A forma arterítica da neuropatia óptica isquêmica anterior: estudo de 25 casos

Abstract

RESUMO -O quadro clínico, laboratorial, campimétrico e angiofluoresceinográfico de 25 pacientes (40 olhos) com a forma arterítica da neuropatia óptica isquémica anterior (NOIA-A) foi estudada com a finalidade de definir o perfil da doença possibilitando seu diagnóstico diferencial com a forma não arterítica (NOIA-NA) e com outras doenças do nervo óptico. A NOIA-A ocorreu em pacientes entre 60 e 88 anos (média 74 anos), predominando no sexo feminino (64%). Em 15 pacientes o envolvimento foi bilateral, ocorrendo simultaneamente ou nas primeiras semanas após o acometimento inicial. Cefaléia e dor ocular foram os pródromos mais frequentes, enquanto todos os pacientes apresentavam, ao momento da perda visual, sintomas e sinais sistémicos da arterite de células gigantes (ACG). Elevação da proteina C reativa, do fibrinogênio e da velocidade de hemossedimentação foram as alterações laboratoriais mais frequentemente encontradas. A acuidade visual, em geral, foi severamente acometida. As principais anormalidades fundoscópicas foram edema do disco óptico, usualmente pálido, com ou sem hemorrragias, e alterações retinianas. Exame do campo visual demonstrou uma variedade de defeitos, principalmente altitudinais inferiores enquanto a principal característica angiofluoresceinográfica observada foi o atraso setorial ou difuso do enchimento da coróide. PALAVRAS-CHAVE: neuropatia óptica isquémica anterior, forma arterítica, forma não arterítica, arterite de células gigantes.The arteritic type of the anterior ischemic optic neuropathy: a study of 25 cases SUMMARY -The clinical, laboratorial,perimetric and fluorescein angiographic features of the arteritic type of the anterior ischemic optic neuropathy (A-AION) was studied in 25 patients (40 eyes) in order to characterize the profile of the disease and to allow the differential diagnosis with the non-arteritic anterior ischemic optic neuropathy (NA-AION) and other disorders of the optic nerve. The A-AION occurred in patients 60 to 88 years old (mean 74 years) and was highly predominant in females (64 per cent). Fifteen patients had both eyes involved , either simultaneously or usually within few days or weeks after the initial involvement. Headache and eye pain were the most commonly observed prodromic complaints whereas systemic symptoms of giant cell arteritis (GCA) were seen in all patients. The laboratorial abnormalities most commonly found were high values of reactive C protein, plasmatic fibrinogen and erythrocyte sedimentation rate. In the great majority of the patients visual acuity was severely affected. The optic disc was always abnormal, usually showing a pale edema. In addition to that retinal changes were commonly found. Goldmann perimetry disclosed a wide variety of visual fields abnormalities, the most common of them being inferior altitudinal defects. Fluorescein fundus angiography revealed delayed or absent disc fluorescence, or sectorial or diffuse hypofluorescence or hyperfluorescence of the optic disc. Choroidal filling delay was the most characteristic and freq...

Nonarteritic anterior ischemic optic neuropathy after uneventful phacoemulsification: case report

“…Nonarteritic anterior ischemic optic neuropathy (NAION) is a devastating form of visual impairment that results from inadequate blood supply to the posterior ciliary arteries (1)(2)(3)(4)(5) . It is characterized by sudden, painless, mostly irreversible, and generally nonprogressive visual loss accompanied by nerve fiber bundle field defects, a relative afferent pupillary defect and optic disk edema (3)(4)(6)(7)(8)(9)(10)(11)(12)(13) .…”

“…It is characterized by sudden, painless, mostly irreversible, and generally nonprogressive visual loss accompanied by nerve fiber bundle field defects, a relative afferent pupillary defect and optic disk edema (3)(4)(6)(7)(8)(9)(10)(11)(12)(13) . Arterial hypertension, diabetes mellitus, hypercholesterolemia, ischemic heart disease, cerebrovascular disease, migraine, sleep apnea syndrome and anterior segment surgeries have been identified as risk factors for NAION (3-5, 8,10-16) .…”