ABSTRACT
ABSTRACT Herein, we report a case of nonarteritic anterior ischemic optic neuropathy (NAION) following uneventful pars plana vitrectomy for macular hole treatment. A 56-year-old previously healthy woman presented with a full-thickness macular hole in right eye (OD) and small cup-to-disc ratios in both eyes. Five days after surgery, she noticed sudden painless loss of vision in OD and was found to have an afferent pupillary defect and intraocular pressure of 29 mmHg. Fundus examination showed right optic disc edema and the resolution of a macular hole with an inferior altitudinal visual field defect. Erythrocyte sedimentation rate, C-reactive protein levels, and general physical examination findings were normal. She was treated with hypotensive eyedrops and oral prednisone, resulting in mild visual improvement and a pale optic disc. A combination of face-down position and increased intraocular pressure due to a small optic disc cup were considered as potential mechanisms underlying NAION in the present case. Vitreoretinal surgeons should be aware of NAION as a potentially serious complication and be able to recognize associated risk factors and clinical findings.
RESUMO Nosso objetivo é descrever a ocorrência de neuropatia óptica isquêmica anterior não-arterítica (NOIA-NA) após vitrectomia posterior para tratamento do buraco macular. Uma mulher de 56 anos de idade previamente hígida apresentou buraco macular de espessura total no olho direito (OD) e uma relação escavação disco pequena em ambos os olhos. No quinto dia de pós-operatório ela notou uma perda visual súbita e indolor OD associado a presença de um defeito pupilar aferente relativo e pressão intraocular de 29 mmHg neste mesmo olho. A avaliação do fundo de olho revelou a presença de edema de disco óptico e buraco macular fechado OD associado a presença de defeito de campo visual altitudinal inferior. A velocidade de hemossedimentação e a dosagem da proteína C reativa foram normais, assim como o exame físico geral. A paciente foi tratada com colírios hipotensores e prednisona oral e evoluiu com discreta melhora visual e palidez de disco óptico. Acreditamos que a combinação de posição de cabeça virada para baixo associado a um aumento da pressão intraocular em um paciente com relação escavação disco pequena são os possíveis mecanismos para a ocorrência de NOIA-NA neste presente caso. Os cirurgiões de retina e vítreo devem estar atentos a esta possível grave complicação e reconhecer os seus fatores de risco relacionados assim como sua apresentação clinica.
Subject(s)
Humans , Female , Middle Aged , Retinal Perforations/surgery , Vitrectomy/adverse effects , Vitrectomy/methods , Optic Neuropathy, Ischemic/etiology , Optic Neuropathy, Ischemic/pathology , Postoperative Complications/etiology , Visual Acuity , Visual Fields , Treatment Outcome , Optic Neuropathy, Ischemic/drug therapy , Optic Neuropathy, Ischemic/diagnostic imaging , Tomography, Optical Coherence , Fundus Oculi , Intraocular PressureABSTRACT
Ischemic optic neuropathies (IONs) consist primarily of two types: anterior ischemic optic neuropathy (AION) and posterior ischemic optic neuropathy (PION). AION comprises arteritic AION (A-AION: due to giant cell arteritis) and non-arteritic AION (NA-AION: due to other causes). PION consists of arteritic PION (A-PION: due to giant cell arteritis), non-arteritic PION (NA-PION: due to other causes), and surgical PION (a complication of several systemic surgical procedures). These five types of ION are distinct clinical entities etiologically, pathogenetically, clinically and from the management point of view. In the management of AION, the first crucial step with patients aged 50 and over is to identify immediately whether it is arteritic or not because A-AION is an ophthalmic emergency and requires urgent treatment with high-dose steroid therapy to prevent any further visual loss in one or both eyes. Patients with NA-AION, when treated with systemic corticosteroid therapy within first 2 weeks of onset, had significantly better visual outcome than untreated ones. Systemic risk factors, particularly nocturnal arterial hypotension, play major roles in the development of NA-AION; management of them is essential in its prevention and management. NA-PION patients, when treated with high-dose systemic steroid therapy during the very early stages of the disease, showed significant improvement in visual acuity and visual fields, compared to untreated eyes. A-PION, like A-AION, requires urgent treatment with high-dose steroid therapy to prevent any further visual loss in one or both eyes. There is no satisfactory treatment for surgical PION, except to take prophylactic measures to prevent its development.
Subject(s)
Dose-Response Relationship, Drug , Emergency Medical Services , Giant Cell Arteritis/complications , Humans , Optic Neuropathy, Ischemic/classification , Optic Neuropathy, Ischemic/complications , Optic Neuropathy, Ischemic/drug therapy , Optic Neuropathy, Ischemic/etiology , Postoperative Complications , Risk Factors , Steroids/administration & dosage , Vision Disorders/etiology , Vision Disorders/physiopathology , Visual Acuity/drug effects , Visual Fields/drug effectsABSTRACT
The purpose of this case report is to evaluate the visual outcome of an intravitreal triamcinolone acetonide injection (IVTA) as a treatment for a patient with acute nonarteritic anterior ischemic optic neuropathy (NAION). A 65-year-old male patient with severe visual loss due to acute NAION was treated with 4 mg/0.1mL IVTA. Fundus examination and measurements of the patient's best-corrected visual acuity and visual field were performed before and after the injection at 2 weeks, 1 month, 3 months, and 6 months. The best-corrected visual acuity changed from 0.05 before the injection to 0.16 at 2 weeks, 0.3 at 1 month, and 0.4 at 3 months and at the final visit. Optic disc swelling had markedly decreased at 1 week postoperatively and disappeared at 2 weeks after the injection. The clinical course of this patient suggests that an IVTA may be effective in increasing visual acuity following an acute NAION. A large randomized controlled trial is needed to assess the efficacy of IVTA as a treatment for NAION.
Subject(s)
Aged , Humans , Male , Acute Disease , Diagnosis, Differential , Fluorescein Angiography , Follow-Up Studies , Fundus Oculi , Glucocorticoids/administration & dosage , Injections , Ophthalmic Solutions , Optic Neuropathy, Ischemic/drug therapy , Triamcinolone Acetonide/administration & dosage , Visual Acuity , Visual Fields , Vitreous BodyABSTRACT
Descreve-se uma paciente com diagnóstico de poliarterite nodosa, em tratamento com citostáticos e corticosteróides que desenvolveu neuropatia óptica isquêmica anterior, uma manifestacão considerada bastante rara para esta doenca.
Subject(s)
Humans , Female , Adult , Optic Neuropathy, Ischemic/etiology , Polyarteritis Nodosa/complications , Anti-Inflammatory Agents/administration & dosage , Cyclophosphamide/administration & dosage , Drug Therapy, Combination , Immunosuppressive Agents/administration & dosage , Optic Neuropathy, Ischemic/diagnosis , Optic Neuropathy, Ischemic/drug therapy , Polyarteritis Nodosa/drug therapy , Prednisolone/administration & dosageABSTRACT
La etiopatogenia de la papilopatía diabética es incierta. La neuropatía óptica isquémica anterior (NOIA) determina alteración visual irreversible; puede presentarse en jóvenes en forma recurrente y entre sus causas se reconoce a la diabetes mellitus. Se presenta un paciente diabético con diagnóstico de papilopatía bilateral, con cuadrantopsia inferonasal de ambos ojos, persistente por más de 12 meses, y en directa relación con no perfusión angiográfica en cuadrantes superotemporales de ambas papilas. Y otro caso de paciente que inicia su enfermedad con papilopatía tipo NOIA, y que su estudio determina diabetes mellitus. Se concluye que en algunos casos de papilopatía diabética puede existir relación directa con NOIA
Subject(s)
Humans , Male , Middle Aged , Diabetes Mellitus/complications , Optic Neuropathy, Ischemic/complications , Papilledema/etiology , Optic Neuropathy, Ischemic/drug therapy , Optic Disk , Papilledema/complications , Papilledema/diagnosis , Prednisone/therapeutic useABSTRACT
A neuropatia óptica isquêmica resulta do infarto da porçäo anterior do nervo óptico. As causas mais comuns säo a artrite de células gigantes e a arteriosclerose. Outras causas incluem vasculites (lúpus eritematoso sistêmico, poliarterite nodosa) e vasculopatias sistêmicas. Os autores relatam um caso de neuropatia óptica isquêmica associado a lúpus eritematoso sistêmico em um paciente que apresentou perda súbita de visäo, acompanhado pelo quadro clínico de papilopatia isquêmica. É enfatizada a importância do diagnóstico diferencial precoce, porque a neuropatia de origem arterítica, se näo tratada adequada e rapidamente, leva inevitavelmente à cegueira