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Ischaemic Optic Neuropathy
1. ISCHAEMIC OPTIC NEUROPATHY
HAYREH, S. S. (2009). ISCHEMIC OPTIC NEUROPATHY. PROGRESS IN RETINAL AND EYE
RESEARCH, 28(1), 34-62.
Ade Wijaya, MD – December 2017
2. INTRODUCTION
One of the major causes of blindness or seriously
impaired vision among the middle-aged or elderly
population
The term ION first used at 1974
Anterior vs posterior
Most common: NA-AION
7. PATHOGENESIS
Due to transient non-perfusion or hypoperfusion of
the ONH circulation. most common
Due to embolic lesions of the arteries/arterioles
feeding the ONH.
8. PATHOGENESIS
Optic nerve
ischaemia /
hypoxia
Axoplasmic flow
stasis in the
optic nerve
fibers
Axonal swelling
Asymtopmatic
optic disc
edema
compression of
the intervening
capillaries
when there is no cup or
only a small cup, the
swollen axons are
crowded in a restricted
space in
the optic disc
11. OCULAR PREDISPOSING RISK FACTORS
Absent or small cup in the optic disc
Raised IOP
Optic disc edema
Location of the watershed zone of the PCAs in
relation to the optic disc
Vascular disorders
Optic disc drusen
Cataract extraction
13. EPIDEMIOLOGY
Incidence: 2.30 – 10,20 per 100,000 population >
50 years old in the US
White > black or hispanic
Middle-aged / elderly
Men > women
14. SIGNS & SYMPTOMS
Sudden painless deterioration of vision
Usually discovered on waking in the morning
Visual field defects
Photophobia
Normal visual acuity doesn’t rule out NA-ION
Might have improvement up to 6 months
RAPD
Acute: disc edema ; Chronic: disc pallor
Simultaneous bilateral onset of NA-AION is
extremely rare, except in patients who develop
sudden, severe arterial hypotension, e.g. during
hemodi-alysis or surgical shock.
17. PATHOGENESIS
Causes: mostly GCA, other types of vasculitis, e.g.,
polyarteritis nodosa, systemic lupus erythematosus,
and herpes zoster.
T-cells dependent disease affecting PCA
Genetic predisposition caucasians
Late middle-aged and elderly
18. SIGNS & SYMPTOMS
Amaurosis fugax
Visual loss
Visual field defects
GCA symptoms
Extraocular motility disorders
RPD
Optic disc changes. ODE, compared to NA-AION,
usually has a diagnostic appearance in A-AION, i.e.
chalky white color
High ESR and CRP
23. INTRODUCTION
First described by Hayreh at 1981
Much less common than AION
A diagnosis of exclusion
Classification: non-arteritic, arteritic, surgical
Middle-age / elderly
Women > men
Clinical manifestation similar to AION with normal
funduscopic appearance
In surgical PION symptoms bilateral
24. DIAGNOSIS
Sudden onset of visual deterioration with or without
deterioration of central visual acuity
Optic nerve related visual field defects
RAPD
Normal fundus
No other ocular, orbital or neurological abnormality
to explain the visual loss;
Development of optic disc pallor, usually within 6–8
weeks
Surgical PION: dramatic visual loss noticed as soon
as the patient is alert enough after a major surgical
procedure
25. MANAGEMENT & PROGNOSIS
Similar to AION
Prognosis:
- NA PION good with steroid
- A PION steroid could prevent further visual
deterioration
- Surgical PION poor prognosis
26. SUMMARY
Spectrum of several type of condition with its own
etiology, pathogenesis, and management
Could cause blindness or severe visual impairment
Therapy during early stage of the diseases might
be beneficial