Journal List > J Korean Ophthalmol Soc > v.59(11) > 1107598

J Korean Ophthalmol Soc. 2018 Nov;59(11):1091-1096. Korean.
Published online November 16, 2018.  https://doi.org/10.3341/jkos.2018.59.11.1091
©2018 The Korean Ophthalmological Society
Bilateral Delayed Nonarteritic Anterior Ischemic Neuropathy Following Acute Primary Angle-closure Crisis
Eun Jung Park, MD, Yeoun Sook Chun, MD, PhD and Nam Ju Moon, MD, PhD
Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.

Address reprint requests to Nam Ju Moon, MD, PhD. Department of Ophthalmology, Chung-Ang University Hospital, #102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea. Tel: 82-2-6299-1666, Fax: 82-2-825-1666, Email: njmoon@cau.ac.kr
Received July 05, 2018; Revised August 01, 2018; Accepted October 18, 2018.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Purpose

We report a case of bilateral nonarteritic anterior ischemic optic neuropathy (NAION) following acute angle-closure crisis (AACC).

Case summary

A 76-year-old female visited our clinic because of a 1-day history of ocular pain and vision loss in both eyes. The visual acuity was 0.02 in both eyes and her intraocular pressure (IOP) was 52 mmHg in the right eye (RE) and 50 mmHg in the left eye (LE). She had corneal edema and a shallow anterior chamber in both eyes, with 4 mm fixed dilated pupils. After decreasing the IOP with intravenous mannitol, laser iridotomy was performed. However, 2 days later, visual acuity was further reduced to finger counting at 10 cm RE and at 50 cm LE, and her optic disc was swollen. Bilateral NAION following AACC was diagnosed. One month later, visual acuity slightly improved to 0.02 RE and 0.04 LE, and the optic disc edema resolved. A small cup-disc ratio, optic disc pallor, and atrophy were observed. Humphrey visual fields demonstrated superior and inferior altitudial visual field defects in the LE, and almost total scotoma in the RE.

Conclusions

AACC can be a predisposing factor for NAION, so the relative afferent pupillary defect, papilledema, and presentation of other risk factors are important clues to a diagnosis of NAION.

Keywords: Angle-closure glaucoma; Anterior ischemic optic neuropathy

Figures


Figure 1
Fundus photography images in both eyes. Fundus photograph at the second visit displayed asteroid aggregates that obscured optic disc of the right eye (A) and diffuse disc edema of the left eye (B). At 1 months (C) and 7 months (D) after nonarteritic anterior ischemic optic neuropathy following acute angle-closure crisis, resolution of optic disc edema, a small cup-to-disc ratio, optic disc pallor and atrophy were observed in left eye.
Click for larger image


Figure 2
Swept-source optical coherence tomography of the optic nerve and macula. (A, B) When nonarteritic anterior ischemic optic neuropathy occurred after acute angle-closure crisis, 3D wide analysis demonstrates optic nerve head edema in both eyes and epiretinal membrane in the right eye. (C, D) At 1 month after cataract surgery and 7 months after nonarteritic anterior ischemic optic neuropathy following acute angle-closure crisis, left eye showed the optic disc edema resolution. However, due to conture of epiretinal membranem (ERM), nasal optic disc sector in the right eye remained slightly elevated. All retinal nerve fiber layer thickness (RNFL) in both eyes were significantly decreased, except for the nasal quadrant RNFL thickness in the right eye due to the ERM. S = superior; T = temporal; N = nasal; I = inferior.
Click for larger image


Figure 3
The 30-2 program of the humphrey visual field analyzer (HVF). (A) When nonarteritic anterior ischemic optic neuropathy occurred after acute angle-closure crisis, HVF demonstrated almost total scotoma in both eyes. (B) At 1 month after cataract surgery and 7 months after nonarteritic anterior ischemic optic neuropathy following acute angle-closure crisis, HVF demonstrated superior and inferior altitudial visual fields defect in the left eye and almost total scotoma in the right eye.
Click for larger image


Figure 4
The standard visual evoked potential (VEP) waveform in response to flash stimuli. (A) When nonarteritic anterior ischemic optic neuropathy occurred after acute angle-closure crisis, VEP showed no response of the right eye and reduced P100 amplitude and prolonged P100 latency with 148 msec in the left eye. (B) At 1 month after cataract surgery and 7 months after nonarteritic anterior ischemic optic neuropathy following acute angle-closure crisis, VEP showed reduced P100 amplitude and prolonged P100 latency with 150 msec in the right eye and 126 msec in the left eye.
Click for larger image

Notes

Conflicts of Interest:The authors have no conflicts to disclose.

References
1. Arnold AC. Pathogenesis of nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol 2003;23:157–163.
2. Sonty S, Schwartz B. Vascular accidents in acute angle closure glaucoma. Ophthalmology 1981;88:225–228.
3. Slavin ML, Margulis M. Anterior ischemic optic neuropathy following acute angle-closure glaucoma. Arch Ophthalmol 2001;119:1215.
4. Nahum Y, Newman H, Kurtz S, Rachmiel R. Nonarteritic anterior ischemic optic neuropathy in a patient with primary acute angle closureglaucoma. Can J Ophthalmol 2008;43:723–724.
5. Choudhari NS, George R, Kankaria V, Sunil GT. Anterior ischemic optic neuropathy precipitated by acute primary-angle closure. Indian J Ophthalmol 2010;58:437–440.
6. Torricelli A, Reis AS, Abucham JZ, et al. Bilateral nonarteritic anterior ischemic neuropathy following acute angle-closure glaucoma in a patient with iridoschisis: case report. Arq Bras Oftalmol 2011;74:61–63.
7. Kuriyan AE, Lam BL. Non-arteritic anterior ischemic optic neuropathy secondary to acute primary-angle closure. Clin Ophthalmol 2013;7:1233–1238.
8. Kim R, Van Stavern G, Juzych M. Nonarteritic anterior ischemic optic neuropathy associated with acute glaucoma secondary to Posner-Schlossman syndrome. Arch Ophthalmol 2003;121:127–128.
9. Irak I, Katz BJ, Zabriskie NA, Zimmerman PL. Posner-Schlossman syndrome and nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol 2003;23:264–267.
10. Shin JH, Lee JW, Choi HY. A case of nonarteritic anterior ischemic optic neuropathy following acute angle-closure glaucoma. J Korean Ophthalmol Soc 2011;52:753–758.
11. Kim KN, Kim CS, Lee SB, Lee YH. Delayed non-arteritic anterior ischemic optic neuropathy following acute primary angle closure. Korean J Ophthalmol 2015;29:209–211.
12. Hayreh SS, Joos KM, Podhajsky PA, Long CR. Systemic diseases associated with nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol 1994;118:766–780.
13. Kim DH, Hwang JM. Risk factors for Korean patients with anterior ischemic optic neuropathy. J Korean Ophthalmol Soc 2007;48:1527–1531.
14. Bayraktar Z, Alacali N, Bayraktar S. Diabetic papillopathy in type II diabetic patients. Retina 2002;22:752–758.
15. Kim JH, Kang SY, Kim NR, et al. Prevalence and characteristics of glaucoma among korean adults. Korean J Ophthalmol 2011;25:110–115.