Management of non-arteritic anterior ischemic optic neuropathy

Hayreh, Sohan Singh

doi:10.1007/s00417-009-1181-8

Cited by 17 publications

(5 citation statements)

References 52 publications

(57 reference statements)

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“… 1 Although the pathogenesis and exact location of the insult in NAION remains uncertain, the prevailing theory is that of vascular insufficiency to the optic nerve head. 2 , 3 It remains uncertain what role, if any, the peripapillary choroid has in the pathogenesis of NAION despite some of the shared circulation from the posterior ciliary arteries.…”

mentioning

confidence: 99%

Peripapillary Pachychoroid in Nonarteritic Anterior Ischemic Optic Neuropathy

Nagia

Huisingh

Johnstone

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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PurposeThis study examined the peripapillary choroidal thickness (PCT) in nonarteritic ischemic optic neuropathy (NAION) in comparison to contralateral eyes and normal eyes.MethodsWe used enhanced depth imaging spectral-domain optical coherence tomography to image the optic nerve head of 20 NAION, 10 contralateral eyes, and 102 normal eyes. Following compensation, the scans were manually delineated to identify relevant surfaces including Bruch's membrane opening (BMO), Bruch's membrane, and anterior sclera. The PCT was defined as the measurement between Bruch's membrane and the anterior sclera and was measured at increasing distance from BMO. Models adjusted for age, BMO area, and axial length were used to compare the mean PCT between NAION and normal eyes, and contralateral eyes and normal eyes. Paired t-tests were used to compare the PCT between NAION and contralateral eyes.ResultsThe mean PCT was thicker in NAION and contralateral eyes when compared with normal eyes at all distances from BMO (P < 0.001). The PCT was not significantly thicker in contralateral eyes when compared with affected NAION eyes. Choroidal thickness was thinnest in the inferior quadrant in all eyes regardless of the group.ConclusionsIncreased peripapillary choroidal thickness was noted in both NAION and contralateral eyes. The thicker choroid may be an associated feature or a result of the disorder. Although further longitudinal study is required to determine causation, these findings may suggest that a thickened peripapillary choroid may be a component of the disk-at-risk clinical phenotype.

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confidence: 99%

Peripapillary Pachychoroid in Nonarteritic Anterior Ischemic Optic Neuropathy

Nagia

Huisingh

Johnstone

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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“…Most cases are believed to develop from either hypoperfusion or nonperfusion of the vessels supplying the optic nerve head [18]. It has been suggested that the optic disc is in a watershed zone between the branches of the short posterior ciliary arteries (SPCAs), and thus is vulnerable to ischemia during states of hypoperfusion [19,20].…”

Section: Pathophysiologymentioning

confidence: 99%

“…They include atherosclerosis and/or lipohyalinosis of small vessels supplying the optic nerve, vasospasm, impaired autoregulation of optic nerve head blood flow, and venous insufficiency [18,23,25]. There has been one large histopathologic study of 193 eyes diagnosed with ischemic optic neuropathy which showed absence of lipohyalinosis, occlusion, and inflammation of small vessels; because these data were not correlated with clinical findings, cases of classic NAION could not be identified [26].…”

Section: Pathophysiologymentioning

confidence: 99%

“…These include a small cup-to-disc ratio with crowding of the optic disc, optic disc drusen, optic disc edema, and posterior vitreous detachment [18,40]. Certain surgical procedures have also been associated with the onset on NAION including: cataract extraction, strabismus surgery, laser-assisted in situ keratomilieusis (LASIK), and intravitreal injections of anti-vascular endothelial growth factor drugs [41][42][43][44][45].…”

Section: Pathophysiologymentioning

confidence: 99%

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Nonarteritic Anterior Ischemic Optic Neuropathy: An Update on Demographics, Clinical Presentation, Pathophysiology, Animal Models, Prognosis, and Treatment

Banik¹

2013

J Clin Exp Ophthalmol

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“…In NAION, visual acuity is often spared, and patients may present with a variety of VF defects, including the typical altitudinal defects. This differs from glaucoma, which usually presents as a gradual loss of peripheral vision before advancing to affect central vision in more severe cases [23]. Further, differences on OCT angiography (OCT-A) can be found between NAION and AAION.…”

Section: Introductionmentioning

confidence: 99%

Differentiating ischemic optic neuropathy from glaucoma using diagnostic tests

Smeets,

Margot,

Barbosa-Breda

et al. 2024

Ophthalmic Res

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Introduction: Anterior ischemic optic neuropathy (AION) can mimic glaucoma and consequently cause difficulties in differential diagnosis. The purpose of this paper is to summarize differences in diagnostic tests that can help perform a correct diagnosis. Methods: The search strategy was performed according to the PRISMA 2009 guidelines and four databases were used: Medline, Embase, Web of Science and Cochrane. 772 references were eligible; 39 were included after screening with respect to inclusion criteria that included English language and published in the 20 years before search date. Results: Ninety percent (n=35) of included studies used optical coherence tomography (OCT). Glaucomatous eyes had a significantly greater cup area, volume and depth, cup-to-disc ratio, and a lower rim volume and area, and a thinner Bruch’s Membrane opening-minimum rim width. Retinal nerve fibre layer (RNFL) thinning in glaucomatous eyes occurred primarily at the superotemporal, inferotemporal and inferonasal sectors, while AION eyes demonstrated mostly superonasal thinning. Glaucoma eyes showed greater macular ganglion cell layer thickness, except at the inferotemporal sector. OCT-angiography measurements demonstrated a significant decrease in superficial and deep macular vessel density (VD) in glaucoma compared to AION with similar degree of visual field (VF) damage; and the parapapillary choroidal VD was spared in AION eyes compared to glaucomatous eyes. Conclusion: By use of OCT imaging, optic nerve head (ONH) parameters seem most informative to distinguish between glaucoma and AION. Although both diseases affect the RNFL thickness, it seems to do so in different sectors. Differences in structure and vascularity of the macula can also help in making the differential diagnosis.

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Management of non-arteritic anterior ischemic optic neuropathy

Cited by 17 publications

References 52 publications

Peripapillary Pachychoroid in Nonarteritic Anterior Ischemic Optic Neuropathy

Peripapillary Pachychoroid in Nonarteritic Anterior Ischemic Optic Neuropathy

Nonarteritic Anterior Ischemic Optic Neuropathy: An Update on Demographics, Clinical Presentation, Pathophysiology, Animal Models, Prognosis, and Treatment

Differentiating ischemic optic neuropathy from glaucoma using diagnostic tests

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