Nonarteritic anterior ischemic optic neuropathy associated with chronic anemia: a case series of myelodysplastic syndrome patients

Abstract

Introduction:We report on three cases of visual loss due to nonarteritic anterior ischemic optic neuropathy that developed during the course of refractory anemia, a subtype of myelodysplastic syndrome.Patients and methods:Patients underwent fundus, visual field examination, and fluorescein angiography. A thrombophilic tendency investigation including prothrombin time, partial thromboplastin time, protein C, free protein S, and antithrombin III, polymerase chain reaction and hybridisation to allele-specific oligonucleotide probes and a bone marrow biopsy were also performed.Results:Relative recovery of visual function was noted in two patients, a 58-year-old man and a 67-year-old woman, whereas the vision of the third patient, a 62-year-old man, showed only marginal improvement during the follow-up period. Two patients received vigorous blood transfusion during hospitalization, while dosage adjustment of the erythropoietin infusion was decided for the third one. Thrombophilic tendency was not identified in any patient.Discussion:Chronic anemia, as presented in myelodysplastic syndrome’s refractory anemia subtype, probably in the presence of additional factors, such as hypotension, is likely to be complicated by optic neuropathy, possibly through a mechanism of anemic hypoxia and/or microvascular insufficiency.

Optic Neuritis Associated with Myelodysplastic Syndrome Accompanied by Eosinophilic Crisis

“…However, little is known regarding optic neuritis associated with MDS. To the best of our knowledge, only a few reports have so far described optic neuritis in MDS (5,6). We herein report a rare case of optic neuritis which developed during the course of trisomy 8 MDS, with elevated eosinophils.…”

“…Kezuka et al examined the occurrence of optic complications in MDS patients and described optic neuritis in two of 41 patients with MDS (5). In addition, Brouzas et al reported a case series of three patients with MDS who had episodes of visual loss and in whom the diagnosis of optic neuropathy was established (6). They believed that chronic anemia due to MDS caused ischemic optic neuropathy.…”

Retinal Nerve Fiber Layer Thickness is Decreased in Patients With Hematologic Malignancy

“…Chronic vascular insufficiency of the optic nerve head is an important risk factor for the progressive form of normal tension glaucoma. 8 Chronic ischemic injury from low hemoglobin levels may lead to retinal ganglion cell layer thinning. An RNFL defect may develop from previous retinal hemorrhage in patients with hematologic malignancy.…”

“…7 In a case report of 3 patients with myelodysplastic syndrome (MDS), the anemia subtype of MDS is likely to be involved in the initiation of NAION through a mechanism of anemic hypoxia and/or microvascular insufficiency. 8 If reduced oxygen delivery leads to NAION, chronic anemia may be a risk factor. The association between ischemic injury and ganglion cell loss has been investigated, 9 but the association between anemia and ganglion cell loss has not been examined.…”

Anterior ischemic optic neuropathy and hematologic malignancy: a systematic review of case reports and case series

“…3). 8,9,[21][22][23][24][25][26][27][28][29][30][31][32][33] We also included our current case report for the final analysis, yielding a total of 19 patients.…”