Bilateral Delayed Nonarteritic Anterior Ischemic Neuropathy Following Acute Primary Angle-closure Crisis
10.3341/jkos.2018.59.11.1091
- Author:
Eun Jung PARK
1
;
Yeoun Sook CHUN
;
Nam Ju MOON
Author Information
1. Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea. njmoon@cau.ac.kr
- Publication Type:Case Report
- Keywords:
Angle-closure glaucoma;
Anterior ischemic optic neuropathy
- MeSH:
Aged;
Anterior Chamber;
Atrophy;
Causality;
Corneal Edema;
Diagnosis;
Edema;
Female;
Fingers;
Glaucoma, Angle-Closure;
Humans;
Intraocular Pressure;
Mannitol;
Optic Neuropathy, Ischemic;
Pallor;
Papilledema;
Pupil;
Pupil Disorders;
Risk Factors;
Scotoma;
Visual Acuity;
Visual Fields
- From:Journal of the Korean Ophthalmological Society
2018;59(11):1091-1096
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
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.
