LDL-apheresis in Acute Anterior Ischemic Optic Neuropathy

Abstract

Acute anterior ischemic optic neuropathy (AION) is a disabling disease which impairs visual function. Standard treatment is unable to affect the outcome and the visual damage persists. We describe the case of a 64-year-old patient affected by AION, whose only known risk factor was hypercholesterolemia. After a first onset of involvement of the right eye (RE), the patient presented four weeks later with an analogous episode affecting the left eye (LE). Since standard treatment, started at involvement of the RE, had not yielded any beneficial effect, the patient underwent three sessions of LDL apheresis. The scotomatous portion of the visual field reduced even after the first session, there was further improvement after the third, and after six months the condition remained stable. Corrected vision improved from 2/10 to 6/10 after the third session. LDL cholesterol and fibrinogen decresade after the third session from 239 mg/dL to 31 mg/dL and from 289 mg/dL to 92 mg/dL, respectively. In conclusion, thanks to its effect of antagonizing hemorheologic disorders of the ocular microcirculation, LDL apheresis seems to be an efficacious treatment of AION, especially in patients suffering from hypercholesterolemia.

Is the Efficacy of LDL Apheresis in Ischemic Optic Neuropathy Linked to a Reduction in Endothelial Activation Markers?

“…Conversely, the evident improvement we observed within 24 h of the first session of apheresis suggests that, in view of this rapid time course, it should be attributed exclusively to the apheretic treatment and not to the concomitant pharmacological treatment. This had already been verified in our previous study [3] , which described the immediate improvement in visual acuity of a patient after a single session of LDL apheresis, whereas traditional treatment, started some weeks before, had not yielded any effect.…”

“…In AMD, the damage to the macula is slow, progressive, and sight loss is attributable to retinal pigment epithelium detachment and choroidal neovascularization. For these reasons, in our previous experience in the treatment of NAION [3,4] we used only three sessions of LDL apheresis, and the improvement in visual acuity was apparent already after the first session. Instead, in AMD, the treatment protocols involved 10 treatments over a period of 21 weeks [19] or 8 treatments over a period of 10 weeks [21] and improvements in the visual parameters were apparent only after several weeks.…”

“…Considering that the best results in terms of visual acuity were already evident after the first session [3,4] , and that in the same way the ability of apheresis to reduce the concentration of endothelial activation markers should be highest in the first session, we correlated only the parameters referring to the first session. We did not obtain substantial improvements in these first results for visual acuity in the later sessions in the few patients tested.…”

“…Traditional therapy based on anticoagulants, platelet antiaggregants and pentoxyphyllin does not significantly change the course of the disease, and the damage remains stable in most cases [1] . In recent experiences, we have demonstrated that treatment with LDL apheresis (HELP system, B. Braun, Melsungen, Germany) in association with the traditional therapy can foster an improvement in the visual field of subjects with NAION [3,4] . It is known that even a single session of LDL apheresis can sharply reduce plasma concentrations of total cholesterol, LDL cholesterol and fibrinogen [5] , as well as the von Willebrand factor [6] , considered to be a marker of endothelial activation [7] .…”

LDL apheresis in the treatment of non-arteritic ischaemic optic neuropathy: a 6-month follow-up study

“…1,2 In previous experiences, we have associated treatment with LDL apheresis and traditional therapy in patients affected by NAION, obtaining convincing results in terms of the improvement of functional parameters. [3][4][5] In this study, 20 patients affected by NAION were randomly subdivided into two groups: a group of 10 patients treated with conventional therapy in combination with LDL apheresis (group 1) and a control group of 10 patients treated with conventional therapy only (group 2).…”