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Donaldson L, Freund P, Aslahi R, Margolin E. Dialysis-Associated Nonarteritic Anterior Ischemic Optic Neuropathy: A Case Series and Review. J Neuroophthalmol 2022; 42:e116-e123. [PMID: 34974487 DOI: 10.1097/wno.0000000000001493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dialysis-associated nonarteritic ischemic optic neuropathy (DA-NAION) occurs secondary to intradialytic hypotension often with catastrophic consequences and is one of the rare situations where NAION can recur in the same eye. We describe 3 cases of DA-NAION associated with hypotension, review the current literature on DA-NAION, and provide recommendations for decreasing the risk of intradialytic hypotension. METHODS In addition to describing 3 cases of DA-NAION, PubMed was searched for all reports of DA-NAION in adults with documented episodes of hypotension preceding the onset of NAION. A total of 50 eyes of 31 patients were included. Age, visual acuity at presentation, rate of bilateral involvement at presentation, sequential involvement of the fellow eye, and recurrence of NAION in the same eye were analyzed. RESULTS We found that most cases of DA-NAION occur in relatively young patients (47.7 ± 14.7 years) with a high rate of bilateral involvement at presentation (23%) and bilateral sequential involvement (39%). Vision loss is severe with 64% of patients presenting with 20/200 acuity or worse in the involved eye and 19% of patients with final visual acuity of 20/200 or worse in both eyes. 3 patients (9.7%) had recurrence of NAION in the previously affected eye. CONCLUSIONS Neuro-ophthalmologists have an important role in identifying patients who have suffered DA-NAION and communicating their findings to nephrologists to minimize the chance of involvement of the fellow eye and recurrence in the same eye. Intradialytic blood pressure must be closely monitored, and fluid balance, dialysate composition, and dialysis protocol must be optimized to prevent occurrence of intradialytic hypotension, which is the culprit for DA-NAION.
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Affiliation(s)
- Laura Donaldson
- Department of Ophthalmology and Vision Sciences (LD, PF, EM), University of Toronto, Toronto, Canada; Department of Medicine (RA), Division of Nephrology, University of Toronto, Toronto, Canada; and Department of Medicine (EM), Division of Neurology, University of Toronto, Toronto, Canada
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Karti O, Top Karti D, Zengin MO, Yüksel B, Oguztoreli M, Kusbeci T. Acute Unilateral Anterior Ischemic Optic Neuropathy Secondary to Optic Nerve Head Drusen: Report of a Rare Coexistence. Neuroophthalmology 2018; 43:330-333. [PMID: 31741680 DOI: 10.1080/01658107.2018.1520900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 07/16/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022] Open
Abstract
A 45-year-old white male noticed on awakening the painless loss of inferior vision in the left eye 2 days ago. He was otherwise well and his medical history was unremarkable. Visual acuity was 20/20 in OD and 20/32 in OS with a left inferior altitudinal defect and right blind spot enlargement demonstrable on visual field test. On fundus examination, both disc margins were blurred and the left disc was diffusely oedematous, with linear haemorrhages in the adjacent nerve fibre layer. Radiologic imaging and laboratory tests were unremarkable. Bilateral optic nerve head drusen (ONHD) was demonstrated by optical coherence tomography and fundus autofluorescence imaging. Unilateral acute non-arteritic anterior ischemic optic neuropathy (NAION) and concomitant bilateral ONHD were diagnosed. NAION may develop secondary to ONHD. Therefore, clinicians should be aware of this rare association and inform the patients about this risk. Patients with ONHD should be followed-up periodically in terms of possible ischemic complications.
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Affiliation(s)
- Omer Karti
- Department of Ophthalmology, University of Health Sciences, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Dilek Top Karti
- Department of Neurology, University of Health Sciences, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Mehmet Ozgur Zengin
- Department of Ophthalmology, University of Health Sciences, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Bora Yüksel
- Department of Ophthalmology, University of Health Sciences, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Mustafa Oguztoreli
- Department of Ophthalmology, University of Health Sciences, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Tuncay Kusbeci
- Department of Ophthalmology, University of Health Sciences, Bozyaka Training and Research Hospital, İzmir, Turkey
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3
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Maio T, Lemos J, Moreira J, Sampaio F, Pereira S. Visual Impairment After Haemodialysis. Neuroophthalmology 2018; 43:43-48. [PMID: 30723524 DOI: 10.1080/01658107.2018.1471093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/21/2018] [Accepted: 04/26/2018] [Indexed: 10/28/2022] Open
Abstract
Hypotension is the most frequent complication of haemodialysis. We report a case of acute visual impairment after one session of haemodialysis in a context of an acute optic neuropathy. The immunological and serological studies were negative. The records of hypotension greater than usual after the dialysis session that coincided with the visual complaints strongly suggest the dialysis-induced hypotension is the underlying mechanism of this non-arteritic anterior ischemic optic neuropathy.
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Affiliation(s)
- Tiago Maio
- Hospital Pedro Hispano, Matosinhos, Portugal
| | - José Lemos
- Hospital Pedro Hispano, Matosinhos, Portugal
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4
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Di Zazzo G, Guzzo I, De Galasso L, Fortunato M, Leozappa G, Peruzzi L, Vidal E, Corrado C, Verrina E, Picca S, Emma F. Anterior ischemic optical neuropathy in children on chronic peritoneal dialysis: report of 7 cases. Perit Dial Int 2016; 35:135-9. [PMID: 25904772 DOI: 10.3747/pdi.2013.00330] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Anterior ischemic optic neuropathy (AION) is characterized by infarction of the optic nerve head due to hypoperfusion of the posterior ciliary arteries and causes sudden blindness in adults on chronic dialysis, but has rarely been described in children. Unlike adults, children do not have comorbidities related to aging. METHODS We retrospectively analyzed data of 7 children on nocturnal continuous cycling peritoneal dialysis (CCPD) who developed AION identified within the Italian Registry of Pediatric Chronic Dialysis. We also summarized data from 10 cases reported in the literature. RESULTS Our 7 patients suffered from acute onset bilateral blindness. Their mean age was 3.2 years and chronic hypotension had been observed prior the AION in 3 of the 7 children. Low systolic blood pressure (SBP) was associated with higher risk of developing AION according to statistical analysis. None recovered completely. In total, 11 out of 16 experienced a partial recovery and no clear evidence emerged favoring specific treatments. CONCLUSIONS Hypotensive children treated with CCPD are at increased risk of developing AION, which often results in irreversible blindness.
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Affiliation(s)
- Giacomo Di Zazzo
- Department of Nephrology and Urology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Isabella Guzzo
- Department of Nephrology and Urology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Lara De Galasso
- Department of Nephrology and Urology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Michele Fortunato
- Department of Ophthalmology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanna Leozappa
- Department of Nephrology and Urology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Licia Peruzzi
- Nephrology, Dialysis and Transplantation Unit, Regina Margherita University Hospital, Turin, Italy
| | - Enrico Vidal
- Department of Pediatrics, Pediatric Nephrology, Dialysis and Transplantation Unit, University of Padua, Italy
| | - Ciro Corrado
- Pediatric Nephrology Unit, G. Di Cristina Children's Hospital, Palermo, Italy
| | - Enrico Verrina
- Nephrology, Dialysis and Transplantation Unit, Giannina Gaslini Institute, Genoa, Italy
| | - Stefano Picca
- Department of Nephrology and Urology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Emma
- Department of Nephrology and Urology, Bambino Gesù Children's Hospital, Rome, Italy
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Unilateral Acute Anterior Ischemic Optic Neuropathy in a Patient with an Already Established Diagnosis of Bilateral Optic Disc Drusen. Case Rep Ophthalmol Med 2015; 2015:730606. [PMID: 26550507 PMCID: PMC4624910 DOI: 10.1155/2015/730606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 08/03/2015] [Indexed: 11/18/2022] Open
Abstract
Optic disc drusen (ODD) are calcific deposits that form in the optic nerve head secondary to abnormalities in axonal metabolism and degeneration. Anterior ischemic optic neuropathy, central retinal artery, and vein occlusion are among the rare vascular complications of disc drusen. We reported the clinical course of a 51-year-old patient with a unilateral acute nonarteritic anterior ischemic optic neuropathy (NAION) who received the diagnosis of bilateral optic disc drusen five years earlier and thereby reiterated the association of ODD and acute NAION.
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Bansal S, Ansons A, Vishwanath M. Hypotension-induced blindness in haemodialysis patients. Clin Kidney J 2014; 7:387-90. [PMID: 25852914 PMCID: PMC4377795 DOI: 10.1093/ckj/sfu036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/25/2014] [Indexed: 12/01/2022] Open
Abstract
Hypotension is a commonly encountered complication in haemodialysis patients and is a significant cause of morbidity and mortality. Bilateral visual loss in dialysis induced hypotension remains poorly recognized as a complication by both renal physicians and ophthalmologists. We report 2 cases of patients on renal dialysis who suffered severe longstanding hypotension with bilateral non-arteritic anterior ischaemic optic neuropathy. Both patients experienced bilateral loss of vision over a short time period. We feel that physicians must be aware of patients complaining of painless visual loss in this high risk group, as control of blood pressure may be the most important factor in prevention of this visually devastating condition.
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Affiliation(s)
- Shveta Bansal
- Department of Neuroophthalmology , Manchester Royal Eye Hospital , Manchester , UK
| | - Alec Ansons
- Department of Neuroophthalmology , Manchester Royal Eye Hospital , Manchester , UK
| | - Mandagere Vishwanath
- Department of Neuroophthalmology , Manchester Royal Eye Hospital , Manchester , UK
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7
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Kim JY, Kim KN, Kim WJ, Lee YH. Acute bilateral visual loss related to orthostatic hypotension. KOREAN JOURNAL OF OPHTHALMOLOGY 2013; 27:372-5. [PMID: 24082776 PMCID: PMC3782584 DOI: 10.3341/kjo.2013.27.5.372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 12/08/2011] [Indexed: 12/02/2022] Open
Abstract
A 50-year-old man had undergone lumbar vertebral surgery and was confined to bed in the supine position for three months. When he sat up from the prolonged supine position, he showed clinical signs of orthostatic hypotension and reported decreased vision in both eyes. He also had underlying anemia. Ophthalmologic findings suggested bilateral anterior ischemic optic neuropathy (ION) as the cause of the visual loss. Although there are numerous reports of ION in the setting of hemodynamic compromise, such as systemic hypotension, cases of ION-associated orthostatic hypotension are very rare.
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Affiliation(s)
- Jung-Yeul Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
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8
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Arnold AC, Costa RMS, Dumitrascu OM. The spectrum of optic disc ischemia in patients younger than 50 years (an Amercian Ophthalmological Society thesis). TRANSACTIONS OF THE AMERICAN OPHTHALMOLOGICAL SOCIETY 2013; 111:93-118. [PMID: 24167327 PMCID: PMC3799463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE To identify the spectrum of clinical and fluorescein angiographic features of optic disc ischemia in patients younger than 50 years. METHODS This retrospective comparative case series from a university consultative neuro-ophthalmology practice consisted of two phases. The first compared 108 cases of nonarteritic anterior ischemic optic neuropathy in patients younger than 50 years (NAIONy) to a cohort of 108 cases in patients 50 years or older (NAIONo). Predisposing risk factors, fluorescein angiographic features, and clinical course were compared. In the second phase, 12 cases of diabetic papillopathy under age 50 were assessed by fluorescein angiographic criteria for evidence of optic disc ischemia and compared to patients with NAIONy. RESULTS NAIONy comprised 108 (12.7%) of 848 NAION cases reviewed. Chronic renal failure with dialysis and migraine were more common in NAIONy. Fellow eye involvement rate was significantly higher for NAIONy patients (46/108, 42.6%) than for NAIONo patients (32/108, 29.6%). Fluorescein angiographic features of ischemia were documented in 44 (81.5%) of 54 eyes studied. In one case, these features were documented in pre-NAION edema. Diabetic papillopathy demonstrated delayed filling consistent with ischemia in 7 of 10 (70.0%), without significant visual field loss. CONCLUSIONS Ischemic optic neuropathy in patients younger than 50 years is not rare. Fellow eye involvement is more frequent in younger patients. Fluorescein angiography confirmation of impaired perfusion in multiple syndromes of optic neuropathy corroborates a spectrum of optic disc ischemia ranging from perfusion delay without visual loss to severely impaired perfusion and visual loss and incorporates optic neuropathies previously considered nonischemic.
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Affiliation(s)
- Anthony C Arnold
- Division of Neuro-Ophthalmology, Jules Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles
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9
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Kwak AY, Kim GA, Choi JB. A Case of Acute Nonarteritic Anterior Ischemic Optic Neuropathy in Patient on Hemodialysis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.12.1960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ae Young Kwak
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Siloam Eye Hospital, Seoul, Korea
| | - Gyu Ah Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Siloam Eye Hospital, Seoul, Korea
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10
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Bartlett S, Cai A, Cairns H. Non-arteritic ischaemic optic neuropathy after first return to haemodialysis. BMJ Case Rep 2011; 2011:bcr.04.2011.4072. [PMID: 22689554 DOI: 10.1136/bcr.04.2011.4072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors present an interesting case of non-arteritic anterior ischaemic optic neuropathy (NAION) after 2 h of haemodialysis, in a 42-year-old Caucasian woman with anaemia (haemoglobin 7.1 g/dl) uraemia (56.3 mmol/l), spurious hypotension (42/26 mm Hg) and previous history of anterior ischaemic optic neuropathy (AION) in the other eye. Thirteen cases of haemodialysis related NAION in adults have been reported to date. NAION is produced when oxygen delivery to the optic nerve is compromised resulting in hypoxic swelling, nerve compression in the optic canal and ischaemia of the optic nerve head. It typically presents as a sudden, unilateral and painless inferior visual field defect with a fixed unreactive pupil after a period of relative hypotension. Clinicians should be aware of this unusual complication when considering and explaining dialysis options, particularly in patients with other risk factors such as hypotension, anaemia, significant uraemia and previous history of AION.
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Affiliation(s)
- Sarah Bartlett
- Renal Medicine, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom.
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11
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Patel NN, Shulman JP, Chin KJ, Finger PT. Optical coherence tomography/scanning laser ophthalmoscopy imaging of optic nerve head drusen. Ophthalmic Surg Lasers Imaging Retina 2010; 41:614-21. [PMID: 20954642 DOI: 10.3928/15428877-20100929-07] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 07/28/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate optical coherence tomography/scanning laser ophthalmoscopy (OCT/SLO) imaging for optic nerve head drusen (ONHD). PATIENTS AND METHODS Nine consecutive eyes with ONHD were imaged. Each underwent visual field testing, 20-MHz B-scan ultrasonography, photography, and OCT/SLO imaging of the nerve head. Similar evaluation was performed on 12 matched, disease-free control eyes for comparison. RESULTS OCT/SLO imaging of ONHD demonstrated lucencies (100%), variable amounts of displacement, and thickening of the overlying nerve fiber layer, as well as disorganization of the adjacent retinal pigment epithelium (44%). Optic nerve head topography was measured (using horizontal and vertical electronic calipers). Mean disc diameter was 1.81 mm (range: 1.49 to 2.12 mm). All ONHD demonstrated anterior displacement of the base of the optic nerve cup (shallowing) compared to controls. The cup base was a mean +0.32 mm anterior to the retinal pigment epithelium for ONHD versus -0.23 mm for normal controls. CONCLUSION OCT/SLO revealed unique and clinically helpful views of ONHD.
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12
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Kaiser HJ, Flammer J, Messerli J. Vasospasm-a risk factor for nonarteritic anterior ischemic optic neuropathy? Neuroophthalmology 2009. [DOI: 10.3109/01658109609009653] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Abstract
A 37-year-old patient presented with acute visual field loss diagnosed as non-arteritic anterior ischemic optic neuropathy in the setting of optic nerve drusen. Her visual field loss had progressed when compared to the visual field done 2 years previously. Fundus examination showed bilateral optic nerve head drusen and left retinal nerve fiber layer edema consistent with non-arteritic anterior ischemic optic neuropathy.
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Affiliation(s)
- Sevim Kavuncu
- Neuro-ophthalmology Service, Wills Eye Institute, Thomas Jefferson University, Phialdelphia, Pennsylvania 19107, USA
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14
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Aumiller MS. Optic disc drusen: Complications and management. ACTA ACUST UNITED AC 2007; 78:10-6. [PMID: 17208669 DOI: 10.1016/j.optm.2006.07.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Accepted: 07/16/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Disc drusen have been found clinically in 0.3% of the population with up to 91% presenting bilaterally. Disc drusen gradually change in their ophthalmoscopic appearance throughout a patient's lifespan. This case highlights the possible ocular complications of disc drusen and the complexity in their treatment because of the risk of visual acuity loss. CASE REPORT A 43-year-old patient with documented bilateral buried disc drusen presented without symptoms for a routine examination. A subretinal neovascular membrane (SNVM) one quarter of a disc diameter in size with an adjacent subretinal hemorrhage was observed in the right eye with a small subretinal hemorrhage in the fellow eye. The patient was evaluated by a retinologist who deferred photocoagulation of the SNVM considering its nasal disc location. CONCLUSIONS Diagnosing disc drusen is critical because of the serious pathology they can mimic, including disc edema. Although typically benign, patients with disc drusen should be monitored on a regular basis to rule out ocular complications, which can be potentially sight threatening.
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Floyd MS, Katz BJ, Digre KB. Measurement of the scleral canal using optical coherence tomography in patients with optic nerve drusen. Am J Ophthalmol 2005; 139:664-9. [PMID: 15808162 DOI: 10.1016/j.ajo.2004.11.041] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2004] [Indexed: 11/17/2022]
Abstract
PURPOSE The etiology of optic nerve drusen (OND) is unknown. A leading hypothesis is that eyes with OND have a small scleral canal. The small scleral canal presumably leads to optic nerve fiber compression, ganglion cell degeneration, extrusion of axonal mitochondria, and calcification of the extruded mitochondria. To determine if subjects with OND have scleral canals that are smaller than subjects without OND, we used optical coherence tomography (OCT) to measure the scleral canal in subjects with and without OND. DESIGN Prospective, observational case control study. METHODS The study was conducted with subjects recruited from the clinics of the John A. Moran Eye Center, University of Utah Department of Ophthalmology and Visual Sciences. The study population included 25 subjects with OND, 13 unaffected first-degree relatives of OND subjects, and 17 control subjects. All subjects underwent measurement of the scleral canal with OCT. The main outcome measure was the scleral canal area calculated by OCT. RESULTS The average areas of the scleral canals were as follows: control eyes: 1.832 mm(2), unaffected eyes of subjects with unilateral OND: 1.836 mm(2), eyes of unaffected first-degree relatives: 2.067 mm(2), and eyes with OND: 2.520 mm(2). The scleral canal area of unaffected eyes of subjects with unilateral drusen was not significantly different from the control. The eyes of first-degree relatives and eyes with OND both had scleral canal areas significantly larger than the control. CONCLUSIONS Scleral canal size is probably not an etiologic factor in the pathogenesis of OND.
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Affiliation(s)
- Michael S Floyd
- Department of Ophthalmology and Visual Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA
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16
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Korzets A, Marashek I, Schwartz A, Rosenblatt I, Herman M, Ori Y. Ischemic optic neuropathy in dialyzed patients: A previously unrecognized manifestation of calcific uremic arteriolopathy. Am J Kidney Dis 2004; 44:e93-7. [PMID: 15558514 DOI: 10.1053/j.ajkd.2004.08.035] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Two patients with end-stage renal disease and on long-term hemodialysis presented with hypotension and an acute unilateral loss of vision. A diagnosis of anterior ischemic optic neuropathy (AION) was made quickly, but despite high-dose steroid therapy, significant vision was not recovered. Temporal artery biopsy results showed extensive medial calcification. The possibility that hypotension, when coupled with calcific uremic arteriolopathy in arteries supplying the optic nerve head, will lead to AION in dialyzed patients is discussed. A short review of AION in the dialysis population is given.
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Affiliation(s)
- Asher Korzets
- Department of Nephrology, Rabin Medical Center (Campus Golda), Petach Tikva, Israel.
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17
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Lapeyraque AL, Haddad E, André JL, Brémond-Gignac D, Taylor CM, Rianthavorn P, Salusky IB, Loirat C. Sudden blindness caused by anterior ischemic optic neuropathy in 5 children on continuous peritoneal dialysis1 1Published partially (case 3) in abstract form in Arch Ped 7:437, 2000, and in Pediatr Nephrol 16:C4, 2001. Am J Kidney Dis 2003; 42:E3-9. [PMID: 14582071 DOI: 10.1016/j.ajkd.2003.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors report the occurrence of sudden blindness in 5 children (mean age, 32 months; range, 11 to 60) during continuous peritoneal dialysis regimen. All children presented with loss of light perception, visual fixation and ocular pursuit, and bilateral mydriasis unreactive to bright light. Fundoscopic examination found signs of anterior ischemic optic neuropathy with disc swelling, edema, and hemorrhages. Whereas 1 patient was dehydrated, the 4 other patients appeared well and not dehydrated. Nevertheless, blood pressure was below the normal range in all of them. Therefore, hypovolemia is highly suspected to have been the cause of ischemic optic neuropathy in all cases. Treatment consisted of steroids (4 patients), anticoagulation or antiagregation drugs (3 patients), plasma or macromolecules infusions (2 patients), vasodilatators (2 patients), and transient dialysis interruption (1 patient). One child with hepatic cirrhosis died 4 days later of acute liver insufficiency owing to ischemic hepatic necrosis. The other children had only partial improvement of vision during the following months. Because the prognosis of ischemic optic neuropathy is very poor, diagnosis and treatment of chronic hypovolemia in children on continuous peritoneal dialysis is essential to prevent such a devastating complication.
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Affiliation(s)
- Anne-Laure Lapeyraque
- Service de Néphrologie and the Service d'Ophtalmologie, Hopital Robert Debré, Assistance Publique-Hopitaux de Paris, Paris, France
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18
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Chutorian AM, Winterkorn JMS, Geffner M. Anterior ischemic optic neuropathy in children: case reports and review of the literature. Pediatr Neurol 2002; 26:358-64. [PMID: 12057795 DOI: 10.1016/s0887-8994(02)00398-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Anterior ischemic optic neuropathy, infarction of the optic nerve head owing to inadequate perfusion through the posterior ciliary arteries, is a common cause of visual loss in adults but is rarely reported in children, in part because the diagnosis is overlooked. We report two cases of young children undergoing chronic peritoneal dialysis, who suffered bilateral visual loss from anterior ischemic optic neuropathy. Predisposing local anatomic and multiple systemic factors included a small optic nerve head with little cupping, possible intraocular hypertension, and systemic hypotension, hypovolemia, and anemia. The literature on anterior ischemic optic neuropathy is reviewed.
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Affiliation(s)
- Abe M Chutorian
- Division of Pediatric Neurology, New York Presbyterian Hospital-Weill Cornell University Medical Center, New York 10021, USA
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19
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Kamath GG, Prasad S, Phillips RP. Bilateral anterior ischaemic optic neuropathy due to optic disc drusen. Eur J Ophthalmol 2000; 10:341-3. [PMID: 11192846 DOI: 10.1177/112067210001000414] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report a case of bilateral anterior ischaemic optic neuropathy due to buried optic disc drusen. METHODS Case report. RESULTS A 64-year-old man presented with swollen optic discs and features suggestive of anterior ischaemic optic neuropathy (AION) in the left and right eye on two separate occasions ten months apart. Detailed ocular examination at presentation and systemic investigations did not reveal an underlying cause for the AION. At a later follow-up, optic disc drusen were noted in both eyes as partial optic atrophy had set in. This was confirmed by ultrasound B scan and demonstration of autofluorescence. CONCLUSIONS In patients presenting with AION uncommon underlying causes must be considered. Routine ultrasound B scan at presentation can easily establish or exclude optic disc drusen as an underlying cause.
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Affiliation(s)
- G G Kamath
- Department of Ophthalmology, Arrowe Park Hospital, Upton, Wirral, UK.
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Bates CM, Baum M, Hunchik M, Quan A. Acute vision loss in children with autosomal recessive polycystic kidney disease. Am J Kidney Dis 1999; 34:1125-8. [PMID: 10585323 DOI: 10.1016/s0272-6386(99)70019-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Patients with autosomal recessive polycystic kidney disease (ARPKD) often present with renal insufficiency and hypertension. We present two children with ARPKD and end-stage renal disease who developed anterior ischemic optic neuropathy and vision loss. Anterior ischemic optic neuropathy occurs rarely in children and has never been reported in children with ARPKD or end-stage renal disease. Both of our patients were chronically hypotensive and anemic, which are known risk factors for ischemic optic neuropathy.
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Affiliation(s)
- C M Bates
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, 75235-9063, USA
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Jackson TL, Farmer CK, Kingswood C, Vickers S. Hypotensive ischemic optic neuropathy and peritoneal dialysis. Am J Ophthalmol 1999; 128:109-11. [PMID: 10482108 DOI: 10.1016/s0002-9394(99)00026-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To report anterior ischemic optic neuropathy associated with systemic hypotension in a patient undergoing continuous ambulatory peritoneal dialysis. METHODS Case report. A 58-year-old man undergoing continuous ambulatory peritoneal dialysis developed painless blurred vision in both eyes and bilateral optic disk swelling with an altitudinal field defect in the left eye. Twenty-four-hour ambulatory blood pressure monitoring was requested in addition to other routine investigations. RESULTS Routine blood pressure measurement in the clinic was 130/86 mm Hg, but ambulatory blood pressure monitoring demonstrated pronounced early morning hypotension with individual readings as low as 91/41 mm Hg. CONCLUSIONS Renal dialysis can render patients hypotensive, and this may be associated with anterior ischemic optic neuropathy. The overnight drop in blood pressure may not be appreciated with routine blood pressure measurement. Therefore, 24-hour ambulatory blood pressure monitoring should be considered when investigating patients with suspected anterior ischemic optic neuropathy who are undergoing renal replacement.
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Affiliation(s)
- T L Jackson
- The Sussex Eye Hospital, Brighton, United Kingdom.
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22
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Liew SC, Mitchell P. Anterior ischaemic optic neuropathy in a patient with optic disc drusen. AUSTRALIAN AND NEW ZEALAND JOURNAL OF OPHTHALMOLOGY 1999; 27:157-60. [PMID: 10379717 DOI: 10.1046/j.1440-1606.1999.00176.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although visual field defects are well-known complications of optic disc drusen, reduction in visual acuity with this condition is rare. METHOD/RESULTS We report on a 68-year-old male with bilateral optic disc drusen who presented with monocular loss of vision in the right eye associated with an inferior altitudinal visual field defect and signs consistent with acute anterior ischaemic optic neuropathy, confirmed on fluorescein angiography. He also had a left inferior nasal step, but no evidence of glaucomatous cupping. The disc drusen were documented clinically and on B scan ultrasound and computed tomography. CONCLUSIONS The diagnosis of acute anterior ischaemic optic neuropathy should be considered in patients with optic disc drusen who present with reduced visual acuity, particularly when the visual loss has been acute and non-progressive and is associated with altitudinal field loss and characteristic fluorescein angiography signs.
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Affiliation(s)
- S C Liew
- Department of Clinical Ophthalmology, University of Sydney, Westmead Hospital, NSW, Australia
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Doorenbos-Bot ACC, Geerlings W, Houtman WA. Anterior ischemic optic neuropathy in patients undergoing hemodialysis. Neuroophthalmology 1996. [DOI: 10.3109/01658109609009675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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