Abstract
Purpose
To introduce a case of bilateral anterior ischemic optic neuropathy (AION) after blood loss due to gastrointestinal bleeding.
Case summary
A 50-year-old male patient with a history of type 1 diabetes mellitus and alcoholic liver cirrhosis presented with 3 days of melena and 1 day of general weakness and dizziness. Initial hemoglobin level was 4.7 g/dL and blood pressure was 100/55 mm Hg. On esophagogastroduodenoscopy, a peptic ulcer with evident recent bleeding was observed. After transfusion of packed red blood cells and endoscopic hemostasis of bleeding, his general condition improved but he complained of blurred vision in both eyes which developed immediately after the onset of melena. Initial best-corrected visual acuity (BCVA) was 0.5 in his right eye and 0.6 in the left eye. On fundus examination, swollen optic disc with blurred margin was noted and he had constricted visual fields. On follow-up, the patient received posterior subtenon triamcinolone injection in his right eye. After the procedure, the BCVA was improved to 0.8 in both eyes, but he still had bilateral pale optic disc with constricted visual field.
References
1. Hayreh SS, Zimmerman MB.Nonarteritic anterior ischemic optic neuropathy: natural history of visual outcome. Ophthalmology. 2008; 115:298–305.e2.
2. Park WC, Chang BL.Clinical features of anterior ischemic optic neuropathy. J Korean Ophthalmol Soc. 2003; 44:144–9.
3. Jun BK, Kim DS, Ko MK.Clinical features in anterior ischemic optic neuropathy. J Korean Ophthalmol Soc. 1999; 40:3460–7.
4. Johnson MW, Kincaid MC, Trobe JD.Bilateral retrobulbar optic nerve infarctions after blood loss and hypotension. A clinicopatho-logic case study. Ophthalmology. 1987; 94:1577–84.
5. Foroozan R, Buono LM, Savino PJ.Optic disc structure and shock-induced anterior ischemic optic neuropathy. Ophthalmology. 2003; 110:327–31.
6. Foroozan R, Varon J.Bilateral anterior ischemic optic neuropathy after liposuction. J Neuroophthalmol. 2004; 24:211–3.
7. Onaran Z, Tan FU, Yı lmazbaş P, Onaran Y.Bilateral non-arteritic anterior ischemic optic neuropathy following second-trimester spontaneous abortion-related haemorrhage. J Clin Neurosci. 2012; 19:1445–7.
8. Shaked G, Gavriel A, Roy-Shapira A.Anterior ischemic optic neu-ropathy after hemorrhagic shock. J Trauma. 1998; 44:923–5.
9. Brouzas D, Charakidas A, Ladas I, Apostolopoulos M.Nonarteritic anterior ischemic optic neuropathy associated with chronic anemia: a case series of myelodysplastic syndrome patients. Clin Ophthalmol. 2009; 3:133–7.
10. Hayreh SS, Zimmerman MB.Non-arteritic anterior ischemic optic neuropathy: role of systemic corticosteroid therapy. Graefes Arch Clin Exp Ophthalmol. 2008; 246:1029–46.
11. Hayreh S.Anterior ischemic optic neuropathy. VIII. Clinical fea-tures and pathogenesis of post-hemorrhagic amaurosis. Ophthalmology. 1987; 94:1488–502.
12. Shin SG, Yoon IH, Won IG.A case of anterior ischemic optic neuropathy. J Korean Ophthalmol Soc. 1987; 28:1371–7.
13. Jin KH, Sohn WS, Kwark HW.Ischemic optic neuropathy follow-ing general anesthesia with prone position. J Korean Ophthalmol Soc. 1997; 38:2241–6.
14. Park S, Rho S, Chung SA.A case of non-arteritic anterior ischemic optic neuropathy after bilateral selective neck dissection. J Korean Ophthalmol Soc. 2012; 53:180–5.
15. Kaeser PF, Borruat FX.Perioperative visual loss: a rare complica-tion of general surgery. Klin Monbl Augenheilkd. 2008; 225:517–9.
16. Ellenberger C Jr, Keltner JL, Burde RM.Acute optic neuropathy in older patients. Arch Neurol. 1973; 28:182–5.
17. Beri M, Klugman MR, Kohler JA, Hayreh SS.Anterior ischemic optic neuropathy. VII. Incidence of bilaterality and various influ-encing factors. Ophthalmology. 1987; 94:1020–8.
18. Singer K.Über Sehstörungen nach Blutverlust. Beitr Z Augenheikd. 1904; 53:1–30.
19. Hollenhorst RW, Wegener HP.Loss of vision after distant hemorrhage. Am J Med Sci. 1950; 219:209–18.
20. Arnold AC.Pathogenesis of nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol. 2003; 23:157–63.
21. Lee AG, Biousse V.Should steroids be offered to patients with nonarteritic anterior ischemic optic neuropathy (NAION)? J Neuroophthalmol. 2010; 30:193–8.