Adult ; Aged ; Brain ; diagnostic imaging ; physiopathology ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Optic Neuropathy, Ischemic ; diagnostic imaging ; physiopathology

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.
Arteritis ; Fluorescein Angiography ; Humans ; Incidence ; Korea ; Magnetic Resonance Imaging ; Medical Records ; Optic Nerve ; Optic Neuropathy, Ischemic ; Retrospective Studies ; Visual Acuity ; Visual Field Tests

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.
Cardiovascular Diseases ; Follow-Up Studies ; Humans ; Medical Records ; Optic Neuropathy, Ischemic ; Retrospective Studies ; Visual Acuity ; Visual Fields

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.
Buffaloes ; Cushing Syndrome ; Female ; Hemodilution ; Humans ; Hypertension ; Incidence ; Intraocular Pressure ; Middle Aged ; Obesity, Abdominal ; Optic Neuropathy, Ischemic ; Perfusion ; Risk Factors ; Spinal Fusion ; Spine ; Thrombophilia ; Venous Thromboembolism

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
Optic Neuritis ; Optic Neuropathy, Ischemic ; Intracranial Hypertension

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.
Dexamethasone ; Intravitreal Injections* ; Liposomes* ; Optic Nerve Diseases ; Optic Nerve* ; Optic Neuropathy, Ischemic

No abstract available.
Giant Cell Arteritis* ; Giant Cells* ; Headache* ; Optic Neuropathy, Ischemic*

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.
Aged ; Alcoholics* ; Anemia* ; Arterial Pressure ; Female ; Gastritis ; Hemorrhage ; Humans ; Infarction ; Iron ; Life Style ; Liver Cirrhosis, Alcoholic* ; Liver Diseases, Alcoholic ; Optic Disk ; Optic Nerve Diseases* ; Optic Neuropathy, Ischemic ; Vitamins

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, P<0.0001). The reductions were specifically remarkable in 14 days after the disease induction (All P<0.01). Conclusions 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.
Animals ; Disease Models, Animal ; Fluorescein Angiography ; Hemodynamics ; physiology ; Humans ; Male ; Optic Disk ; pathology ; physiopathology ; Optic Neuropathy, Ischemic ; pathology ; physiopathology ; Rats ; Rats, Sprague-Dawley ; Retinal Ganglion Cells ; physiology

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.
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