Arteritic anterior ischaemic optic neuropathy: An update

Abstract

Ischaemic optic neuropathy (ION) is a major cause of blindness. The clinical approach and management is a matter of debate for the treating neurologist and the ophthalmologist. Of the two broad varieties namely the posterior (PION) and anterior ischaemic optic neuropathy (AION), the arteritic variety of the AION (AAION) is usually due to giant cell arteritis. Giant cell arteritis may only present with visual loss in up to 25% of cases. AAION is a neuro-ophthalmic emergency. Early recognition and differentiation from AAION is imperative in order to prevent further devastating visual loss. A literature search was conducted on pubmed using key words as AAION, arteritic anterior ischaemic optic neuropathy, giant cell arteritis (GCA) and articles from the year 2000 till date were included. In any case very few reviews are available on AAION. The literature search on pubmed provided holistic overview about this clinical significant entity and the same is compiled in this review. Moreover the histopathologic features of a temporal artery biopsy have been described with its microscopic images. In any case reviews are mostly available on the Non arteritic variety of AION. This review recapitulates the diagnostic and management protocol of a patient presenting with AAION.

Arteritic Anterior Ischemic Optic Neuropathy (AAION) Associated with COVID-19 Infection: A Case Report and Review of the Literature

“…Most often, AAIONs are associated with giant cell arteritis (GCA) vasculitis and SPCA involvement. Rarely, it can also result from other types of vasculitis, such as systemic lupus erythematosus, polyarteritis nodosa, and herpes zoster [4]. The vascular endothelium is affected by both AAION and COVID-19.…”

“…AAION is an ocular emergency, and treatment must begin immediately to prevent further visual loss in the normal unaffected eye. Treatment includes a high dose of intravenous corticosteroids (methylprednisolone pulse therapy) for 3-5 days followed by oral prednisolone tapered slowly over 12 months or more [ 4 ].…”

Recent advances in the use of optical coherence tomography in neuro‐ophthalmology: A review

“…In patients with arteritic anterior ischemic optic neuropathy (A‐AION), FFA may show posterior ciliary artery occlusion, peripapillary choroid delay, disc leakage, and disc filling defects 49 . However, FFA is invasive and may cause side effects such as allergy.…”

Perioperative Care of the Patient with Eye Pathologies Undergoing Nonocular Surgery

“…91 Arteritic anterior ischemic optic neuropathy, caused by mechanical vascular occlusion of the short posterior ciliary arteries from giant cell or temporal arteritis, generally occurs in those older than 60 yr, has a female predilection, and responds to steroids. 92 Nonarteritic posterior ischemic optic neuropathy is rare outside of the perioperative setting. In contrast, posterior ischemic optic neuropathy is a common presentation of arteritic ischemic optic neuropathy.…”