Fluorescein angiographic features of choroidal insufficiency in anterior ischemic optic neuropathy

Hypothesis: Watershed zones in the human eye are a key for understanding glaucomatous retinal damage

The pathogenesis of glaucoma is complex which has led to numerous hypothesizes concerning the important factors creating this specific type of inner retinal degeneration namely apoptosis of retinal ganglion cells. We favor a primary vascular etiology and provide evidence that the pathogenesis of glaucoma should not be confined to changes exclusively at the optic nerve head but must include changes occurring in the peripheral retina with particular emphasis on the watershed zones of both the retina and choroid. This focus may help to sharpen ones awareness for early glaucoma treatment particularly in patients with minimal findings suggestive of glaucoma.

Analysis of Fundus Photography and Fluorescein Angiography in Nonarteritic Anterior Ischemic Optic Neuropathy and Optic Neuritis

Purpose

We evaluated fundus and fluorescein angiography (FAG) findings and characteristics that can help distinguish nonarteritic anterior ischemic optic neuropathy (NAION) from optic neuritis (ON).

Methods

Twenty-three NAION patients and 17 ON with disc swelling patients were enrolled in this study. We performed fundus photography and FAG. The disc-swelling pattern, hyperemia grade, presence of splinter hemorrhages, cotton-wool spots, artery/vein ratio and degree of focal telangiectasia were investigated. The FAG findings for each patient were compared with respect to the following features: the pattern of disc leakage in the early phase, arteriovenous (artery/vein) transit time (second), and the presence and pattern of the filling delay.

Results

Cotton-wool spots, focal telangiectasia, and venous congestion were more common in the affected eyes of NAION patients. Upon FAG, 76.5% of the patients in the ON group exhibited normal choroidal circulation. However, 56.5% of patients in the NAION group demonstrated abnormal filling defects, such as peripapillary, generalized, or watershed zone filling delays.

Conclusions

Fundus findings, including cotton-wool spots, focal telangiectasia, and venous congestion in the affected eye, may be clues that can be used to diagnose NAION. In addition, choroidal insufficiencies on FAG could be also helpful in differentiating NAION from ON.

Evaluation of the macular choroidal thickness using spectral optical coherence tomography in patients with obstructive sleep apnoea syndrome

BACKGROUND

To assess the choroidal thickness (CT) in patients with obstructive sleep apnoea syndrome (OSAS) and healthy controls.

DESIGN

Prospective, cross-sectional study

PARTICIPANTS

Ninety-two eyes of 92 patients with OSAS and 32 eyes of 32 aged and body mass index-matched healthy subjects were enrolled.

METHODS

OSAS patients were further divided into mild, moderate and severe OSAS groups according to their apnoea hypopnea index (AHI) values. The macular CT and peripapillary retinal nerve fibre layer (RNFL) thickness measurements of the subjects were obtained using spectral domain optical coherence tomography (RTVue-100, Optovue). The CT and RNFL thickness measurements of the groups were compared, and correlations among the AHI values and these measurements were calculated.

MAIN OUTCOME MEASURES

Choroidal thickness.

RESULTS

There were no significant differences in subfoveal and temporal CT measurements of the groups. A pairwise comparison between the groups revealed that severe OSAS group has significantly thinner CT than mild OSAS group at 3.0 mm nasal to the fovea. Also, compared with severe OSAS group, the CT measurements at 1.5 mm and 3.0 mm nasal to the fovea were significantly thicker in control eyes (both, P < 0.05). There were weak negative correlations between the nasal CT measurements and AHI in the OSAS group (nasal 1.5 mm, P = 0.002, r = -0.358; nasal 3.0 mm, P = 0.004, r = -0.336). Compared with controls, severe OSAS group had significantly thinner nasal and superior RNFL thickness measurement.

CONCLUSIONS

Sleep apnoea patients had choroidal structural alterations that may have significance on the pathophysiology of the ophthalmic disorders associated with OSAS.

Diabetic papillopathy and its relation to optic nerve ischemia

PURPOSE

This presentation exhibits a case report and review of multiple reported cases of hyperemic optic disc swelling in patients with diabetes. After excluding all other known causes of optic nerve insult, this pathology has typically been labeled as diabetic papillopathy.

CASE REPORT

We offer a case of a 65-year-old veteran with unilateral hyperemic optic disc swelling, presenting with minimal optic nerve dysfunction. After an extensive evaluation to rule out other causative pathology, this patient was diagnosed with diabetic papillopathy.

CONCLUSIONS

Presented are clinical data of a case of diabetic papillopathy and a literature review to delineate the typical published clinical characteristics and course of this disease process. We also review literature to summarize the typical characteristics of anterior ischemic optic neuropathy and offer a hypothesis to reconcile the dilemmas regarding its relation to diabetic papillopathy.

Activated protein C resistance in anterior ischaemic optic neuropathy

PURPOSE

Protein C is a major component of the natural anticoagulant pathway. Resistance of coagulation factor V (FV) to activated protein C (APC), mostly due to FV Leiden mutation, is the most common cause of inherited thrombophilia. The aim of this retrospective study was to determine the prevalence of APC resistance and Leiden mutation in patients with non-arteritic anterior ischaemic optic neuropathy (NAION).

METHODS

A total of 25 patients with NAION were examined between 1997 and 2002. The patients were screened for APC resistance and FV Leiden mutation as well as for acquired risk factors of vascular disease such as diabetes mellitus, hypercholesterolaemia, hypertonia and ischaemic heart disease. A control group of subjects without ocular vascular disease and with homogenous distribution of the same risk factors was used for comparison.

RESULTS

Six of the 25 patients (24%) with NAION had APC resistance due to the heterozygous Leiden mutation of FV. The frequency of the same genetic mutation in the control group was only 5.9%. Odds ratio calculations showed that patients with the Leiden mutation were at a significantly higher risk of NAION than control patients (p < or = 0.021).

CONCLUSION

The high frequency of Leiden mutation in NAION suggests a pathogenic role of the mutation in the disease.