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Angioinvasive aspergillosis is an aggressive fungal infection that is potentially life threatening without prompt treatment. Optic nerve involvement of Aspergillus can mimic optic neuritis commonly seen in demyelinating and other inflammatory conditions. Treatment of Aspergillus infection with steroids may worsen the clinical course. We describe a unique case of disseminated central nervous system aspergillosis, initially presenting as an optic neuropathy, with subsequent stroke in multiple vascular territories.

Background: Optic nerve sheath decompression (ONSD) is a procedure that is advocated for the treatment of certain types of optic nerve dysfunction associated with progressive decline in visual function. The reported postoperative complications attributed to ONSD surgery are relatively few and predominantly transient and benign. Few postoperative vascular complications are reported., Methods: The authors performed a retrospective review of the operative and postoperative course of 31 consecutive patients (38 eyes) undergoing ONSD surgery for various types of optic nerve dysfunction associated with progressive decline in visual acuity, visual fields, or both. The authors evaluated the reports of other investigators to ascertain the spectrum and diversity of postoperative complications associated with ONSD., Results: Fifteen (40%) of the 38 eyes undergoing ONSD had postoperative complications, including temporary motility disorders (29%) and pupillary dysfunction (11%). Additionally, four eyes (11%) had postoperative vascular complications, including two central retinal artery occlusions (CRAOs), one superotemporal branch retinal artery occlusion (BRAO), and one episode of transient outer retinal ischemia. Both eyes with postoperative CRAOs had poor visual outcome. Eyes that had undergone prior ONSD were significantly more likely to have vascular complications than those without a previous operation (Fisher's exact test, P = 0.025)., Conclusions: Optic nerve sheath decompression can be associated with a variety of postoperative complications, the majority of which are minor and resolve without sequelae. Other complications, such as a CRAO, can be associated with significant visual loss. The physician and patients should be aware of the potential risks of ONSD, including significant visual morbidity, when considering this form of treatment.

Several reports have suggested that nonarteritic anterior ischemic optic neuropathy (AION) may be related to increased intraocular pressure. We reviewed the records of 45 patients aged 48 through 86 years with nonarteritic AION (10 patients had bilateral AION) for intraocular pressure measurements and the diagnosis of glaucoma or suspected glaucoma. This group was compared with 45 age- and sex-matched patients with normal eye examination results. The mean +/- SD intraocular pressures were 16.3 +/- 3.3 mm Hg for 45 eyes of the 45 patients with AION and 16.1 +/- 2.8 mm Hg for 45 eyes of the 45 control patients (paired t test, P = .70). Among patients with unilateral AION, intraocular pressure was not greater in the involved eye than in the uninvolved eye. Three patients with AION had a previous diagnosis of glaucoma, while three of the control patients were being followed up with suspected glaucoma. We found no evidence in our series to support the hypothesis that AION is associated with increased intraocular pressure.