Nonarteritic Anterior Ischemic Optic Neuropathy Induced Retinal Folds and Deformations

Abstract

PurposeWe hypothesized that the edema/swelling in the retina due to acute nonarteritic anterior ischemic optic neuropathy (NAION) can induce retinal folds (RF). We determined the pattern and frequency of folds in NAION at presentation and in follow-up, and the relationship between folds and a number of functional and structural parameters over time.MethodsWe prospectively studied eyes with acute NAION by spectral-domain optic coherence tomography (SD-OCT). We used transaxial and en face views to evaluate the presence of peripapillary fluid (PPF), peripapillary wrinkles (PPW), RF, choroidal folds (CF), creases, macular edema, and vitreous traction on the optic disc. Retinal deformations were correlated with the retinal nerve fiber layer (RNFL) thickness, logMAR visual acuity (VA) and mean deviation (MD).ResultsAt presentation, 60 eyes had mean RNFL = 224 ± 75 μm, no vitreous traction, and similar VA and MD regardless of the retinal deformation or macular edema. There was PPF in 73%, PPW in 57%, RF in 38%, creases in 20%, and macular edema in 18% of eyes, and no CF. Eyes with retinal deformations had significantly greater RNFL thickness (P < 0.026). At 1 to 2 months, 49 eyes had reduction of the RNFL (112 ± 40 μm, P = 0.001) and unchanged VA and MD that did not correlate with fewer eyes having PPF (15%, P = 0.001), PPW (10%, P = 0.001), RF (10%, P = 0.001), creases (17%), and macular edema (0%, P = 0.007).ConclusionsRF in NAION reflect stresses and strains due to extracellular fluid without increased pressure in the retrolaminar tissue and subarachnoid space, seen with papilledema. In NAION, the deformations and their resolution do not correlate with vision loss.

Noninvasive Diagnostic Strategy of Ocular Toxocariasis Based on Clinical Features

“…20 Retinal fold was defined as a periodic surface or intraretinal undulations greater than half the disc diameter from the disk. 21 Representative examples of these clinical features are presented in Figure 1.…”

Optical Coherence Tomography Neuro-Toolbox for the Diagnosis and Management of Papilledema, Optic Disc Edema, and Pseudopapilledema

“…Folds are common in patients with papilledema and other causes of disc edema ( 77 , 86 – 89 ). Based on the IIHTT, folds were detected with SD-OCT in at least one eye in 73% of patients.…”

“…On occasion, PPW can persist for years, long after the optic disc edema resolves and thus may provide a telltale sign of mild, resolving, or chronic papilledema (Fig. 11 ) ( 85 , 86 , 88 , 89 ). Although the amplitude of CF may decrease with time, they are distinctively persistent long after the papilledema resolves.…”

Plasmapheresis in Ophthalmology

“…Circulatory disorders in the optic disc are the leading cause of reduced sight in individuals over 50 years old [60]. The emerging pericapillary retinal edema contributes to its "folding" [61]. In this case, the ganglion cells thickness of the retinal nerve fibers decreases down to their disappearance [62].…”