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

PURPOSE: We evaluated fundus and fluorescein angiography (FAG) findings and characteristics that can help distinguish nonarteritic anterior ischemic optic neuropathy (NAION) from optic neuritis (ON). METHODS: Twenty-three NAION patients and 17 ON with disc swelling patients were enrolled in this study. We performed fundus photography and FAG. The disc-swelling pattern, hyperemia grade, presence of splinter hemorrhages, cotton-wool spots, artery/vein ratio and degree of focal telangiectasia were investigated. The FAG findings for each patient were compared with respect to the following features: the pattern of disc leakage in the early phase, arteriovenous (artery/vein) transit time (second), and the presence and pattern of the filling delay. RESULTS: Cotton-wool spots, focal telangiectasia, and venous congestion were more common in the affected eyes of NAION patients. Upon FAG, 76.5% of the patients in the ON group exhibited normal choroidal circulation. However, 56.5% of patients in the NAION group demonstrated abnormal filling defects, such as peripapillary, generalized, or watershed zone filling delays. CONCLUSIONS: Fundus findings, including cotton-wool spots, focal telangiectasia, and venous congestion in the affected eye, may be clues that can be used to diagnose NAION. In addition, choroidal insufficiencies on FAG could be also helpful in differentiating NAION from ON.
Choroid/blood supply/*diagnostic imaging ; Female ; Fluorescein Angiography/*methods ; Fundus Oculi ; Humans ; Male ; Middle Aged ; Optic Disk/blood supply/*diagnostic imaging ; Optic Neuritis/*diagnosis ; Optic Neuropathy, Ischemic/*diagnosis ; Photography/*methods ; Retrospective Studies

PURPOSE: To report a case of uremic optic neuropathy occurring in a patient with chronic renal failure. CASE SUMMARY: A 40-year-old male who was diagnosed with chronic renal failure and treated with peritoneal dialysis and hemodialysis for 17 years presented with blurred vision and a moving pain in his left eye for 2 days. The best corrected visual acuity (BCVA) was 0.2 in his left eye, and an inferior altitudinal visual field defect was noted on Humphrey perimetry. Fundus examination and optical coherence tomography showed optic disc swelling in his left eye; the right eye was unremarkable. These findings were compatible with a diagnosis of uremic optic neuropathy or anterior ischemic optic neuropathy of his left eye. After treatment of hemodialysis and intravenous high dose steroid pulse therapy, the BCVA in his left eye was 0.8. However, since he refused oral steroid maintenance therapy, his BCVA later decreased to 0.4. After treatment with subtenon triamcinolone injection, the BCVA in his left eye was 1.0 and showed a stable disease course. CONCLUSIONS: When patient with chronic renal failure presents with acute decrease in visual acuity and visual field defect, optic neuropathies including uremic optic neuropathy should be considered and prompt hemodialysis and systemic steroid treatment should be done.
Adult ; Diagnosis ; Humans ; Kidney Failure, Chronic* ; Male ; Optic Nerve Diseases* ; Optic Neuropathy, Ischemic ; Peritoneal Dialysis ; Renal Dialysis ; Tomography, Optical Coherence ; Triamcinolone ; Uremia ; Visual Acuity ; Visual Field Tests ; Visual Fields

No abstract available.
Aged ; Giant Cell Arteritis/*complications/diagnosis ; Humans ; Male ; Optic Neuropathy, Ischemic/diagnosis/*etiology ; Republic of Korea ; Temporal Arteries/diagnostic imaging ; Ultrasonography ; *Visual Acuity

PURPOSE: To investigate the differences in retinal nerve fiber layer (RNFL) change and optic nerve head parameters between non-arteritic anterior ischemic optic neuropathy (NAION) and open angle glaucoma (OAG) with altitudinal visual field defect. METHODS: Seventeen NAION patients and 26 OAG patients were enrolled prospectively. The standard visual field indices (mean deviation, pattern standard deviation) were obtained from the Humphrey visual field test and differences between the two groups were analyzed. Cirrus HD-OCT parameters were used, including optic disc head analysis, average RNFL thickness, and RNFL thickness of each quadrant. RESULTS: The mean deviation and pattern standard deviation were not significantly different between the groups. In the affected eye, although the disc area was similar between the two groups (2.00 +/- 0.32 and 1.99 +/- 0.33 mm2, p = 0.586), the rim area of the OAG group was smaller than that of the NAION group (1.26 +/- 0.56 and 0.61 +/- 0.15 mm2, respectively, p < 0.001). RNFL asymmetry was not different between the two groups (p = 0.265), but the inferior RNFL thickness of both the affected and unaffected eyes were less in the OAG group than in the NAION group. In the analysis of optic disc morphology, both affected and unaffected eyes showed significant differences between two groups. CONCLUSIONS: To differentiate NAION from OAG in eyes with altitudinal visual field defects, optic disc head analysis of not only the affected eye, but also the unaffected eye, by using spectral domain optical coherence tomography may be helpful.
Aged ; Arteritis/diagnosis ; Diagnosis, Differential ; Female ; Glaucoma, Open-Angle/*diagnosis ; Humans ; Male ; Middle Aged ; Nerve Fibers/*pathology ; Optic Disk/*pathology ; Optic Neuropathy, Ischemic/*diagnosis ; Prospective Studies ; Retinal Ganglion Cells/*pathology ; Tomography, Optical Coherence ; Vision Disorders/*diagnosis ; Visual Field Tests ; *Visual Fields

No abstract available.
Female ; Glaucoma, Angle-Closure/complications/surgery ; Humans ; Middle Aged ; Optic Neuropathy, Ischemic/complications/*diagnosis

No abstract available.
Female ; Glaucoma, Angle-Closure/complications/surgery ; Humans ; Middle Aged ; Optic Neuropathy, Ischemic/complications/*diagnosis

PURPOSE: To introduce a case of bilateral anterior ischemic optic neuropathy (AION) after blood loss due to gastrointestinal bleeding. CASE SUMMARY: A 50-year-old male patient with a history of type 1 diabetes mellitus and alcoholic liver cirrhosis presented with 3 days of melena and 1 day of general weakness and dizziness. Initial hemoglobin level was 4.7 g/dL and blood pressure was 100/55 mm Hg. On esophagogastroduodenoscopy, a peptic ulcer with evident recent bleeding was observed. After transfusion of packed red blood cells and endoscopic hemostasis of bleeding, his general condition improved but he complained of blurred vision in both eyes which developed immediately after the onset of melena. Initial best-corrected visual acuity (BCVA) was 0.5 in his right eye and 0.6 in the left eye. On fundus examination, swollen optic disc with blurred margin was noted and he had constricted visual fields. On follow-up, the patient received posterior subtenon triamcinolone injection in his right eye. After the procedure, the BCVA was improved to 0.8 in both eyes, but he still had bilateral pale optic disc with constricted visual field. CONCLUSIONS: In the case of visual loss after recent blood loss, AION should be considered as a diagnosis, which can present as bilateral involvement.
Blood Pressure ; Diabetes Mellitus, Type 1 ; Diagnosis ; Dizziness ; Endoscopy, Digestive System ; Erythrocytes ; Follow-Up Studies ; Hemorrhage* ; Hemostasis, Endoscopic ; Humans ; Liver Cirrhosis, Alcoholic ; Male ; Melena ; Middle Aged ; Optic Neuropathy, Ischemic* ; Peptic Ulcer ; Triamcinolone ; Visual Acuity ; Visual Fields

PURPOSE: To report a case of optic neuritis difficult to differentiate from ischemic optic neuropathy and optic nerve glioma. CASE SUMMARY: A 63-year-old male visited our clinic because of a sudden painless decrease in visual acuity in his right eye. He had a relative afferent pupillary defect and inferior altitudinal scotoma with disc pallor in his right eye. Ischemic optic neuropathy was suspected based on these clinical observations. However, a focal enhancing lesion was found in the intracranial portion of the right optic nerve on gadolinium-enhanced T1-weighted MRI. The radiologist's report revealed right intracranial optic glioma. Optic neurectomy was planned in accordance with the suspicion for optic glioma. However, a systemic mega-dose methylprednisolone therapy which is relatively less invasive was performed first based on the decision that optic neuritis should be distinguished from optic nerve glioma. The patient was hospitalized and 1 gram of methylprednisolone was injected intravenously daily for 3 days. The patient's visual acuity in the right eye improved from 0.1 before treatment to 0.3 after treatment. MRI scans at 8 months after steroid treatment showed disappearance of the previously enhanced lesion suspicious for optic glioma with developed atrophic change. The patient was finally diagnosed with optic neuritis based on these results. CONCLUSIONS: Careful differential diagnoses and therapeutic approaches to possible diseases are necessary because optic neuritis can manifest as a variety of clinical entities and imaging findings.
Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Male ; Methylprednisolone ; Middle Aged ; Optic Nerve ; Optic Nerve Glioma* ; Optic Neuritis* ; Optic Neuropathy, Ischemic* ; Pallor ; Pupil Disorders ; Scotoma ; Visual Acuity

We report five cases of non-arteritic anterior ischaemic optic neuropathy (NA-AION) where spontaneous resolution of the optic disc swelling occurred, and all relevant visual modalities were normal at presentation and remained so until resolution of the process after a median time of 9.6 weeks. This condition, which can be termed 'incipient NA‑AION' or 'threatened NA-AION', should be recognised so that unnecessary investigations for other and more serious causes of optic disc swelling can be prevented.
Adrenergic alpha-2 Receptor Agonists ; therapeutic use ; Adult ; Brimonidine Tartrate ; therapeutic use ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Ophthalmic Solutions ; Optic Disk ; pathology ; Optic Neuropathy, Ischemic ; diagnosis ; Singapore ; Time Factors ; Vision, Ocular ; Visual Acuity