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Central retinal artery occlusion and non-arteritic anterior ischemic optic neuropathy associated with an overlap syndrome: a case report.

Lima VC, Prata TS, Liebmann JM, Ritch R - J Med Case Rep (2008)

Bottom Line: The appearance of a new risk factor can alter the course and prognosis of previously stable disease.Exfoliation syndrome is a leading cause of glaucoma and is associated with vascular disease.She also developed ischemic arterial events in both eyes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Einhorn Clinical Research Center, The New York Eye and Ear Infirmary, New York, NY, USA. vecastrolima@yahoo.com.br

ABSTRACT

Introduction: An "overlap syndrome" is defined as the sequential appearance over time of two or more risk factors for glaucomatous damage. The appearance of a new risk factor can alter the course and prognosis of previously stable disease. Exfoliation syndrome is a leading cause of glaucoma and is associated with vascular disease. We report a case of central retinal artery occlusion and non-arteritic anterior ischemic optic neuropathy in a patient with overlap syndrome.

Case presentation: An 87-year-old woman with longstanding stable primary open-angle glaucoma developed bilateral exfoliation syndrome, after which her intraocular pressure became uncontrolled and her glaucomatous damage progressed rapidly. She also developed ischemic arterial events in both eyes.

Conclusion: The case presented here shows that overlap syndromes can lead to rapid, irreversible vision impairment. To the best of our knowledge, this is the first reported case of central retinal artery occlusion and non-arteritic anterior ischemic optic neuropathy in a patient with overlap syndrome.

No MeSH data available.


Related in: MedlinePlus

Biomicroscopy of the left eye showing exfoliation material on the anterior lens capsule and pupillary margin (white arrows).
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Figure 1: Biomicroscopy of the left eye showing exfoliation material on the anterior lens capsule and pupillary margin (white arrows).

Mentions: One year later, she had developed exfoliation material (XFM) on the anterior lens capsule and pupillary margin OS (Figure 1). Her IOP was 24 mmHg OD and 34 mmHg OS. Gonioscopy showed open-angles OU with visualization of XFM on the trabecular meshwork OS. Fundoscopy showed a cup-to-disc ratio of 0.5 and 0.7, respectively. This asymmetry of structural damage was attributed to the XFS onset and additional antiglaucoma topical treatment was initiated OS. Six months later, the patient complained of a marked decrease of vision OS, and a central retinal artery occlusion (CRAO) was confirmed by clinical and fluorescein angiographic examinations. Over the following 3 years, the glaucoma damage advanced OS due to uncontrolled IOP, despite treatment (Figure 2). At this time, she refused surgical or laser intervention. The OS presented an enlarged cup-to-disc ratio (0.9–1.0) and her visual acuity dropped to counting fingers at two inches (Figure 3). Several months later, XFM was noted on OD and the IOP had increased to 30 mmHg, followed by rapid glaucoma damage progression. After 2 years, cup-to-disc ratio was of 0.8 OD and 1.0 OS.


Central retinal artery occlusion and non-arteritic anterior ischemic optic neuropathy associated with an overlap syndrome: a case report.

Lima VC, Prata TS, Liebmann JM, Ritch R - J Med Case Rep (2008)

Biomicroscopy of the left eye showing exfoliation material on the anterior lens capsule and pupillary margin (white arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2630328&req=5

Figure 1: Biomicroscopy of the left eye showing exfoliation material on the anterior lens capsule and pupillary margin (white arrows).
Mentions: One year later, she had developed exfoliation material (XFM) on the anterior lens capsule and pupillary margin OS (Figure 1). Her IOP was 24 mmHg OD and 34 mmHg OS. Gonioscopy showed open-angles OU with visualization of XFM on the trabecular meshwork OS. Fundoscopy showed a cup-to-disc ratio of 0.5 and 0.7, respectively. This asymmetry of structural damage was attributed to the XFS onset and additional antiglaucoma topical treatment was initiated OS. Six months later, the patient complained of a marked decrease of vision OS, and a central retinal artery occlusion (CRAO) was confirmed by clinical and fluorescein angiographic examinations. Over the following 3 years, the glaucoma damage advanced OS due to uncontrolled IOP, despite treatment (Figure 2). At this time, she refused surgical or laser intervention. The OS presented an enlarged cup-to-disc ratio (0.9–1.0) and her visual acuity dropped to counting fingers at two inches (Figure 3). Several months later, XFM was noted on OD and the IOP had increased to 30 mmHg, followed by rapid glaucoma damage progression. After 2 years, cup-to-disc ratio was of 0.8 OD and 1.0 OS.

Bottom Line: The appearance of a new risk factor can alter the course and prognosis of previously stable disease.Exfoliation syndrome is a leading cause of glaucoma and is associated with vascular disease.She also developed ischemic arterial events in both eyes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Einhorn Clinical Research Center, The New York Eye and Ear Infirmary, New York, NY, USA. vecastrolima@yahoo.com.br

ABSTRACT

Introduction: An "overlap syndrome" is defined as the sequential appearance over time of two or more risk factors for glaucomatous damage. The appearance of a new risk factor can alter the course and prognosis of previously stable disease. Exfoliation syndrome is a leading cause of glaucoma and is associated with vascular disease. We report a case of central retinal artery occlusion and non-arteritic anterior ischemic optic neuropathy in a patient with overlap syndrome.

Case presentation: An 87-year-old woman with longstanding stable primary open-angle glaucoma developed bilateral exfoliation syndrome, after which her intraocular pressure became uncontrolled and her glaucomatous damage progressed rapidly. She also developed ischemic arterial events in both eyes.

Conclusion: The case presented here shows that overlap syndromes can lead to rapid, irreversible vision impairment. To the best of our knowledge, this is the first reported case of central retinal artery occlusion and non-arteritic anterior ischemic optic neuropathy in a patient with overlap syndrome.

No MeSH data available.


Related in: MedlinePlus