Erythropoietin in Recurrent Anterior Ischaemic Optic Neuropathy

A 44-year-old man suffered sequential episodes of anterior ischaemic optic neuropathy in first the left and then right eye. He had suffered a previous episode of anterior ischaemic optic neuropathy in the right eye. Recent studies have shown neuroprotective properties of erythropoietin. Based on our previous studies on erythropoietin in anterior ischaemic optic neuropathy, we used intravenous erythropoietin in this patient. The patient received intravenous human recombinant erythropoietin. Visual functions significantly improved following treatment. Intravenous erythropoietin, as a neuroprotective agent, may herald a new modality of treatment in anterior ischaemic optic neuropathy.     

Choroidal Vascularity in Non-arteritic Anterior Ischaemic Optic Neuropathy

This study evaluates the peripapillary choroidal vascularity in eyes with non-arteritic anterior ischaemic optic neuropathy (NAION) and compares it with the vascularity of healthy fellow eyes and age-matched subjects. The peripapillary choroidal vascularity index (CVI), a new tool of measurement, was calculated using horizontal swept-source optical coherence tomography scans. CVI was calculated using a previously validated automated algorithm. CVI in NAION and fellow eyes of NAION patients were compared with age-matched eyes of healthy individuals using Kruskal–Wallis test. A total of 20 eyes of 20 patients with acute unilateral NAION with healthy fellow eyes (20 eyes) and 40 eyes of 40 healthy patients were included in the study. The average age of patients with NAION was 56 ± 8 and 55 ± 7 years in age-matched healthy controls. NAION eyes had a significantly lower CVI than age-matched controls in both nasal and temporal areas. NAION nasal CVI was 0.47 ± 0.47 compared to 0.62 ± 0.04 in controls (p < 0.001). NAION temporal CVI was 0.45 ± 0.48 compared to 0.58 ± 0.04 in controls (p < 0.001). Temporal CVI was 0.45 ± 0.48 in NAION eyes and was significantly lower than counterpart healthy fellow eyes 0.48 ± 0.02 (p = 0.007). In conclusion, NAION eyes have significantly reduced vascularity in the peripapillary area. CVI is lower in the nasal and temporal of the optic disc compared to healthy individuals. This may suggest those with smaller CVI are more prone to ischaemia from reduced vascularity resulting in NAION.     

Non-arteritic Anterior Ischaemic Optic Neuropathy after Uneventful Cataract Extraction

We present the case of a 74-year-old Caucasian female who suffered sudden visual loss after routine phacoemulsification cataract surgery. The patient was subsequently diagnosed with non-arteritic anterior ischaemic optic neuropathy. The case is described in detail, and a concise review of the literature is presented together with the authors’ view on the subject outlined. This is a very rare complication after cataract surgery even in high-risk patients with associated systemic co-morbidities. We suspect that the previous history of obesity, coronary artery disease, and arteriosclerosis contributed to the development of this serious ocular complication. We suggest appropriate measures to reduce the risk of its occurrence.     

Bilateral Simultaneous Nonarteritic Anterior Ischaemic Optic Neuropathy: Case Report

Abstract

Bilateral simultaneous nonarteritic anterior ischaemic optic neuropathy (NAION) is extremely rare. A 57-year-old woman presented with bilateral optic disc oedema and peripapillary splinter haemorrhages. Initial visual acuities were hand movements in the right eye and light perception in the left eye. The patient had a mildly elevated diastolic blood pressure and glucose intolerance. Erythrocyte sedimentation rate and C-reactive protein levels were within normal limits. Temporal artery biopsy was negative for temporal arteritis. Marked visual improvement occurred in both eyes (0.8 in the right eye, 0.6 in the left eye) after systemic steroid therapy in the 16th month of follow-up.     

Adalimumab and Non-Arteritic Anterior Ischaemic Optic Neuropathy: A Case Report

Abstract

Sequential anterior ischaemic optic neuropathy was observed in a patient treated with a tumour necrosis factor α (TNF) inhibitor, adalimumab, for ankylosing spondylitis. He developed decreased visual acuity in the right eye after 17 months of treatment. Findings showed right optic disc oedema with haemorrhages and visual field defect. Adalimumab was discontinued and vision stabilised. After restarting adalimumab, he developed optic neuropathy in the left eye. Findings showed optic disc oedema, with haemorrhages and visual field changes in the left eye. Adalimumab may be associated with optic neuropathy; providers prescribing TNF inhibitors should be aware of optic neuropathy as a potential complication.     

Adalimumab and Non-Arteritic Anterior Ischaemic Optic Neuropathy: A Case Report

Sequential anterior ischaemic optic neuropathy was observed in a patient treated with a tumour necrosis factor α (TNF) inhibitor, adalimumab, for ankylosing spondylitis. He developed decreased visual acuity in the right eye after 17 months of treatment. Findings showed right optic disc oedema with haemorrhages and visual field defect. Adalimumab was discontinued and vision stabilised. After restarting adalimumab, he developed optic neuropathy in the left eye. Findings showed optic disc oedema, with haemorrhages and visual field changes in the left eye. Adalimumab may be associated with optic neuropathy; providers prescribing TNF inhibitors should be aware of optic neuropathy as a potential complication.     

Posterior Vitreous Detachment Associated with Non-arteritic Ischaemic Optic Neuropathy

It has been hypothesised that non-arteritic ischaemic optic neuropathy is caused by vitreous traction on the optic nerve. The authors recently took care of a patient who developed a posterior vitreous detachment shortly after she was diagnosed with non-arteritic ischaemic optic neuropathy. Her visual field spontaneously improved after the posterior vitreous detachment. This case report provides some evidence that non-arteritic ischaemic optic neuropathy, vitreous traction, and posterior vitreous detachment may be related.     

Silent Post Cataract Bilateral Sequential Nonarteritic Anterior Ischaemic Optic Neuropathy

Nonarteritic anterior ischaemic optic neuropathy (NAION) has been reported as a rare occurrence following cataract surgery. Bilateral sequential NAION following cataract surgery is extremely rare. We report an 83-year-old male who developed bilateral sequential NAION within 5 and 3 weeks of undergoing uneventful cataract surgeries in each eye. A brief review of the literature on this topic is provided. This case serves to add to the ongoing debate about the association between cataract surgery and NAION.     

Risk Factors for Non-arteritic Anterior Ischaemic Optic Neuropathy in a Korean Population

To determine the risk factors for non-arteritic anterior ischaemic optic neuropathy (NAION) in Korean patients, medical records from 45 Korean patients group and 45 healthy controls group were retrospectively reviewed. 10 NAION risk factors, including age, sex, associated systemic disease, past medical/social history, and fundus findings were analyzed. Significant risk factors for NAION in Korean patients were diabetes mellitus (odds ratio (OR) = 3.613, p = 0.020), hypercholesterolaemia (OR = 5.200, p = 0.001), smoking (OR = 3.58, p = 0.014), microaneurysm/haemorrhage (OR = 5.375, p = 0.024), and crowded small cup (OR = 17.200, p < 0.001).     

Optic Disc Cupping in Arteritic Anterior Ischemic Optic Neuropathy Resembles Glaucomatous Cupping

Five cases of anterior ischemic optic neuropathy secondary to biopsy-proven giant cell arteritis are presented. In each case, cupping of the optic disc, which closely resembled glaucomatous cupping, was observed in the affected eye. The presence of glaucoma was ruled out on the basis of normal intraocular pressures and normal tonographic measurements of facility of outflow. These cases indicate that arteritic ischemic optic neuropathy can result in optic disc cupping, which closely resembles glaucomatous cupping. The similarities in the appearance of cupping of these discs with that seen in eyes with glaucoma suggest that the pathogenesis of cupping in glaucoma and in arteritic ischemic optic neuropathy may share some common mechanisms.     

Bilateral Inflammatory Optic Neuropathy Related to Graft versus Host Disease Following Allogeneic Bone Marrow Transplantation for Hodgkin Disease

Graft versus host disease (GvHD) is a common and often troublesome complication of allogeneic bone marrow transplantation. Neurological complications usually involve the peripheral nervous system and muscle, but the central nervous system may be affected. When an optic neuropathy develops, it is often difficult to determine the cause quickly; infective complications and drug toxicity may have arisen, but an inflammatory disorder due to GvHD should also be considered, particularly since treatment with steroids and immune suppression may improve the outcome significantly. This brief case report shows how this may be the case and reviews our current understanding of the pathophysiology and treatment of the disorder within the nervous system.     

Bilateral Inflammatory Optic Neuropathy Related to Graft versus Host Disease Following Allogeneic Bone Marrow Transplantation for Hodgkin Disease

Abstract

Graft versus host disease (GvHD) is a common and often troublesome complication of allogeneic bone marrow transplantation. Neurological complications usually involve the peripheral nervous system and muscle, but the central nervous system may be affected. When an optic neuropathy develops, it is often difficult to determine the cause quickly; infective complications and drug toxicity may have arisen, but an inflammatory disorder due to GvHD should also be considered, particularly since treatment with steroids and immune suppression may improve the outcome significantly. This brief case report shows how this may be the case and reviews our current understanding of the pathophysiology and treatment of the disorder within the nervous system.     

Decompensated Strabismus after Bilateral Perioperative Ischaemic Optic Neuropathy with Subsequent Recovery

Diplopia occurred in a patient who suffered peri-operative bilateral anterior ischaemic optic neuropathy. It is hypothesized that this occurred because of non-overlapping residual visual fields, as has been described in cases of bitemporal hemianopia. The symptom of diplopia resolved following some recovery of vision which resulted in a binocularly overlapping visual field region.     

Bilateral Sequential Anterior Ischaemic Optic Neuropathy After Coronary Artery Bypass Surgery

ABSTRACT

A 63 year-old man underwent coronary artery bypass surgery. The day following the surgery he complained of blurred vision in the lower-half of the visual field of his left eye. Two days after the surgery blurred vision also developed in his right eye. Sequential involvement of the eyes and elevation of the erythrocyte sedimentation rate led to consideration of a diagnosis of arteritic anterior ischaemic optic neuropathy. A temporal artery biopsy was performed to rule out giant cell arteritis which was negative and a final diagnosis of non-arteritic anterior ischaemic optic neuropathy was made. This case emphasizes that sequential involvement of the eyes may be seen in patients with non-arteritic anterior ischaemic optic neuropathy associated with non-ocular surgery although simultaneous involvement is more commonly seen in this situation.     

Central Retinal Vein Occlusion in a Childhood Optic Nerve Tumour

The authors describe the first paediatric patient with an aggressive optic nerve tumour of uncertain histology causing a central retinal vein occlusion, retinochoroidal collaterals, arteriovenous anastomoses, and peripheral retinal non-perfusion. He first presented with pale optic nerve head, followed by development of optic disc oedema a year later. Certain optic nerve tumours can present with central retinal vein occlusion in the paediatric age group.     

Comparison of Ishihara and Hardy-Rand-Rittler Pseudoisochromatic Plates in Non-Arteritic Anterior Ischaemic Optic Neuropathy

Pseudoisochromatic plates, such as Ishihara and Hardy-Rand-Rittler (HRR) tests, are designed as screening tools to test colour vision defects. The tests are often designed to detect congenital red-green colour blindness and their measurement properties for acquired optic neuropathies are not known. The aim of this study is to determine the sensitivity and specificity of Ishihara and HRR pseudoisochromatic plates in detecting dyschromatopsia in patients with unilateral non-arteritic anterior ischaemic optic neuropathy. Nineteen such patients were tested using Ishihara and the HRR plates in the affected and the unaffected (control) eye. The results were correlated to that on an anomaloscope (Oculus HMC Anomaloskop MR^®). Mild deuteranomaly was the dyschromatopsia detected by an anomaloscope in the affected eye of the patients. The sensitivity and specificity of the Ishihara test in the affected eyes are 75% and 40%, respectively. The sensitivity and specificity of the HRR test in eyes affected with non-arteritic anterior ischaemic optic neuropathy are 100% and 20%, respectively. It is concluded that the anomaloscope that was considered the “gold standard” has several limitations and may not detect all acquired dyschromatopia. On the other hand, whilst it is correct that pseudoisochromatic plates are screening tests and the results must be correlated with other optic nerve functions, the HRR test has a higher sensitivity and specificity than Ishihara colour plates in detecting dyschromatopsia in non-arteritic anterior ischaemic optic neuropathy eyes.     

Changes in Visual Function over Time in Koreans with Non-arteritic Anterior Ischaemic Optic Neuropathy

Non-arteritic anterior ischaemic optic neuropathy (NAION) causes severe visual loss in elderly patients. However, there are not much data of clinical course of NAION in Asian patients. To evaluate changes in visual acuity and visual field defects associated with non-arteritic anterior ischaemic optic neuropathy (NAION) among Korean patients, the medical records of 50 eyes from 43 patients with NAION patients seen from 1989 to 2011 were reviewed. A significant change in visual acuity was defined as a three-line change in Snellen acuity. Visual field defects were evaluated with Goldmann perimetry. Changes in the visual field were evaluated using the grid method. Thirty-eight percent of eyes showed improvement, 54% showed no change, and 8% showed deterioration of visual acuity at the last follow-up. Thirty-four percent of eyes showed improvement, 54% showed no change, and 12% showed deterioration of the visual field at the last follow-up. Most improvement in visual acuity occurred during the first month after the initial visit and in visual field between the first and third months of follow-up. The prognosis of visual acuity in association with NAION was worse in Korean patients as compared with Western studies. However, improved prognosis of visual field defects might come from the use of different methods for evaluation of the visual field.     

Anterior Ischaemic Optic Neuropathy (AION) Associated with Post Dialysis Hypotension

Three patients on haemodialysis presented with acute painless visual loss. From each, a comprehensive medical and ophthalmic history was taken and each underwent a complete ophthalmic examination. Visual evaluation was carried out by recording Snellen visual acuities, Ishihara colour test scores, the presence of a relative afferent pupillary defect (RAPD) and visual fields with either Goldmann or Humphrey perimetry. Review of renal case notes was performed and appropriate laboratory investigations including imaging were carried out to investigate the cause of disc swelling in all cases. All cases presented with acute painless visual loss, a RAPD, disc swelling, impaired colour vision and a visual field defect. All cases had a history of post-dialysis hypotension. In 2 cases, post-dialysis hypotension was documented just prior to the development of anterior ischaemic optic neuropathy (AION) suggesting a causal relationship. Falls in mean arterial pressure (MAP) of 31 and 22 mmHg were recorded. None of the cases had other well documented risk factors for AION such as diabetes or hypercholesterolaemia. One case had crowded discs. Two cases had bilateral involvement. Two cases were treated with corticosteroids and 1 with aspirin. Visual improvement was noted in 1 case coincident with corticosteroid treatment. Common risk factors in all 3 cases were anaemia and post-dialysis hypotension. In conclusion, patients undergoing haemodialysis may be at risk of AION particularly if they are anaemic and develop post-dialysis hypotension. They should be informed of a small and unpredictable risk of visual loss.     

Changes in Visual Function over Time in Koreans with Non-arteritic Anterior Ischaemic Optic Neuropathy

Abstract

Non-arteritic anterior ischaemic optic neuropathy (NAION) causes severe visual loss in elderly patients. However, there are not much data of clinical course of NAION in Asian patients. To evaluate changes in visual acuity and visual field defects associated with non-arteritic anterior ischaemic optic neuropathy (NAION) among Korean patients, the medical records of 50 eyes from 43 patients with NAION patients seen from 1989 to 2011 were reviewed. A significant change in visual acuity was defined as a three-line change in Snellen acuity. Visual field defects were evaluated with Goldmann perimetry. Changes in the visual field were evaluated using the grid method. Thirty-eight percent of eyes showed improvement, 54% showed no change, and 8% showed deterioration of visual acuity at the last follow-up. Thirty-four percent of eyes showed improvement, 54% showed no change, and 12% showed deterioration of the visual field at the last follow-up. Most improvement in visual acuity occurred during the first month after the initial visit and in visual field between the first and third months of follow-up. The prognosis of visual acuity in association with NAION was worse in Korean patients as compared with Western studies. However, improved prognosis of visual field defects might come from the use of different methods for evaluation of the visual field.     

Bilateral Non-arteritic Anterior Ischaemic Optic Neuropathy as the Presentation of Systemic Amyloidosis

A 75-year-old hypertensive female with stable idiopathic intermediate uveitis presented with bilateral sequential optic neuropathy with optic disc swelling. The optic neuropathy in the first affected eye (right) was thought to be due to non-arteritic anterior ischaemic optic neuropathy (NAION). Asymptomatic left optic disc swelling was found at routine review 2 months later, and a diagnosis of giant cell arteritis (GCA) was sought. Temporal artery duplex ultrasound showed the “halo sign,” but a subsequent temporal artery biopsy showed light-chain (AL) amyloidosis with no signs of giant cell arteritis. In this case, bilateral sequential ischaemic optic neuropathy mimicking non-arteritic anterior ischaemic optic neuropathy was the presenting sign of systemic amyloidosis involving the temporal arteries.