Ischemic optic neuropathy

Anterior ischemic optic neuropathy, not associated with arteritis

Pathogenesis

Anterior ischemic optic neuropathy, unrelated to arteritis, is a partial or total infarction of the optic disc, caused by the occlusion of the short posterior ciliary arteries. Usually occurs in patients aged 45-65 years with a dense structure of the optic nerve disk, when physiological excavation is very small or absent. Predisposing systemic conditions include hypertension, diabetes mellitus, hypercholesterolemia, collagen-vascular diseases, antiphospholipid syndrome, sudden hypotension and surgical cataract treatment.

Symptoms

It manifests itself as a sudden, painless, monocular loss of vision without prodromal visual disorders. Reducing vision is often found on awakening, which suggests the important role of nocturnal hypotension.

• visual acuity in 30% of patients is normal or slightly reduced. The rest - a decrease from moderate to significant;
• visual field defects are usually lower altituminal, central, paracentral, quadrant and arcuate are also found;
• Dyschromatopsia is proportional to the level of visual disturbances as opposed to optical neuritis, in which color vision can be severely impaired, even when visual acuity is quite good;
• disc is pale, with diffuse or sectoral edema, may be surrounded by several dashed hemorrhages. Swelling is gradually resolved, but the pallor remains.

The phage during the acute stage reveals local hyperfluorescence of the disk, which becomes more intense and eventually involves the entire disk. With the onset of atrophy of the optic nerve, the FAH reveals uneven choroidal filling in the arterial phase; in the late stages of hyperfluorescence of the disk is enhanced.

Special studies include serological studies, determination of the lyoid profile and fasting blood glucose level. It is also very important to exclude latent giant cell arteritis and other autoimmune diseases.

Forecast

There is no definite therapy; conduct treatment predisposing to the emergence of anterior ischemic optic neuropathy, unrelated to the arteritis of systemic diseases and advised to quit smoking. In most patients, vision does not subsequently decrease, but in some, vision loss continues for 6 weeks. In 30-50% of patients after a few months or years, the paired eye is affected, but the likelihood of this decreases when taking aspirin. With the defeat of the second eye - atrophy of the optic nerve of one eye and edema of the other disk - there is a "pseudosyndrome Foster-Kennedy".

NB: Anterior ischemic neuropathy does not recur in the same eye.

[1], [2], [3]

Anterior ischemic optic neuropathy associated with arteritis

Giant cell arteritis is an urgent condition, because the prevention of blindness is determined by the speed of diagnosis and treatment. The disease usually develops after 65 years, affects the arteries of medium and large caliber (especially the superficial temporal, ocular, posterior ciliary and proximal part of the vertebral). The severity and extent of the lesion depends on the amount of elastic tissue in the middle and adventitious artery envelope. The intracranial arteries, in which the elastic tissue is small, are usually preserved. There are 4 most important diagnostic criteria for GCR: pain in chewing muscles during chewing, cervical spikes, level of C-reactive protein> 2.45 mg / dL and ESR> 47 mm / h. Ocular complications of giant cell arteritis:

Anterior ischemic optic neuropathy associated with arteritis is the most common case. Occurs in 30-50% of untreated patients, in 1/3 of cases - bilateral lesion.

[4], [5], [6], [7]