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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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Related in: MedlinePlus

Four visual fields in eyes with NA-PION, showing varying sizes and densities of central scotoma and other field defects, with normal peripheral visual fields[13]
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Figure 0013: Four visual fields in eyes with NA-PION, showing varying sizes and densities of central scotoma and other field defects, with normal peripheral visual fields[13]

Mentions: PION, like NA-AION, is seen mostly in the middle-aged and elderly population but no age is immune. Clinically, patients with A-PION and NA-PION typically present with acute, painless visual loss in one or both eyes, sometimes discovered upon waking up in the morning. In some eyes, it may initially be progressive. Patients with surgical PION discover visual loss as soon as they are alert postoperatively, which may be several days after the surgery. s0 urgical PION usually tends to cause bilateral massive visual loss or even complete blindness, which is usually permanent. Visual acuity depends upon the type of PION. In one series,[13] it was 20/20–20/75 in 17%, better than 20/40 in 20%, 20/200 or worse in 69% in NA-PION, and 29, 43, 50%, respectively, in A-PION, and in surgical PION often only light perception. The most common visual field defect is central visual loss, alone or in combination with other types of visual field defects [Fig. 13], and much less commonly the reverse pattern, i.e., the central field normal with marked loss of peripheral fields[13] [Fig. 14].


Management of ischemic optic neuropathies.

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

Four visual fields in eyes with NA-PION, showing varying sizes and densities of central scotoma and other field defects, with normal peripheral visual fields[13]
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0013: Four visual fields in eyes with NA-PION, showing varying sizes and densities of central scotoma and other field defects, with normal peripheral visual fields[13]
Mentions: PION, like NA-AION, is seen mostly in the middle-aged and elderly population but no age is immune. Clinically, patients with A-PION and NA-PION typically present with acute, painless visual loss in one or both eyes, sometimes discovered upon waking up in the morning. In some eyes, it may initially be progressive. Patients with surgical PION discover visual loss as soon as they are alert postoperatively, which may be several days after the surgery. s0 urgical PION usually tends to cause bilateral massive visual loss or even complete blindness, which is usually permanent. Visual acuity depends upon the type of PION. In one series,[13] it was 20/20–20/75 in 17%, better than 20/40 in 20%, 20/200 or worse in 69% in NA-PION, and 29, 43, 50%, respectively, in A-PION, and in surgical PION often only light perception. The most common visual field defect is central visual loss, alone or in combination with other types of visual field defects [Fig. 13], and much less commonly the reverse pattern, i.e., the central field normal with marked loss of peripheral fields[13] [Fig. 14].

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