Optic neuropathy following COVID-19 vaccine / Neuropatia óptica após a vacina contra a COVID-19

ABSTRACT This case series describes four patients who presented with retinal and optic nerve vascular occlusions after administration of different COVID-19 vaccines. The first patient received the ChAdOx1 nCoV-19 vaccine (AZD1222; Oxford/AstraZeneca) and 42 days later developed central retinal artery occlusion. The second patient developed a painless visual impairment in the left eye and was diagnosed with anterior ischemic optic neuropathy 6 days after receiving the Sinovac-CoronaVac vaccine. The third patient presented with the same condition 22 days after receiving the third dose of the COVID-19 Pfizer (Comirnaty®) vaccine. The fourth patient developed bilateral retrobulbar optic neuritis after receiving the Oxford/AstraZeneca vaccine. The purpose of this case series is to discuss the possibility of a causal association between ischemic eye alterations and COVID-19 virus vaccination. Long-term follow-up and evaluation of similar cases will help elucidate the degree of the association between the vaccine and ischemic ocular events.

RESUMO Esta série de casos descreve quatro casos de pacientes que apresentaram oclusões vasculares de retina e nervo óptico após a administração de tipos diferentes de vacinas contra COVID-19. O primeiro paciente tomou a vacina ChAdOx1 nCoV-19 (AZD1222; Oxford/AstraZeneca) e 42 dias depois desenvolveu oclusão da artéria central da retina. O segundo paciente teve défice visual indolor no olho esquerdo após 6 dias da vacina Sinovac (CoronaVac) e foi diagnosticado com neuropatia óptica isquêmica anterior. O terceiro paciente apresentou o mesmo quadro após 22 dias da terceira dose da vacina COVID-19 Pfizer (Comirnaty®). O quarto paciente desenvolveu neurite óptica retrobulbar bilateral após vacina Oxford/AstraZeneca. O objetivo da nossa série de casos é discutir a possibilidade de correlação entre os quadros oculares isquêmicos e a vacinação contra a COVID-19. Nossos pacientes receberam vacinas contra COVID-19 com tecnologias diferentes e apresentaram quadros isquêmicos oculares relacionados temporalmente à vacinação. O acompanhamento e a avaliação a longo prazo de novos estudos semelhantes elucidarão o grau de associação entre a vacina e esse possível evento adverso.

Hemorragia peripapilar subretinal profunda como complicación asociada a drusen de nervio óptico / Deep subretinal peripapillary bleeding as a complication associated to optic nerve drusen

RESUMEN Los drusen de nervio óptico fueron descritos por primera vez por Liebreich en el año 1868. Otros términos para designar esta entidad incluyen cuerpos hialinos y cuerpos coloides del disco óptico. Tienen una prevalencia de 1 por 500 y el 60 por ciento de los casos se encuentran profundos en la cabeza del nervio óptico. La patogenia primaria de los drusen puede ser una displasia hereditaria del canal óptico del disco óptico y su vasculatura, lo que predispone a la formación de estos. La evolución natural de los drusen es un proceso dinámico que transcurre durante toda la vida. Entre las complicaciones asociadas se presentan defectos de campo visual, pérdida de visión central (rara pero bien documentada), neuropatía óptica isquémica, oclusiones vasculares retinales, pérdidas transitorias de la visión, neovascularización subretinal peripapilar, corioretinopatia serosa central peripapilar y hemorragias pre y peripapilares. Se presenta una paciente de 64 años de edad con antecedente de haber sido operada de desprendimiento de retina del ojo izquierdo, y en el ojo derecho presentaba una hemorragia peripapilar subretinal profunda asociada a drusen(AU)

ABSTRACT Optic nerve drusens were first described by Liebreich in the year 1868. Other terms to designate this condition are optic disc hyaline bodies and colloid bodies. They have a prevalence of 1 per 500 and 60 percent of the cases occur deep in the optic nerve head. The primary pathogenesis of drusens may be an inherited dysplasia of the optic canal of the disc and its vasculature, which leads to their formation. The natural evolution of drusens is a lifelong dynamic process. Associated complications include visual field defects, central vision loss (rare but well documented), ischemic optic neuropathy, retinal vascular occlusion, transient sight loss, peripapillary subretinal neovascularization, central serous peripapillary chorioretinopathy, and pre- and peripapillary bleeding. A case is reported of a 64-year-old female patient with a history of surgery for retinal detachment of the left eye. In the right eye the patient presented deep peripapillary subretinal bleeding associated to drusen(AU)

Perdas visuais agudas: uma revisão dos últimos 10 anos de causas não infecciosas e não maculares / Acute visual loss: a review from the last 10 years of non-infectious and non-macular causes

Objetivo: o conhecimento das principais causas de perda visual aguda possibilita o diagnóstico precoce do paciente, o que favorece o tratamento mais rápido e eficaz, a fim de preservar a acuidade visual. Neste artigo de revisão, as principais causas não infeciosas e não oriundas da mácula são abordadas, a fim de buscar e revisar os tópicos mais pertinentes sobre cada tema, como as manifestações clínicas e os tratamentos mais utilizados. Métodos: trata-se de uma revisão de literatura, com 30 artigos selecionados e revisados da plataforma MEDLINE. Resultados: as causas de perda visual aguda discutidas são cinco. Primeiro, as por baixa acuidade visual, súbita, unilateral, sem dor e sem hiperemia: hemorragia vítrea, descolamento de retina, oclusão vascular de retina e neuropatia óptica isquêmica anterior. Posteriormente, por baixa acuidade visual, súbita, unilateral, com dor e sem hiperemia: neurite óptica. Por meio deste estudo, alguns fatores de risco podem ser evidenciados e os principais tratamentos destacados. Conclusão: o diagnóstico precoce das perdas visuais agudas deve ser realizado, com os exames físicos adequados, como a fundoscopia e os exames complementares necessários solicitados. Além disso, o encaminhamento ao oftalmologista é de extrema importância para minimizar sequelas e evitar complicações.

Objective: The knowledge of the main causes of acute visual loss enables the early diagnosis of the patient, which favors faster and more effective treatment in order to preserve visual acuity. In this review article, the main non-infectious causes not originating from the macula are addressed in order to search and review the most relevant topics on each theme, such as the clinical manifestations and the most used treatments. Methods: This is a literature review with 30 articles selected and reviewed from the MEDLINE platform. Results: Five causes of acute visual loss are discussed. First, those for sudden, unilateral, without pain, and without hyperemia low visual acuity are reviewed: vitreous hemorrhage, retinal detachment, retinal vascular occlusion, and anterior ischemic optic neuropathy. Subsequently, one due to low visual acuity, sudden, unilateral, with pain and without hyperemia is evaluated: optic neuritis. Through this study, some risk factors and main treatments can be highlighted. Conclusion: The early diagnosis of acute visual loss should be performed with appropriate physical exams, such as fundoscopy and the necessary complementary exams. In addition, referral to an ophthalmologist is extremely important to minimize sequelae and avoid complications.

Landmark studies in neuro-ophthalmology

@#High-quality clinical evidence, derived from well-designed and implemented clinical trials, serves to advance clinical care and to allow physicians to provide the most effective treatments to their patients. The field of ophthalmology, including the subspecialty of neuro-ophthalmology, abounds with such high-quality clinical trials that provide Level 1 clinical evidence. This review article summarizes the research design, key findings, and clinical relevance of select monumental clinical studies in neuro-ophthalmology with the primary goal of providing the readers with the rationale for current standard of care of various neuro-ophthalmic diseases. This includes the Optic Neuritis Treatment Trial, Ischemic Optic Neuropathy Decompression Trial, Idiopathic Intracranial Hypertension Treatment Trial, Rescue of Hereditary Optic Disease Outpatient Study, and Controlled High-Risk Avonex® Multiple Sclerosis Study

Cushing Syndrome: A Potential Risk of Bilateral Postoperative Ischemic Optic Neuropathy after Lumbar Fusion / 대한신경손상학회지

This is a report of a 58-year-old female with Cushing syndrome who underwent posterior lumbar fusion and lost both her vision completely. She was diagnosed with posterior ischemic optic neuropathy. Cushingoid features such as buffalo hump and central obesity might have attributed in triggering posterior ischemic optic neuropathy. When laid prone for surgery, perioperative high abdominal pressure causes venous hypertension leading to increase amount of blood loss. To compensate, infusion of large quantities of intravenous fluids is necessary which leads to hemodilution which decreases ocular perfusion pressure. Hypercoagulability of Cushing syndrome is also potentially a risk factor of this condition which increases the incidence of venous thromboembolism. For there is no known effective treatment for posterior ischemic optic neuropathy, means to prevent this complication must be strategically reviewed. When performing long spine surgery on patient who has Cushing syndrome or cushingoid features, caution must be taken to avoid this devastating complication.

Arteritic Anterior Ischemic Optic Neuropathy Associated with Giant-Cell Arteritis in Korean Patients: A Retrospective Single-Center Analysis and Review of the Literature

BACKGROUND AND PURPOSE: The aim of this study is to report the relative incidence of arteritic anterior ischemic optic neuropathy (AAION) associated with giant-cell arteritis (GCA) in a single-center and evaluate the clinical features of AAION in Korean patients. METHODS: The medical records of patients with presumed AION who visited our hospital from January 2013 to August 2018 were examined retrospectively. The patients were divided into two groups: AAION associated with GCA, and non AION (NAION). We additionally reviewed the literature and identified all cases of AAION in Korean and Caucasian patients. We evaluated the clinical data including the initial and final best-corrected visual acuities, fundus photographs, visual field tests, fluorescein angiography, and contrast-enhanced MRI, and compared the data with those for Caucasian patients in the literature. RESULTS: Of the 142 patients with presumed AION, 3 (2.1%) were diagnosed with AAION and 139 (97.9%) were diagnosed with NAION. Seven Korean patients with AAION associated with GCA were identified in our data and the literature review. We found no difference in any clinical features other than laterality: four of the seven Korean patients had bilateral involvement. Moreover, the optic nerve sheath was enhanced in two of our Korean patients. CONCLUSIONS: AAION associated with GCA is a very rare condition compared to NAION in Korea. However, GCA should be considered in all cases of ischemic optic neuropathy because AAION is associated with poor visual outcome, and sometimes presents bilaterally.

The Function of the Fellow Eye in Patients with Unilateral Nonarteritic Anterior Ischemic Optic Neuropathy

PURPOSE: To investigate the function of the fellow eye in patients with unilateral nonarteritic anterior ischemic optic neuropathy (NAION). METHODS: From 2009 to March 2018, 18 patients with NAION who underwent bilateral visual field examinations and follow-up visits at least two times were enrolled in this study. Initial visual acuity, final visual acuity, degree of visual field defects, the cup-disc (C/D) ratio of the fellow eye, and the presence or absence of cardiovascular disease was retrospectively analyzed using medical records. RESULTS: The fellow eye mean best-corrected visual acuity was 0.03 ± 0.53 (logMAR) and the mean visual field defect was −4.68 ± 3.65 dB in 18 eyes of patients with unilateral NAION (p = 0.007 and p = 0.001, respectively). The C/D ratios were divided into two groups: > 0.3 and < 0.3. The visual field defect was improved significantly from −4.92 dB to −2.37 dB in the group with optic disc ratios < 0.3 (p = 0.013). When the changes in visual field defects were analyzed according to the presence or absence of cardiovascular disease, the visual field defects were improved from −5.65 dB to −4.49 dB in patients with cardiovascular disease, and improved from −3.69 dB to −1.46 dB in patients without cardiovascular disease (p = 0.025 and p = 0.021, respectively). CONCLUSIONS: In patients with unilateral NAION, reduced function in the fellow eye may appear temporarily, so a visual field examination should be performed in both eyes. The possibility of incipient NAION should be considered in patients with visual field abnormalities in the fellow eye.

Neuropatía úptica isquémica anterior unilateral asociada con ergotismo / Anterior unilateral ischemic optic neuropathy associated to ergotism

Case report of a patient with ergotism. ergotism is a complication of acute intoxication of chronic abuse of ergot derivates. Ergot is a fungus that grows on rye and less commonly on other grases such as wheat. Ergotism is a severe reaction to ergocontaminated food (such as rye bread). Ergot refers to a group of fungi of the genus Claviceps. It is a condition that develops of longterm ingestion of ergotamines. In excess, ergotamine can cause symptos such as hallucinations, severe gastrointestinal upset, a type-of dry gangrene and a pain-ful sensation in the extremities. Our patient is presented with anterior unilateral ischemic optic neuropathy. The studies performed and the clinical evaluatiion, are presented, and the treatment the same as the follow-up, are described in the article.

Bilateral Delayed Nonarteritic Anterior Ischemic Neuropathy Following Acute Primary Angle-closure Crisis

PURPOSE: We report a case of bilateral nonarteritic anterior ischemic optic neuropathy (NAION) following acute angle-closure crisis (AACC). CASE SUMMARY: A 76-year-old female visited our clinic because of a 1-day history of ocular pain and vision loss in both eyes. The visual acuity was 0.02 in both eyes and her intraocular pressure (IOP) was 52 mmHg in the right eye (RE) and 50 mmHg in the left eye (LE). She had corneal edema and a shallow anterior chamber in both eyes, with 4 mm fixed dilated pupils. After decreasing the IOP with intravenous mannitol, laser iridotomy was performed. However, 2 days later, visual acuity was further reduced to finger counting at 10 cm RE and at 50 cm LE, and her optic disc was swollen. Bilateral NAION following AACC was diagnosed. One month later, visual acuity slightly improved to 0.02 RE and 0.04 LE, and the optic disc edema resolved. A small cup-disc ratio, optic disc pallor, and atrophy were observed. Humphrey visual fields demonstrated superior and inferior altitudial visual field defects in the LE, and almost total scotoma in the RE. CONCLUSIONS: AACC can be a predisposing factor for NAION, so the relative afferent pupillary defect, papilledema, and presentation of other risk factors are important clues to a diagnosis of NAION.

Effective Delivery of Exogenous Compounds to the Optic Nerve by Intravitreal Injection of Liposome

PURPOSE: To improve the treatment efficiency of optic nerve diseases by delivering therapeutic materials to the optic nerve directly. METHODS: We tried to optimize liposomal composition to deliver a payload to the optic nerve efficiently when it is injected intravitreally. After loading dexamethasone into this liposome, we tested the therapeutic effect of liposomes in this treatment using a murine model of ischemic optic neuropathy. RESULTS: Our optimized liposome can deliver its payload to the optic nerve more efficiently than other tested compositions. Moreover, dexamethasone-loaded liposomes had a significant therapeutic effect in a murine model of ischemic optic neuropathy. CONCLUSIONS: Here, we demonstrate the optimal composition of liposomes that could efficiently deliver intravitreally injected exogenous compounds to the optic nerve. We expect that the intravitreal injection of liposomes with the suggested composition would improve the delivery efficacy of therapeutic compounds to the optic nerve.

Giant Cell Arteritis Associated Arteritic Anterior Ischemic Optic Neuropathy: Sudden Vision Loss on the Contralateral Side of Headache

No abstract available.

Bilateral optic neuropathy related to severe anemia in a patient with alcoholic cirrhosis: A case report and review of the literature

Anemia appears frequently in patients with alcoholic liver disease (ALD) but has never been linked to bilateral nonarteritic anterior ischemic optic neuropathy (NAION). A 65-year-old woman with a medical history of alcoholic cirrhosis was admitted for bilateral NAION. On admission, she was found to have a low arterial pressure and severe normocytic anemia (48 g/L). The anemia was related to chronic bleeding due to antral gastritis along with other factors associated with ALD. The applied treatment consisted of urgent transfusion followed by high doses of proton-pump inhibitors, iron and vitamin supplementation, and support in lifestyle measures. Her hemoglobin levels remained stable after 2 years but the patient still suffered from visual loss. This case highlights the link between anemia and bilateral NAION in ALD patients. The optic nerve head is prone to infarction in this context due to the vascularization characteristics of ALD. Hemoglobin levels should be monitored in ALD patients to avoid the severe complication of NAION.

Longitudinal Measurement of Hemodynamic Changes within the Posterior Optic Nerve Head in Rodent Nonarteritic Anterior Ischemic Optic Neuropathy / 中国医学科学杂志(英文版)

Objective To assess the in vivo dynamic blood flow features of posterior optic nerve head (ONH) in rat model of nonarteritic anterior ischemic optic neuropathy (rNAION). Methods rNAION was established with Rose Bengal and argon green laser in Sprague-Dawley rats. Fundus photography and fundus fluorescein angiography (FFA) were performed to assess the dynamic changes of optic disc in morphology in 90 days and in blood perfusion in 3 hours after the induction of disease. Histological examinations were performed to evaluate the success of modeling. The dynamic blood flow kinetics of posterior ONH in rNAION were measured by Laser Doppler Flowmetry (LDF) on the day 3, 7, 14, 21, and 40 after the disease induction. One-way ANOVA, Student's t-test and Bonferroni adjustment were used for multiple comparisons of kinetic measurements of blood flow. Results Optic disc edema and subsequent resolution associated with the development of optic disc pallor were observed in rNAION. FFA showed that the optic disc was hypofluorescence in the early phase and hyperfluorescence in the late phase. Histological studies suggested edema and loosened tissues of ONH, loss of retinal ganglion cells (RGCs), optic nerve substance and gliosis. Compared to the naive rats, the blood flow kinetics of posterior ONH in rNAION significant reduced at each time point after modeling (F=175.06, PConclusions Continuous blood perfusion reduction was found in rNAION, with significant alteration in 14 days after disease induction. Our results provided important information for understanding the hemodynamic changes in rNAION.

Neutrophil to Lymphocyte Ratio in Patients with Nonarteritic Anterior Ischemic Optic Neuropathy

PURPOSE: To evaluate the neutrophil to lymphocyte ratio (NLR) in patients with nonarteritic anterior ischemic optic neuropathy (NAION). METHODS: We investigated 112 subjects comprising 56 patients with NAION and 56 healthy controls at Süleyman Demirel University. Complete blood count, demographic, and clinic data from NAION patients were evaluated in this study. The NLR was calculated in all individuals and compared between the patient and control groups. Cut-off values were also determined. Then, the relationship between NLR and visual outcomes was investigated. RESULTS: The cut-off value for NLR was 1.64. NLR values were significantly higher in NAION patients than in healthy subjects (p < 0.001) and were directly correlated with erythrocyte sedimentation rate levels (r = 0.263, p = 0.006). Also, the NLR value was associated with visual outcomes. Receiver operator characteristic curve analysis revealed a 0.63 area under the curve (confidence interval, 53.7% to 74.1%), 85% sensitivity and 41% specificity at the cut-off NLR value. CONCLUSIONS: The NLR may be a biomarker with good sensitivity that is quick, cost effective and easily detected in serum. It can be used in clinical practice to predict a NAION patient's prognosis in terms of visual outcomes.

Diffusion-Weighted MRI Findings of Ischemic Optic Neuropathy

No abstract available.

Bilateral Arteritic Anterior Ischemic Optic Neuropathy Associated with Giant Cell Arteritis in Korea

No abstract available.

Therapeutic Effect of Steroids in Patients with Non-arteritic Anterior Ischemic Optic Neuropathy

PURPOSE: To investigate the effect of steroid treatment (intravenous injection, oral) in patients with non-arteritic anterior ischemic optic neuropathy (NAION). METHODS: From January, 2005 to December, 2016, 41 patients who were diagnosed with NAION and observed for more than 6 months were included in this study. The treatment was decided based on patient's choice after explaining the advantages and disadvantages of steroid therapy. The patients were divided into three groups (intravenous steroid injection, oral steroid, no treatment). Initial visual acuity, final visual acuity, degree of visual field defect, fluorescein angiography, visual evoked potential and brain magnetic resonance imaging were analyzed by chart review. RESULTS: The chief complaints of the 41 NAION patients at the first visit were decreased visual acuity (n = 24), visual field defect (n = 10), no symptoms (n = 4), diplopia (n = 2), and floaters (n = 1). The distribution of the patients according to steroid administration method was 15 patients with intravenous steroid injection, 14 patients with oral steroid and 12 patients with no treatment. The improvement in visual acuity was greatest in intravenous steroid injection (87%), oral steroid (43%) and no treatment (33%) in that order. CONCLUSIONS: In a retrospective comparison of treatment effects after explaining the advantages and disadvantages of steroid therapy in patients with NAION, the intravenous steroid injection group showed 87% improvement in visual acuity and an odds ratio of 5.5 (95% confidence interval [CI] 1.05–28.88, p-value 0.04), while the oral steroid group showed 43% improvement and an odds ratio of 1.5 (95% CI 0.30–7.43, p-value 0.62). The steroid treatment group showed better visual acuity improvement than the no treatment group, and the intravenous steroid injection group showed 5.5 times greater improvement in visual acuity compared to the no treatment group.

Nonarteritic anterior ischemic optic neuropathy following pars plana vitrectomy for macular hole treatment: case report / Neuropatia óptica isquêmica anterior não arterítica pós vitrectomia pars plana para tratamento do buraco macular: relato de caso

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.

Arteritic Anterior Ischemic Optic Neuropathy Associated with Giant Cell Arteritis in an Elderly Korean Man

No abstract available.

Uremic Optic Neuropathy in Chronic Renal Failure

PURPOSE: To report a case of uremic optic neuropathy occurring in a patient with chronic renal failure. CASE SUMMARY: A 40-year-old male who was diagnosed with chronic renal failure and treated with peritoneal dialysis and hemodialysis for 17 years presented with blurred vision and a moving pain in his left eye for 2 days. The best corrected visual acuity (BCVA) was 0.2 in his left eye, and an inferior altitudinal visual field defect was noted on Humphrey perimetry. Fundus examination and optical coherence tomography showed optic disc swelling in his left eye; the right eye was unremarkable. These findings were compatible with a diagnosis of uremic optic neuropathy or anterior ischemic optic neuropathy of his left eye. After treatment of hemodialysis and intravenous high dose steroid pulse therapy, the BCVA in his left eye was 0.8. However, since he refused oral steroid maintenance therapy, his BCVA later decreased to 0.4. After treatment with subtenon triamcinolone injection, the BCVA in his left eye was 1.0 and showed a stable disease course. CONCLUSIONS: When patient with chronic renal failure presents with acute decrease in visual acuity and visual field defect, optic neuropathies including uremic optic neuropathy should be considered and prompt hemodialysis and systemic steroid treatment should be done.