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.

Papilledema with Cerebral Venous Sinus Thrombosis

PURPOSE: We report two patients diagnosed with a sinus thrombosis with papillary edema. CASE SUMMARY: Case 1 was a 27-year-old male who presented with complaints of headache and vomiting for 2 months and blurred vision in both eyes. The best-corrected visual acuity (BCVA) was 1.0 in the right eye and 1.0 in the left eye. A visual field (VF) examination revealed a binocular peripheral VF defect and optical coherence tomography (OCT) and a fundus examination indicated optic disc swelling in both eyes. Brain magnetic resonance imaging (MRI) showed no specific finding but magnetic resonance venography revealed filling defect signs in the transverse sinus and a cerebrospinal fluid examination indicated elevated intracranial pressure (ICP). Case 2 was a 54-year-old female who came to our hospital with suspicion of bilateral optic disc swelling. The BCVA was 0.9 in the right eye and 1.0 in the left eye. A VF examination revealed an inferior-temporal VF defect and blind spot enlargement in the right eye. OCT and a fundus examination showed optic disc swelling in both eyes. Brain MRI showed no specific finding but magnetic resonance venography revealed a decrease in blood flow in the transverse sinus, sigmoid sinus. A cerebrospinal fluid examination indicated elevated ICP. CONCLUSIONS: In the case of optic disc swelling in both eyes, a secondary cause of ICP elevation and the possibility of optic disc swelling due to sinus thrombosis should be considered, and brain MRI and venography are needed to distinguish these possibilities.