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Nonarteritic anterior ischemic optic neuropathy (NA-AION) is the most common form of acute painless, usually unilateral, optic neuropathy in the elderly population. Systemic risk factors include diabetes mellitus, arterial hypertension, sleep apnea syndrome, and cardiovascular disease. Α 52-year-old man developed sequential, bilateral NA-AION, involving a worsening, severe vision compromising attack in the secondly affected eye. Thrombophilia testing revealed compound heterozygosity for the C6777T mutation of the MTHFR gene and the prothrombin G20210A (FII mutation). Oral anticoagulation treatment was initiated. A thorough systemic and family history, especially in the absence of major vasculopathic disease, should alert toward investigation for thrombophilia in middle-aged patients with atypical forms of NA-AION and initiation of anticoagulant treatment should be considered. [ABSTRACT FROM AUTHOR]

Calciphylaxis resulting in ischemic optic neuropathy secondary to calcification of the central retinal artery is a rare occurrence. Only 12 reports of calciphylaxis resulting in optic neuropathy have been published. While it is important to consider giant cell arteritis (GCA) in cases of acute vision loss with pallid disc swelling, clinicians must also maintain a high index of suspicion of calciphylaxis in a patient with risk factors of hypercalcaemia. We present a 56-year-old lady with end-stage renal failure with acute onset painless right eye vision loss and ipsilateral pallid chalky white swollen optic disc. However, she did not have the other features typical of GCA. Temporal artery biopsy and subsequent skin biopsy of lower limb eschar and indurated dermal plaques found features consistent with calciphylaxis. [ABSTRACT FROM AUTHOR]

Aim: A variety of manifestations in different organs could be associated with severe COVID-19; for example, ocular manifestations. Case report: A 52-year-old male complaining of sudden onset unilateral painless vision loss in the right eye for 1 month (started just 1 week after COVID-19 remission) came to the ophthalmology clinic. On further evaluations, he was diagnosed with anterior ischemic optic neuropathy (AION). Considering his past history and the result of evaluations, the hypothesis of association between AION and COVID-19 was proposed. Results & discussion: Ocular and neurologic manifestations of COVID-19 are more likely to happen in patients with more severe conditions. Complications occur secondary to two basic mechanisms including severe inflammatory response and hypercoagulable state. Conclusion: Our findings indicated that non-arteritic AION is another manifestation of microangiopathic/thrombotic events which may occur in the course of COVID-19. [ABSTRACT FROM AUTHOR]

Purpose To investigate the efficacy of intravitreal injection of granulocyte colony-stimulating factor (G-CSF) for the treatment of non-arteritic anterior ischemic optic neuropathy (NAION).Methods: Patients with acute NAION were enrolled in this prospective interventional case series. They received an intravitreal injection of 60 micrograms in 0.1 ml of G-CSF within 2 weeks of the onset of the disease. Visual acuity, visual field, intraocular pressure (IOP), corneal endothelial cell density, and peripapillary retinal nerve fiber layer (RNFL) thickness were recorded before injections and 1 week, 1 month, 3 months, 6 months, and one year after the injections. Full-field electroretinography (ERG) was obtained at the baseline, 1 month, and 12 months post- injections.Results: Fourteen eyes of 14 patients entered the study. Best-corrected visual acuity (BCVA) significantly improved in the first month following injections (p =.007), decreased subsequently, and the final BCVA showed no significant improvement (p =.278) compared to the baseline measurements. A significant decrease in RNFL thickness was observed in all quadrants compared to the baseline measurements. Also, no improvement in the visual field parameters was observed. From the toxicity aspect, no significant changes in the corneal endothelial cell density, IOP, and ERG recordings were observed.Conclusion: Intravitreal injection of G-CSF seems to be safe. The effect may last for one month and then decline. [ABSTRACT FROM AUTHOR]

To date, corticosteroids remain the cornerstone treatment of ocular involvement of GCA, and no other treatment has proven to be effective in this setting. We herein report on a unique case of GCA with ocular involvement worsening despite high dose corticosteroids and recovering with intravenous iloprost. A 70-year-old man presented with acute vision loss in his left eye related to anterior ischemic optic neuropathy. The diagnosis of giant-cell arteritis was confirmed by a temporal artery biopsy. Despite intravenous pulse methylprednisolone for 3 days then oral prednisone at 60 mg/day, the patient developed from day 5 fluctuating vision loss in the right eye, related to ocular ischemia by occlusion of the ophthalmic artery, and responsive to hyperhydration. Iloprost, an analog of prostacyclin PGI2, was then administered intravenously for 5 days and resulted in a stable improvement in visual acuity in the right eye. This case highlights the potential role of vasodilatator agents in giant cell arteritis with ocular involvement. [ABSTRACT FROM AUTHOR]

A 39-year-old male patient with end-stage renal failure presented with unexplained isolated unilateral anterior ischemic optic neuropathy, high sedimentation rate, and high CRP. Despite the relatively young age of the patient, an ipsilateral temporal artery biopsy was performed, disclosing calciphylaxis, a highly morbid condition associated with end-stage renal failure, which requires urgent, specific management. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the possible relationship between AAION (arteritic anterior ischemic optic neuropathy) and NAION (non-arteritic anterior ischemic optic neuropathy) with blood platelet parameters and NLR (neutrophil-to-lymphocyte ratio). The medical records of 12 patients with AAION, 33 patients with NAION, and 35 healthy subjects were examined. MPV, PDW, and PCT values showed marked elevation in AAION and NAION groups compared with control group. The mean NLR was statistically significantly higher only in AAION group compared to the NAION and control groups, suggesting that platelet function plays an important role in AIONs and NLR might be used to differentiate AAION from NAION. [ABSTRACT FROM AUTHOR]

Carotid atherosclerosis and giant cell arteritis (GCA) are two distinct medical conditions with an overlapping clinical spectrum of vascular symptoms such as vision loss and ischemic stroke. This is because both diseases cause arterial ischemia with a predilection for carotid vasculature. In addition, high-vascular risk individuals who are diagnosed with GCA are usually elderly with age >55 years with high-vascular risk and thus can have underlying atherosclerosis. All these factors can pose a diagnostic dilemma for the physicians as GCA is a medical emergency which if left untreated can result in significant morbidity and mortality. Thus, it is important to avoid attributing occlusive arterial disease in elderly patients to atherosclerosis alone because some may have GCA. We present a case report in which presence of diffuse atherosclerosis was a major pitfall while making a timely diagnosis of GCA. [ABSTRACT FROM AUTHOR]

Optic nerve disorders lead to visual loss and can result: from multiple etiologies, including optic neuritis, anterior ischemic optic neuropathy, glaucoma, Leber's hereditary optic neuropathy and dominant optic atrophy. The recent advances in imaging technologies often supplement the history and clinical examination for identification of optic neuropathies. Correlation between the structural and functional changes in eye is important to validate these diagnostic techniques. Advancement in the understanding of disease process has led to the development of new potential therapeutic targets that may enable apt management of these conditions. Animal models play a crucial role in understanding the pathophysiology of these disorders, identifying therapeutic targets and testing prospective drugs, which are vital for providing better patient care. In this review, the authors aim to provide a clinical update to the readers about these optic neuropathies in addition to the essential role played by animal research in progressing their current state of knowledge. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of anterior ischemic optic neuropathy (AION) associated with the combined therapy of pegylated interferon alpha (PEG-IFNα) and ribavirin. Methods: Case report. Results: A 57-year-old male with chronic hepatitis C, treated with PEG-IFNα -2b and ribavirin for 6 months, noted sudden onset of painless blurred vision in his right eye. The initial visual acuity decreased to 20/60 in the right eye. Fundoscopy of right eye revealed optic disc edema with disc hemorrhage. Visual field examination disclosed inferior altitudinal defect. Relative afferent pupillary defect with poor color vision function was also noted in the right eye. Visual evoked potential demonstrated decreased amplitude in the right eye. A marked resolution of disc edema and improvement of visual acuity to 20/20 were noted at 6 weeks follow-up. Conclusions: AION may occur in combined treatment of PEG-IFNα -2b and ribavirin for chronic hepatitis C. Patients who are candidates for this treatment should be informed about its possible occurrence. [ABSTRACT FROM AUTHOR]

Purpose: To investigate levels of proinflammatory cytokines in a mouse model of anterior ischemic optic neuropathy (rAION). Methods: AION was induced in C57/BL6 mice and levels of IL-6, TNF-α, and MIP-2 were measured in plasma by ELISA and in the optic nerves by RT-PCR at predetermined intervals. Results: Plasma: IL-6 levels were elevated immediately after rAION induction and decreased gradually thereafter. TNF-α showed an early peak on day 1 and again from day 21. MIP-2 levels were increased until day 7. Optic nerve: IL-6, TNF-α, and MIP-2 levels increased within a few hours and then decreased gradually. IL-6 had a second peak on day 3. Conclusions: Proinflammatory cytokines may play a role in the pathogenesis of rAION. [ABSTRACT FROM AUTHOR]

Giant cell arteritis (GCA), a large and medium-sized blood vessel vasculitis, is the most common v asculitis in elderly people in Western countries. Ocular ischemic complications, including irreversible loss of vision, are the major source of chronic disability among GCA patients. A temporal artery biopsy is the gold-standard test for the diagnosis of GCA and glucocorticoids are the cornerstone therapy. Alternative steroid-sparing drugs, such as methotrexate or anti-tumor necrosis factor-a monoclonal antibody therapy, have been used. Antiplatelet therapy may also be useful to reduce the frequency of ischemic events. [ABSTRACT FROM AUTHOR]

Giant cell arteritis (GCA) is a systemic vasculitis that can cause blindness in the elderly. GCA is a medical emergency since it frequently causes blindness if left untreated. Blindness can even occur in a small percentage of patients who undergo treatment. The etiology remains unknown. Presenting symptoms of GCA vary widely and visual manifestations are an extremely common mode of presentation. All physicians must have a high level of suspicion to diagnose and initiate early and aggressive treatment, which in most patients can arrest but rarely reverses the disease. Early and prolonged high-dose corticosteroids remain the cornerstone of GCA treatment. In symptomatic patients, the combination of abnormal levels of C-reactive protein in addition to Westergren erythrocyte sedimentation rate has 97% specificity in the laboratory diagnosis of GCA. The gold standard for diagnosis is the temporal artery biopsy, but biopsy-negative GCA cases have been reported. [ABSTRACT FROM AUTHOR]

Optic neuropathy in patients taking amiodarone presents a diagnostic challenge. The changes at the optic discs and the optic nerve dysfunction could be induced directly by amiodarone, could be the result of a nonarteritic anterior ischemic optic neuropathy or could be a combination of these two factors. Various clinical criteria for the diagnosis of amiodarone-induced optic neuropathy have been described during the past 5 years. These include bilateral, usually insidious, visual loss and protracted optic disc edema over several months. Ophthalmological examinations should be carried out within the first 12 months (and particularly within 4 months) of initiating amiodarone and subsequently. Discontinuation of amiodarone should be considered in patients presenting with clinical features of amiodarone-induced optic neuropathy. However, in those patients in whom the mechanism of optic neuropathy is indeterminate or likely to be due to anterior ischemia, continuation with amiodarone therapy would be appropriate. Future studies aimed at understanding the effect of amiodarone on optic nerve axon biochemistry, physiology and structure leading to optic neuropathy, as well as identifying the influence of amiodarone in the perfusion of the anterior optic nerve by altering the blood flow in the short posterior ciliary arteries, will improve our understanding of the association between amiodarone intake and optic neuropathy. [ABSTRACT FROM AUTHOR]

Several major eye diseases may be characterized by deficits in ocular blood flow. Maintaining adequate nutrient delivery to the choroid, retina, and optic nerve head may prevent cellular damage and loss, complementing efforts to provide neuroprotection. The ability to quantify deficits in ocular blood flow has increased in recent years with the introduction of several new techniques. 1) Scanning laser ophthalmoscopic fluorescein angiography allows the measurement of bulk retinal flow and macular capillary transit rates. 2) Scanning laser ophthalmoscopic indocyanine green angiography measures choroidal perfusion in selected areas near the optic nerve head and macula. 3) Confocal scanning laser Doppler flowmetry permits quantitation of retinal capillary perfusion. 4)Color Doppler ultrasound imaging measures flow velocities in the ophthalmic, central retinal, and short posterior ciliary arteries. While these techniques represent a major advance, significant issues regarding blood flow and ocular disease remain. First, the hemodynamic characteristics of the disease state need further definition. Second, the blood flow effects of current and future treatments must be established. Third, improvements in ocular blood flow techniques are required, both to increase anatomic precision and to allow non-invasive measurements during times of potential ischemic risk such as sleep. These developments could enhance prevention, diagnosis, and treatment of several major eye diseases. [ABSTRACT FROM AUTHOR]

A 61-year-old female presented with a moderate decrease in vision in the left eye. The patient denied any other ocular or systemic symptoms related to giant cell arteritis. Visual acuity was 20/50 in the left eye with a 2+ relative afferent pupillary defect and markedly abnormal color vision. Dilated fundus examination and flourescein angiography revealed optic disc edema as well as a cilioretinal artery occlusion. Erythrocyte sedimentation rate was only slightly elevated. Subsequent biopsy of the superficial temporal artery confirmed the diagnosis of giant cell arteritis. Cilioretinal arteries are anatomical variants derived from the short posterior ciliary arteries. Arteritic anterior ischemic optic neuropathy typically results from thrombotic occlusion of the short posterior ciliary arteries. Consequently, arteritic occlusion of the short posterior ciliary arteries can result in concomitant occlusion of the cilioretinal artery. This case highlights the situation where clinical symptoms were not suspicious for giant cell arteritis but the presence of an anterior ischemic optic neuropathy and a cilioretinal artery occlusion was virtually pathognomonic for giant cell arteritis. [ABSTRACT FROM AUTHOR]

Anterior ischemic optic neuropathy (AION) is a well-described cause of visual loss in patients who have undergone cardiac surgery with cardiopulmonary bypass. The etiology of AION following cardiac surgery with cardio-pulmonary bypass is believed to be multifactorial. Microembolisation and pump-related platelet dysfunction have been considered risk factors for the development of AION following cardiac surgery with cardiopulmonary bypass. Currently, 10–15% of cardiac procedures are performed without cardiopulmonary bypass to reduce morbidity. To the best of our knowledge, this is the second report of a patient who underwent off-pump cardiac surgery and developed an AION postoperatively. The patient's potential risk factors were severe anemia, new onset of atrial fibrillation with rapid ventricular rate, hypotension postoperatively, a small optic disc, uncontrolled diabetes mellitus and a past medical history of hypertension and coronary artery disease. [ABSTRACT FROM AUTHOR]