An unusual presentation of nonarteritic ischemic optic neuropathy with subretinal fluid treated with intravitreal bevacizumab

Abstract

A 62-year-old hypertensive male presented with acute nonarteritic ischemic optic neuropathy (NAION) with contiguous macular edema and subretinal fluid in the right eye. Presenting vision was 20/1000. The patient was treated with intravitreal bevacizumab 1.25 mg/0.05 ml. At 1 month follow-up, the macular edema and the optic nerve head edema completely resolved with a good visual improvement up to 20/40. The visual improvement was maintained at the last follow-up 6 months postinjection. Intravitreal bevacizumab may be a good option for acute NAION especially in an unusual presentation with macular edema and subretinal fluid.

Visual worsening despite resolution of subfoveal fluid in nonarteritic ischemic optic neuropathy

“…Some authors have proposed the use of intravitreal antivascular endothelial growth factor injections to reduce macular edema in this subgroup of nAION patients, finding improvement in visual function after intravitreal injections of these drugs. 7 However, evidence to support the use of this drug is scarce, especially considering that visual improvement also takes place after spontaneous resorption of the fluid and that this is a condition for which pathogenesis, although not completely understood, is considered mainly ischemic.…”

New Research Advances in the Treatment of Nonarteritic Anterior Ischemic Optic Neuropathy

“…Anti-VEGF drugs reduce inflammatory response, decrease vascular permeability, and promote the regression of optic disc edema. Furthermore, an intravitreal injection of bevacizumab for NAION reduces optic disc edema and improves visual acuity in patients [25,26]. However, the results of the study by Rootman et al did not reveal any improvement in visual acuity or retinal peripheral nerve fiber layer thickness [27].…”

Literature Commentary

“…When found, I might involve my retinal colleagues to make sure we are not looking at an alternative entity, but if we all agree we are looking at NAION, treatment of the macular edema has never been pursued, although intravitreal bevacizumab was followed by a good outcome in one case report. 4 -Marc Dinkin, MD…”