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Management of ischemic optic neuropathies.

Hayreh SS - Indian J Ophthalmol (2011 Mar-Apr)

Bottom Line: Patients with NA-AION, when treated with systemic corticosteroid therapy within first 2 weeks of onset, had significantly better visual outcome than untreated ones.NA-PION patients, when treated with high-dose systemic steroid therapy during the very early stages of the disease, showed significant improvement in visual acuity and visual fields, compared to untreated eyes.There is no satisfactory treatment for surgical PION, except to take prophylactic measures to prevent its development.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, IA, USA. sohan-hayreh@uiowa.edu

ABSTRACT
Ischemic optic neuropathies (IONs) consist primarily of two types: anterior ischemic optic neuropathy (AION) and posterior ischemic optic neuropathy (PION). AION comprises arteritic AION (A-AION: due to giant cell arteritis) and non-arteritic AION (NA-AION: due to other causes). PION consists of arteritic PION (A-PION: due to giant cell arteritis), non-arteritic PION (NA-PION: due to other causes), and surgical PION (a complication of several systemic surgical procedures). These five types of ION are distinct clinical entities etiologically, pathogenetically, clinically and from the management point of view. In the management of AION, the first crucial step with patients aged 50 and over is to identify immediately whether it is arteritic or not because A-AION is an ophthalmic emergency and requires urgent treatment with high-dose steroid therapy to prevent any further visual loss in one or both eyes. Patients with NA-AION, when treated with systemic corticosteroid therapy within first 2 weeks of onset, had significantly better visual outcome than untreated ones. Systemic risk factors, particularly nocturnal arterial hypotension, play major roles in the development of NA-AION; management of them is essential in its prevention and management. NA-PION patients, when treated with high-dose systemic steroid therapy during the very early stages of the disease, showed significant improvement in visual acuity and visual fields, compared to untreated eyes. A-PION, like A-AION, requires urgent treatment with high-dose steroid therapy to prevent any further visual loss in one or both eyes. There is no satisfactory treatment for surgical PION, except to take prophylactic measures to prevent its development.

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Fundus photographs of left eye of a 53-year-old man: (a) Normal disc before developing NA-AION, (b) with optic disc edema and hyperemia during the active phase of NA-AION, and (c) after resolution of optic disc edema and development of optic disc pallor (more marked in temporal part than nasal part)[16]
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Figure 0005: Fundus photographs of left eye of a 53-year-old man: (a) Normal disc before developing NA-AION, (b) with optic disc edema and hyperemia during the active phase of NA-AION, and (c) after resolution of optic disc edema and development of optic disc pallor (more marked in temporal part than nasal part)[16]

Mentions: The main clinical finding on ophthalmic evaluation at the onset of visual loss is optic disc edema [Figs. 5b, 6a, 7][40] which resolves spontaneously in 7.9 (5.8–11.4) weeks, resulting in generalized or sectoral pallor of the optic disc [Fig. 5a–c].[40] There is a characteristic evolutionary pattern of optic disc edema in NA-AION.[40] The presence of a few splinter hemorrhages on the optic disc [Fig. 6a] or immediate peripapillary region [Fig. 7] is common in association with the optic disc edema.


Management of ischemic optic neuropathies.

Hayreh SS - Indian J Ophthalmol (2011 Mar-Apr)

Fundus photographs of left eye of a 53-year-old man: (a) Normal disc before developing NA-AION, (b) with optic disc edema and hyperemia during the active phase of NA-AION, and (c) after resolution of optic disc edema and development of optic disc pallor (more marked in temporal part than nasal part)[16]
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3116541&req=5

Figure 0005: Fundus photographs of left eye of a 53-year-old man: (a) Normal disc before developing NA-AION, (b) with optic disc edema and hyperemia during the active phase of NA-AION, and (c) after resolution of optic disc edema and development of optic disc pallor (more marked in temporal part than nasal part)[16]
Mentions: The main clinical finding on ophthalmic evaluation at the onset of visual loss is optic disc edema [Figs. 5b, 6a, 7][40] which resolves spontaneously in 7.9 (5.8–11.4) weeks, resulting in generalized or sectoral pallor of the optic disc [Fig. 5a–c].[40] There is a characteristic evolutionary pattern of optic disc edema in NA-AION.[40] The presence of a few splinter hemorrhages on the optic disc [Fig. 6a] or immediate peripapillary region [Fig. 7] is common in association with the optic disc edema.

Bottom Line: Patients with NA-AION, when treated with systemic corticosteroid therapy within first 2 weeks of onset, had significantly better visual outcome than untreated ones.NA-PION patients, when treated with high-dose systemic steroid therapy during the very early stages of the disease, showed significant improvement in visual acuity and visual fields, compared to untreated eyes.There is no satisfactory treatment for surgical PION, except to take prophylactic measures to prevent its development.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, IA, USA. sohan-hayreh@uiowa.edu

ABSTRACT
Ischemic optic neuropathies (IONs) consist primarily of two types: anterior ischemic optic neuropathy (AION) and posterior ischemic optic neuropathy (PION). AION comprises arteritic AION (A-AION: due to giant cell arteritis) and non-arteritic AION (NA-AION: due to other causes). PION consists of arteritic PION (A-PION: due to giant cell arteritis), non-arteritic PION (NA-PION: due to other causes), and surgical PION (a complication of several systemic surgical procedures). These five types of ION are distinct clinical entities etiologically, pathogenetically, clinically and from the management point of view. In the management of AION, the first crucial step with patients aged 50 and over is to identify immediately whether it is arteritic or not because A-AION is an ophthalmic emergency and requires urgent treatment with high-dose steroid therapy to prevent any further visual loss in one or both eyes. Patients with NA-AION, when treated with systemic corticosteroid therapy within first 2 weeks of onset, had significantly better visual outcome than untreated ones. Systemic risk factors, particularly nocturnal arterial hypotension, play major roles in the development of NA-AION; management of them is essential in its prevention and management. NA-PION patients, when treated with high-dose systemic steroid therapy during the very early stages of the disease, showed significant improvement in visual acuity and visual fields, compared to untreated eyes. A-PION, like A-AION, requires urgent treatment with high-dose steroid therapy to prevent any further visual loss in one or both eyes. There is no satisfactory treatment for surgical PION, except to take prophylactic measures to prevent its development.

Show MeSH
Related in: MedlinePlus