Non-arteritic anterior ischemic optic neuropathy secondary to Posner-Schlossman syndrome in a twenty-six-year-old female.

Purpose: To describe a case of non-arteritic ischemic optic neuropathy (NAION) secondary to Posner-Schlossman syndrome in a twenty-six-year-old female. Observations: A 26-year-old female presented with painful visual loss of the left eye, elevated intraocular pressure of 38 mmHg, and trace to 1+ anterior chamber cell. Diffuse optic disc edema in the left eye and a small cup-to-disc ratio of the right optic disc were evident. Magnetic resonance imaging was unremarkable. Conclusions and Importance: The patient was diagnosed with NAION secondary to Posner-Schlossman syndrome, an uncommon ocular entity that can significantly affect vision. Posner-Schlossman syndrome can cause a decrease in ocular perfusion pressure involving the optic nerve and can lead to ischemia, swelling, and infarction. NAION should be considered in the differential diagnosis of young patients with sudden development of optic disc swelling and increased intraocular pressure with normal magnetic resonance imaging findings.

Comparison of peripapillary retinal nerve fiber layer loss and visual outcome in fellow eyes following sequential bilateral non-arteritic anterior ischemic optic neuropathy.

AIM: To report on the correlation of structural damage to the axons of the optic nerve and visual outcome following bilateral non-arteritic anterior ischemic optic neuropathy. METHODS: A retrospective review of the medical records of 25 patients with bilateral sequential non-arteritic anterior ischemic optic neuropathy was performed. Outcome measures were peripapillary retinal nerve fiber layer thickness measured with the Stratus optical coherence tomography scanner, visual acuity and visual field loss. RESULTS: Median peripapillary retinal nerve fiber layer (RNFL) thickness, mean deviation (MD) of visual field, and visual acuity of initially involved NAION eyes (54.00 µm, -17.77 decibels (dB), 0.4, respectively) were comparable to the same parameters measured following development of second NAION event in the other eye (53.70 µm, p = 0.740; -16.83 dB, p = 0.692; 0.4, p = 0.942, respectively). In patients with bilateral NAION, there was a significant correlation of peripapillary RNFL thickness (r = 0.583, p = 0.002) and MD of the visual field (r = 0.457, p = 0.042) for the pairs of affected eyes, whereas a poor correlation was found in visual acuity of these eyes (r = 0.279, p = 0.176). Peripapillary RNFL thickness following NAION was positively correlated with MD of visual field (r = 0.312, p = 0.043) and negatively correlated with logMAR visual acuity (r = -0.365, p = 0.009). CONCLUSION: In patients who experience bilateral NAION, the magnitude of RNFL loss is similar in each eye. There is a greater similarity in visual field loss than in visual acuity between the two affected eyes with NAION of the same individual.

Long-term retinal nerve fiber layer changes following nonarteritic anterior ischemic optic neuropathy.

BACKGROUND: In cases of nonarteritic anterior ischemic optic neuropathy (NAION), retinal nerve fiber layer (RNFL) thickness changes have been described during the first 12 months following the acute event. The purpose of this study was to report on the long-term RNFL changes in these eyes beyond the first year following onset of NAION. METHODS: Fourteen eyes of 13 patients with NAION were analyzed in this retrospective observational case series study. Uninvolved eyes served as controls. All patients underwent a complete neuro-ophthalmological examination and repeat measurements of peripapillary RNFL thickness using Stratus optical coherence tomography. RESULTS: On optical coherence tomography scan performed on average 6 months following onset of NAION, the mean global RNFL thickness (59.8 ± 11.8 µm) was significantly thinner (P < 0.001) compared with uninvolved eyes (95.1 ± 13.9 µm). In a second optical coherence tomography scan performed on average 13 (range 12-23) months later, the mean global RNFL thickness (58.9 ± 6.5 µm) was not significantly different (P = 0.702) from the first scan. CONCLUSION: There appears to be no further RNFL loss beyond the first 6 months following an acute event of NAION.

Advances in imaging of the optic disc and retinal nerve fiber layer.

In the past decade, three technologies for imaging the optic disc and retinal nerve fiber layer have become commercially available: 1) confocal scanning laser tomography with the Heidelberg retinal tomograph; 2) confocal scanning laser polarimetry with the GDx VCC; and 3) optical coherence tomography with the Stratus OCT. Each uses different principles of physics. Understanding the merits and limitations of each of these technologies requires familiarity with the principles of operation of each device. This knowledge should be considered a prerequisite for the appropriate clinical utilization of these devices and for accurate interpretation of their results.