Bilateral Diabetic Anterior Ischemic Optic Neuropathy

ABSTRACT

PURPOSE: To evaluate the clinical findings of diabetic patients with bilateral anterior ischemic optic neuropathy. METHODS: Three diabetic patients with bilateral anterior ischemic optic neuropathy showed different clinical findings. One eye developed AION and the contralateral eye was diagnosed with diabetic papilloapthy with a subclinical disc swelling in Case I. The contralateral eye with diabetic papillopathy progressed to AION 3 months after showing the initial symptoms. In Case II, one eye developed AION, which continued in the contralateral eye after 6 months. In Case III, AION developed in both eyes simultaneously. RESULTS: A fundus examination revealed an edema of the optic disc in all cases. Prominent leakage of fluorescein dye from the capillaries of the optic disc was demonstrated on fluorescein angiography. Different field patterns including central scotoma, paracentral scotoma, an enlarged physiologic blind spot, and the constriction of the peripheral field of the visual field were revealed on Goldmann perimetry. The visual evoked cortical potential showed decreased amplitude and a prolonged latency. The visual acuity of the five eyes improved after administering high dose methylprednisolone. However, visual acuity of one eye with diabetic papillopathy did not improve. CONCLUSIONS: The clinical findings of the anterior ischemic optic neuropathies in the diabetic patients vary, and their prognosis is fair in most cases.