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Anterior ischemic optic neuropathy precipitated by acute primary angle closure.

Choudhari NS, George R, Kankaria V, Sunil GT - Indian J Ophthalmol (2010 Sep-Oct)

Bottom Line: A 59-year-old man with a history of longstanding systemic hypotension developed asymmetric non-arteritic anterior ischemic optic neuropathy (NAION) apparently precipitated by bilateral sequential acute primary angle closure.In contrast to optical coherence tomography, the failure of scanning laser polarimetry to detect axonal swelling was another interesting finding.Possible reasoning for these observations is discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Glaucoma, Jadhavbhai Nathamal Singhvi, Medical Research Foundation, Sankara Nethralaya, Chennai-600 006, India.

ABSTRACT
A 59-year-old man with a history of longstanding systemic hypotension developed asymmetric non-arteritic anterior ischemic optic neuropathy (NAION) apparently precipitated by bilateral sequential acute primary angle closure. NAION is very rarely reported in association with raised intraocular pressure. In contrast to optical coherence tomography, the failure of scanning laser polarimetry to detect axonal swelling was another interesting finding. Possible reasoning for these observations is discussed.

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Color photograph of the left optic disc following resolution of acute angle closure
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Figure 0001: Color photograph of the left optic disc following resolution of acute angle closure

Mentions: On the subsequent day, applanation pressures were 10 (RE) and 7 mmHg (LE). A relative afferent pupillary defect (RAPD) was evident in LE. Post-iridotomy gonioscopy revealed 360-degree peripheral anterior synechiae in BE. The right optic disc was moderate in size (vertical disc diameter 1.8 mm) with a pink neuroretinal rim and had a vertical cup-disc ratio of 0.4:1 while the left optic disc (approximate vertical disc diameter 1.8 mm) showed pallid edema [Fig. 1A,B]. Color vision recording with Ishihara plates were 14/14 in both eyes. He was found to have visual field constriction in RE and a tubular field in LE (SITA Standard 30-2 program, Humphrey perimeter, Carl Zeiss Meditec, Dublin, CA, Fig. 2). Fundus fluorescein angiography (FFA) showed choroidal defects and hypo-perfusion of the nasal half of the left optic disc [Fig. 3]. There was significantly increased retinal nerve fiber layer (RNFL) thickness in LE on Optical Coherence Tomography (Stratus OCT, Carl Zeiss Meditec, Germany). However, RNFL thickness with Scanning Laser Polarimetry (SLP [GDx VCC, Carl Zeiss Meditec, Germany]) was almost within the normal range in BE. His physical evaluation was unremarkable with a pulse rate of 60/min and blood pressure of 110/70 mmHg. His complete hemogram including erythrocyte sedimentation rate was normal.


Anterior ischemic optic neuropathy precipitated by acute primary angle closure.

Choudhari NS, George R, Kankaria V, Sunil GT - Indian J Ophthalmol (2010 Sep-Oct)

Color photograph of the left optic disc following resolution of acute angle closure
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2992925&req=5

Figure 0001: Color photograph of the left optic disc following resolution of acute angle closure
Mentions: On the subsequent day, applanation pressures were 10 (RE) and 7 mmHg (LE). A relative afferent pupillary defect (RAPD) was evident in LE. Post-iridotomy gonioscopy revealed 360-degree peripheral anterior synechiae in BE. The right optic disc was moderate in size (vertical disc diameter 1.8 mm) with a pink neuroretinal rim and had a vertical cup-disc ratio of 0.4:1 while the left optic disc (approximate vertical disc diameter 1.8 mm) showed pallid edema [Fig. 1A,B]. Color vision recording with Ishihara plates were 14/14 in both eyes. He was found to have visual field constriction in RE and a tubular field in LE (SITA Standard 30-2 program, Humphrey perimeter, Carl Zeiss Meditec, Dublin, CA, Fig. 2). Fundus fluorescein angiography (FFA) showed choroidal defects and hypo-perfusion of the nasal half of the left optic disc [Fig. 3]. There was significantly increased retinal nerve fiber layer (RNFL) thickness in LE on Optical Coherence Tomography (Stratus OCT, Carl Zeiss Meditec, Germany). However, RNFL thickness with Scanning Laser Polarimetry (SLP [GDx VCC, Carl Zeiss Meditec, Germany]) was almost within the normal range in BE. His physical evaluation was unremarkable with a pulse rate of 60/min and blood pressure of 110/70 mmHg. His complete hemogram including erythrocyte sedimentation rate was normal.

Bottom Line: A 59-year-old man with a history of longstanding systemic hypotension developed asymmetric non-arteritic anterior ischemic optic neuropathy (NAION) apparently precipitated by bilateral sequential acute primary angle closure.In contrast to optical coherence tomography, the failure of scanning laser polarimetry to detect axonal swelling was another interesting finding.Possible reasoning for these observations is discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Glaucoma, Jadhavbhai Nathamal Singhvi, Medical Research Foundation, Sankara Nethralaya, Chennai-600 006, India.

ABSTRACT
A 59-year-old man with a history of longstanding systemic hypotension developed asymmetric non-arteritic anterior ischemic optic neuropathy (NAION) apparently precipitated by bilateral sequential acute primary angle closure. NAION is very rarely reported in association with raised intraocular pressure. In contrast to optical coherence tomography, the failure of scanning laser polarimetry to detect axonal swelling was another interesting finding. Possible reasoning for these observations is discussed.

Show MeSH
Related in: MedlinePlus