disc in the LE. The patient was counseled to discontinue sildenafil, and 3 weeks later VA was 1.0 in both eyes and the optic disc edema in the RE was resolved. However, a visual field defect remained in the RE. Three months later, visual fields were unchanged. To the best of our knowledge, this is the first reported case of simultaneous bilateral NAION due to sildenafil use.     

The optic disk in anterior ischemic optic neuropathy associated with retinal artery occlusion

Two patients who had retinal artery occlusion associated with impaired peripapillary choroidal circulation were followed up ophthalmoscopically, to evaluate the appearance of the optic disk. The first patient showed central retinal artery occlusion, and the second patient demonstrated branch retinal artery occlusion. A peripapillary choroidal filling defect was noted in both cases by fluorescein angiography, suggesting an association with anterior ischemic optic neuropathy. The first patient exhibited optic atrophy without demonstrating pale disk edema. The second patient showed pale disk edema, but a sectorial defect of disk swelling was noted in the quadrant that corresponded to the area affected by branch retinal artery occlusion.     

Bilateral arteritic anterior ischemic optic neuropathy

Background

Arteritic anterior ischemic optic neuropathy (AION) is a disease of the optic nerve head seen in patients over the age of 50 and more commonly over the age of 70. With few exceptions, arteritic AION is caused by giant cell arteritis. Early diagnosis and prompt treatment with corticosteroids are essential for preventing potentially devastating visual loss from this disease.

Case Report

A 63-year-old white man presented with the complaints of blurred vision of the right eye and visual field loss of the left eye. Ocular examination found bilateral swollen optic nerve heads. Visual field testing showed altitudinal defects in each eye. Laboratory testing was significant for elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. The patient was treated with oral prednisone for arteritic AION and referred to a rheumatologist. At follow-up, the patient’s ESR and CRP levels showed significant improvement. The optic nerve head of the left eye showed a reduction in swelling, and the visual field finding was stable.

Conclusion

Arteritic AION is an ocular emergency. Optometrists need to be able to recognize and diagnose this condition quickly to initiate critical corticosteroid treatment.     

Bilateral optic neuropathy associated with amiodarone therapy

Amiodarone, an antiarrhythmic agent, has been associated with mild visual loss secondary to papillopathy and papilledema. We report a patient who developed bilateral optic neuropathy 4 weeks after initiation of amiodarone therapy. Nine months later, his vision was 20/50 in the right eye and 20/200 in the left. This report provides additional evidence that amiodarone may cause toxic optic neuropathy.     

Non-arteritic anterior ischemic optic neuropathy with retinal emboli

We report a case of non-arteritic anterior ischemic optic neuropathy (NAION) associated with retinal emboli in a 68-year-old man with decreased vision. Carotid Doppler imaging revealed critical stenosis (80–99%) of the ipsilateral internal carotid artery. Carotid endarterectomy was performed and two weeks postoperatively a partial improvement in visual acuity was noted with resolution of the disc swelling.     

Ischemic optic neuropathy associated with retinal embolism

Ischemic optic neuropathy occurred in three patients (a 55-year-old man and two women, 64 and 68 years old). Visual loss followed coronary bypass surgery in two patients who also had diffuse atherosclerotic disease. Retinal emboli were present in both eyes of each. The third patient developed ischemic optic neuropathy with evidence of ipsilateral retinal emboli shortly after cardiac catheterization. Her only other risk factor for ischemic optic neuropathy was systemic hypertension. Although highly unusual, ischemic optic neuropathy may be associated with and possibly caused by a shower of emboli to the eye.     

Anterior ischemic optic neuropathy associated with udenafil

We report a case of anterior ischemic optic neuropathy associated with udenafil. A 54-year-old male presented with an acute onset visual field defect of the right eye after udenafil use. Examination revealed a relative afferent pupillary defect and a swollen disc. Automated visual fields revealed an enlarged blind spot and a narrowed visual field. Fluorescein angiography revealed both an inferior choroidal filling delay and an inferior sector filling delay of the optic disc in the arteriovenous phase as well as diffuse leakage of the optic disc in the late phase. Optical coherent tomography revealed increased thickness of the retinal nerve fiber layer, especially in the area of the inferior disc. The patient was counseled to discontinue the use of udenafil and to monitor his blood pressure regularly. The disc swelling was resolved with residual optic atrophy one month after discontinuing the use of udenafil.     

Bilateral anterior ischaemic optic neuropathy associated with optic disc drusen and systemic hypotension.

We report a case of bilateral anterior ischaemic optic neuropathy in a 23-year-old woman which was probably attributable to optic disc drusen and systemic hypotension related to peritoneal dialysis for renal failure.     

Bilateral posterior ischemic optic neuropathy after spinal surgery

PURPOSE: To report the association between bilateral posterior ischemic optic neuropathy and spinal surgery. METHOD: Case report. RESULTS: After prone-position spinal surgery of 8 hours' duration, a 68-year-old woman was completely blind in both eyes. Moderate periorbital edema and temporal conjunctival chemosis were present bilaterally. Ophthalmic examination disclosed normal-appearing optic nerve heads, except for bilateral nasal fullness related to bilateral optic nerve drusen, and no retinal edema. Immediate cerebral arteriography, magnetic resonance imaging, and electroretinography were normal. Visual-evoked response was not detectable, and 7 weeks later, severe bilateral optic nerve head pallor developed. CONCLUSIONS: Severe selective hypoperfusion of the retrobulbar optic nerves may occur after spinal surgery. Pressure to the periorbital region may be a contributing factor.     

Acute retinal necrosis associated optic neuropathy

Acute retinal necrosis (ARN) syndrome is characterized by severe intraocular inflammation, occlusive vasculopathy and peripheral retinal necrosis. Vision threatening complications of this syndrome include retinal detachment, macular oedema and ischaemia and optic neuropathy. Optic nerve involvement may be the presenting sign of ARN and this condition should be included in the differential diagnosis of acute papillitis. Several mechanisms may lead to ARN associated optic neuropathy including vasculitis, optic nerve ischaemia and direct optic nerve invasion by the herpes virus. We review optic nerve involvement during ARN and present its incidence, pathogenesis, differential diagnosis and treatment.     

Anterior ischemic optic neuropathy associated with macrocytic anemia

A 37-year-old man experienced the acute onset of blurred vision, particularly in the inferior hemifield of his left eye. Neuro-ophthalmic examination showed a left afferent pupillary defect, a left inferior altitudinal visual field deficit, bilateral nerve fiber layer infarcts and hemorrhages, and left optic disc elevation with edema of the nerve fiber bundle. Complete examination and laboratory studies revealed only a severe folate deficiency anemia. This is the first well-documented report of anterior ischemic optic neuropathy associated with anemia in the absence of other systemic abnormalities.     

缺血性视神经病变相关分子的病理机制

非动脉炎性前部缺血性视神经病变(NAION)是由于供应视盘筛板区的睫状后短动脉缺血引起,好发于50岁以上人群,以急性、单眼及无痛性视力下降为特征的急性视神经病变,常导致严重的永久视力损害和视野缺损,日益受到临床科研工作者的重视。本文从NAION发病机制、病理改变,以及既往研究中相关蛋白分子和易感基因方面综述了目前该病的分子病理机制,为今后研究NAION的病理机制及治疗提供理论依据。     

Bilateral posterior ischemic optic neuropathy after lumbar spine surgery

PURPOSE: To report a case of bilateral posterior ischemic optic neuropathy (PION) in a healthy young patient after lumbar spine surgery which was initially diagnosed as functional visual loss. DESIGN: Observational case report. PARTICIPANT: A 33-year-old woman who experienced visual loss in the immediate postoperative period after a lumbar spine fusion. TESTING: Serial visual field testing and fundus examinations, ERG. RESULTS: Bilateral PION was confirmed 2 months postoperatively with the development of bilateral optic disc pallor and a normal ERG. CONCLUSION: Young patients without vascular risk factors may develop bilateral PION after otherwise uncomplicated lumbar spine surgery. In subjects complaining of visual loss in the postoperative period who have a normal fundus and normal neuroimaging, a diagnosis of PION should be suspected, and close follow-up is warranted.