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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 the both eyes of a 51-year-old diabetic woman, who developed NA-AION, first in the right eye (a, b) and 8 months later in the left eye (c, d). (a, c) Optic disc edema with marked telangiectatic vessels on the optic disc, multiple punctate peripapillary hemorrhages; (b, d) no edema, no abnormal vessels on the disc, and no peripapillary retinal hemorrhages on resolution[41]
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Figure 0008: Fundus photographs of the both eyes of a 51-year-old diabetic woman, who developed NA-AION, first in the right eye (a, b) and 8 months later in the left eye (c, d). (a, c) Optic disc edema with marked telangiectatic vessels on the optic disc, multiple punctate peripapillary hemorrhages; (b, d) no edema, no abnormal vessels on the disc, and no peripapillary retinal hemorrhages on resolution[41]

Mentions: In diabetics, optic disc changes in NA-AION may have some characteristic diagnostic features. During the initial stages, the optic disc edema is usually (but not always) associated with characteristic prominent, dilated and frequently telangiectatic vessels over the disc, and peripapillary retinal hemorrhages that are much more numerous than in non-diabetics[4142] [Fig. 8a and c]. These findings may easily be mistaken for proliferative diabetic retinopathy associated with optic disc neovascularization. When the optic disc edema resolves spontaneously, these prominent telangiectatic disc vessels and retinal hemorrhages also resolve spontaneously [Fig. 8b and d]. The presence of these characteristic fundus changes in some diabetics with NA-AION has led to a good deal of controversy because it has been thought to be a separate clinical entity that is described under different eponyms, the most common being “diabetic papillopathy”, when in fact it is NA-AION.[42]


Management of ischemic optic neuropathies.

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

Fundus photographs of the both eyes of a 51-year-old diabetic woman, who developed NA-AION, first in the right eye (a, b) and 8 months later in the left eye (c, d). (a, c) Optic disc edema with marked telangiectatic vessels on the optic disc, multiple punctate peripapillary hemorrhages; (b, d) no edema, no abnormal vessels on the disc, and no peripapillary retinal hemorrhages on resolution[41]
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0008: Fundus photographs of the both eyes of a 51-year-old diabetic woman, who developed NA-AION, first in the right eye (a, b) and 8 months later in the left eye (c, d). (a, c) Optic disc edema with marked telangiectatic vessels on the optic disc, multiple punctate peripapillary hemorrhages; (b, d) no edema, no abnormal vessels on the disc, and no peripapillary retinal hemorrhages on resolution[41]
Mentions: In diabetics, optic disc changes in NA-AION may have some characteristic diagnostic features. During the initial stages, the optic disc edema is usually (but not always) associated with characteristic prominent, dilated and frequently telangiectatic vessels over the disc, and peripapillary retinal hemorrhages that are much more numerous than in non-diabetics[4142] [Fig. 8a and c]. These findings may easily be mistaken for proliferative diabetic retinopathy associated with optic disc neovascularization. When the optic disc edema resolves spontaneously, these prominent telangiectatic disc vessels and retinal hemorrhages also resolve spontaneously [Fig. 8b and d]. The presence of these characteristic fundus changes in some diabetics with NA-AION has led to a good deal of controversy because it has been thought to be a separate clinical entity that is described under different eponyms, the most common being “diabetic papillopathy”, when in fact it is NA-AION.[42]

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