Abstract
Compromised blood supply to the optic nerve with concurrent ischemic damage is a common cause of optic neuropathy and has many variants. This chapter focuses on this entity and its types. A brief description of the relevant clinical anatomy is included along with a short description of the pertinent points to be considered during history taking and clinical examination of these patients. Nonarteritic anterior ischemic optic neuropathy (NAION), which is the commonest type of ischemic optic neuropathy, is discussed in detail—including clinical features, investigations, and recent advances and trials for the management of this entity. A complete review of arteritic ischemic optic neuropathy—associated with giant cell arteritis (GCA)—is also included including management of the acute episode and long-term management. Less common variants such as posterior ischemic optic neuropathy (PION) are also discussed to provide a complete overview of the topic.
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References
Kupfer C, Chumbly L, Downer JC. Quantitative histology of optic nerve tract and lateral geniculate nucleus of man. J Anat. 1967;101:393–401.
Potts AM, Hodges D, Sherman CB, et al. Morphology of the primate optic nerve: I-III. Invest Ophthalmol Vis Sci. 1972;11:980–1016.
Hayreh SS. The 1994 Van Sallman Lecture: the optic nervehead circulation in health and disease. Exp Eye Res. 1995;61:259–72.
Onda E, Cioffi GA, Bacon DR, et al. Microvasculature of the human optic nerve. Am J Ophthalmol. 2008;43:308–12.
Johnson LN, Arnold AC. Incidence of nonarteritic anterior ischemic optic neuropathy. Population-based study in the state of Missouri and Los Angeles County, California. J Neuroophthalmol. 1994;14:38–44.
Arnold AC, et al. The spectrum of optic disc ischemia in patients younger than 50 years. Trans Am Ophthalmol Soc. 2013;111:93–118.
Hattenhauer MG, Leavitt JA, Hodge DO, et al. Incidence of non-arteritic anterior ischemic optic neuropathy. Am J Ophthalmol. 1997;123:103–7.
Hayreh SS, Joos KM, Podhajsky PA, et al. Systemic diseases associated with nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol. 1994;118:766–80.
Jacobson DM, Vierkant RA, Belongia EA. Nonarteritic anterior ischemic optic neuropathy. A case-control study of potential risk factors. Arch Ophthalmol. 1997;115:1403–7.
Ischemic Optic Neuropathy Decompression Trial Study Group. Characteristics of patients with nonarteritic anterior ischemic optic neuropathy eligible for the Ischemic Optic Neuropathy Decompression Trial. Arch Ophthalmol. 1996;114:1366–74.
Hayreh SS, Podhajsky PA, Zimmerman B. Nonarteritic anterior ischemic optic neuropathy: time of onset of visual loss. Am J Ophthalmol. 1997;124:641–7.
Hayreh SS, Podhajsky P, Zimmerman MB. Role of nocturnal arterial hypotension in optic nerve head ischemic disorders. Ophthalmologica. 1999;213:76–96.
Doro S, Lessell S. Cup disc ratio and ischemic optic neuropathy. Arch Ophthalmol. 1993;103:1143–4.
Beck RW, Servais GE, Hayreh SS. Anterior ischemic optic neuropathy. IX. Cup to disc ratio and its role in pathogenesis. Ophthalmology. 1987;94:1502–8.
Fry CL, Carter JE, Kanter MC, et al. Anterior ischemic optic neuropathy is not associated with carotid artery atherosclerosis. Stroke. 1993;24:539–42.
Mojan DS, Hedges TR, Ehrenberg B, et al. Association between sleep apnea syndrome and nonarteritic anterior ischemic optic neuropathy. Arch Ophthalmol. 2002;120:601–5.
Pomeranz HD, Smith KH, Hart WM Jr, et al. Sildenafil-associated nonarteritic anterior ischemic optic neuropathy. Ophthalmology. 2002;109:584–7.
Campbell UB, et al. Acute nonarteritic anterior ischemic optic neuropathy and exposure to phosphodiesterase type 5 inhibitors. J Sex Med. 2015;12:139–51.
Fraunfelder FW, Pomeranz HD, Egan RA. Nonarteritic anterior ischemic optic neuropathy and sildenafil. Arch Ophthalmol. 2006;124:733–4.
Nathoo NA, et al. Association between phosphdiesterase-5 inhibitors and nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol. 2015;35:12–5.
Repka MX, Savion PJ, Schatz NJ, et al. Clinical profile and long-term implications of anterior ischemic optic neuropathy. Am J Ophthalmol. 1983;96:478–83.
Swartz NG, Beck RW, Savino PJ, et al. Pain in anterior ischemic optic neuropathy. J Neuroophthalmol. 1995;15:9–10.
Warner JEA, Lessell S, Rizzo JF, et al. Does optic disc appearance distinguish ischemic optic neuropathy from optic neuritis. Arch Ophthalmol. 1997;115:1408–10.
Friedland S, Winterkorn JM, Burde RM. Luxury perfusion following anterior ischemic optic neuropathy. J Neuroophthalmol. 1996;16:163–71.
Arnold AC, Hepler RS. Natural history of non arteritic ischemic optic neuropathy. J Neuroophthalmol. 1994;14:66–9.
Newman NJ, Scherer R, Langenberg P, et al. The fellow eye in NAION: report from the ischemic optic neuropathy decompression trial follow-up study. Am J Ophthalmol. 2002;134:317–28.
Hayreh SS, Zimmerman MB. Nonarteritic anterior ischemic optic neuropathy: clinical characteristics in diabetic patients versus nondiabetic patients. Ophthalmology. 2008;115:1818–25.
Hayreh SS. Anterior ischemic optic neuropathy. I. Terminology and pathogenesis. Br J Ophthalmol. 1974;58:955–63.
Lessell S. Nonarteritic anterior ischemic optic neuropathy: enigma variations (editorial). Arch Ophthalmol. 1999;117:386–8.
Arnold AC. Pathogenesis of nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol. 2003;23:157–63.
Galetta SL, Plock GL, Kushner MJ, et al. Ocular thrombosis associated with antiphospholipid antibodies. Ann Ophthalmol. 1991;23:207–12.
Knox DL, Hanneken AM, Hollows FC. Uremic optic neuropathy. Arch Ophthalmol. 1988;106:50–4.
The Ischemic Optic Neuropathy Decompression Trial Research Group. Optic nerve decompression surgery for nonarteritic ischemic optic neuropathy (NAION) is not effective and may be harmful. JAMA. 1995;273:625–32.
Arnold AC, Helper RS, Lieber M, et al. Hyperbaric oxygen therapy for nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol. 1996;122:535–41.
Botelho PJ, Johnson LN, Arnold AC. The effect of aspirin on the visual outcome of nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol. 1996;121:450–1.
Bennett JL, Thomas S, Olson JL, et al. Treatment of nonarteritic anterior ischemic optic neuropathy with intravitreal bevacizumab. J Neuroopthalmol. 2007;27:238–40.
Kaderli B, Avci R, Yucel A, et al. Intravitreal triamcinolone improves recovery of visual acuity in nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol. 2007;27:164–8.
Kupersmith MJ, Miller NR. A nonarteritic anterior ischemic optic neuropathy clinical trial: an industry and NORDIC collaboration. J Neuroopthalmol. 2016;36(3):235–7.
Regillo CD, Brown GC, Savino PJ, et al. Diabetic papillopathy. Patient characteristics and fundus findings. Arch Ophthalmol. 1995;113:889–95.
Mansour AM, El-Dairi MA, Shehab MA, et al. Periocular corticosteroids in diabetic papillopathy. Eye. 2005;19:45–51.
Al-Haddad CE, Jurdi FA, Bashshur ZF. Intravitreal triamcinolone acetonide for the management of diabetic papillopathy. Am J Ophthalmol. 2004;137:1151–3.
Chew SS, Kerr NM, Danesh-Meyer HV. Giant cell arteritis. J Clin Neurosci. 2009;16:1263–8.
Goodman BW. Temporal arteritis. Am J Med. 1979;67:839–53.
Liu NH, LaBree LD, Feldon SE, et al. The epidemiology of giant cell arteritis: a 12 year retrospective study. Ophthalmology. 2001;108:1145–9.
Brack A, Martinez-Taboada V, Stanson A, Goronzy JJ, Weyand CM. Disease pattern in cranial and large-vessel giant cell arteritis. Arthritis Rheum. 1999;42:311–7.
ICHD-II. Available at http://ihs-classification.org/en/.
Brass SD, Durand ML, Stone JH, Chen JW, Stone JR. Case records of the Massachusetts General Hospital. Case 36-2008. A 59-year-old man with chronic daily headache. N Engl J Med. 2008;359:2267–78.
Kattah JC, Mejico L, Chrousos GA, et al. Pathologic findings in steroid responsive optic infarct in giant cell arteritis. Neurology. 1999;53:177–80.
McDonnell PJ, Moore GW, Miller NR, et al. Temporal arteritis. A clinicopathologic study. Ophthalmology. 1986;93:518–30.
Jonasson F, Cullen JF, Elton RA. Temporal arteritis. A 14-year epidemiological, clinical, and prognositic study. Scott Med J. 1979;24:111–7.
Salvarani C, Cantini F, Boiardi L, et al. Polymyalgia rheumatic and giant cell arteritis. N Engl J Med. 2002;347:261–71.
Simmons RJ, Cogan DG. Occult temporal arteritis. Arch Ophthalmol. 1962;68:8–18.
Gonzalez-Gay MA, Garcia-Porrua C, Llorca J, et al. Visual manifestations of giant cell arteritis. Trends and clinical spectrum in over 161 patients. Medicine. 2000;79:283–92.
Hayreh SS, Podhajsky PA, Zimmerman B. Occult giant cell arteritis: ocular manifestations. Am J Ophthalmol. 1998;125:521–6.
Eshaghian J. Controversies regarding giant cell arteritis. Doc Ophthalmol. 1979;47:43–67.
Huna-Baron R, Mizrachi IB, Glovinsky Y. Intraocular pressure is low in eyes with giant cell arteritis. J Neuroophthalmol. 2006;26:273–5.
Barricks ME, Traviesa DB, Glaser JS, et al. Ophthalmoplegia in cranial arteritis. Brain. 1977;100:209–21.
El-Dairi MA, Chang L, et al. Diagnostic algorithm for patients with suspected giant cell arteritis. J Neuro-Oncol. 2015;35:246–53.
Hall JK, Volpe NJ, Galetta SL, Liu GT, Syed NA, Balcer LJ. The role of unilateral temporal artery biopsy. Ophthalmology. 2003;110:543–8.
Boyev LR, Miller NR, Green WR. Efficacy of unilateral versus bilateral temporal artery biopsies for the diagnosis of giant cell arteritis. Am J Ophthalmol. 1999;128:211–5.
Miller NR. Giant cell arteritis. J Neuroophthalmol. 2000;20:219–20.
Lessell S. Bilateral temporal artery biopsies in giant cell arteritis. J Neuroophthalmol. 2000;20:220–1.
Chambers WA, Bernadino VB. Specimen length in temporal artery biopsies. J Clin Neuroophthalmol. 1988;8:121–5.
Jacobson DM, Slamovitz TL. ESR and its relationship to hematocrit in giant cell arteritis. Arch Ophthalmol. 1987;105:965–7.
Hayreh SS, Podhajsky PA, Raman R, et al. Giant cell arteritis: validity and reliability of various diagnostic criteria. Am J Ophthalmol. 1997;123:285–96.
Parikh M, Miller NR, Lee AG, et al. Prevalence of a normal C-reactive protein with an elevated erythrocyte sedimentation rate in biopsy-proven giant cell arteritis. Ophthalmology. 2006;113:1842–5.
Sadun F, Pece A, Brancato R. Fluorescein and indocyanine green angiography in the diagnosis of giant cell arteritis. Br J Ophthalmol. 1998;82:1344–5.
Landau K, Savino PJ, Gruber P. Diagnosing giant cell arteritis: is ultrasound enough? J Neuroophthalmol. 2013;33:394–400.
Chan CC, Paine M, O’Day J. Steroid management in giant cell arteritis. Br J Ophthalmol. 2001;85:1061–4.
Cornblath WT, Eggenberger ER. Progressive vision loss from giant cell arteritis despite high dose intravenous methylprednisolone. Ophthalmology. 1997;104:854–8.
Clearkin LG. IV steroids for central retinal artery occlusion in giant cell arteritis. Ophthalmology. 1992;99:1482–3.
Hayreh SS, Biousse V. Treatment of acute visual loss in giant cell arteritis: should we prescribe high-dose intravenous steroids or just oral steroids? J Neuroophthalmol. 2012;32:278–87.
Hayreh SS, Zimmerman B. Visual deterioration in giant cell arteritis patient while on high doses of corticosteroid therapy. Ophthalmology. 2003;110:1204–15.
Lessell S. Optic neuropathy in giant cell arteritis. J Neuroophthalmol. 2005;25:247.
Kim N, Trobe JD, Flint A, Keoleian G. Late ipsilateral recurrence of ischemic optic neuropathy in giant cell arteritis. J Neuroophthalmol. 2003;23:122–6.
Chan CCK, Paine M, O’Day J. Predictors of recurrent ischemic optic neuropathy in giant cell arteritis. J Neuroophthalmol. 2005;25:14–7.
Weyand CM, Liao YJ, Goronzy JJ. The immunopathology of giant cell arteritis: diagnostic and therapeutic implications. J Neuroophthalmol. 2012;32:259–65.
Liu GT, Glaser IS, SCHatz NJ, et al. Visual morbidity in giant cell arteritis: clinical characteristics and prognosis for vision. Ophthalmology. 1994;101:1779–85.
Rauser M, Rismondo V. Ischemic optic neuropathy during corticosteroid therapy for giant cell arteritis. Arch Ophthalmol. 1995;113:707–8.
Kupersmith MJ, Speira R, Langer R, Richmond M, Peterson M, Speira H, Mitnick H, Paget S. Visual function and quality of life among patients with giant cell (temporal) arteritis. J Neuroophthalmol. 2001;21:266–73.
Sadda SR, Nee M, Miller NR, et al. Clinical spectrum of posterior ischemic optic neuropathy. Am J Ophthalmol. 2001;132:743–50.
Hayreh SS. Posterior ischemic optic neuropathy: clinical features, pathogenesis, and management. Eye. 2004;18:1188–206.
Gilden DH, Lipton HL, Wolf JS, et al. Two patients with unusual forms of varicella-zoster virus vasculopathy. N Engl J Med. 2002;347:1500–3.
Harrison EQ. Complications of herpes zoster ophthalmicus. Am J Ophthalmol. 1965;60:1111–4.
Buono LM, Foroozan R. Perioperative posterior ischemic optic neuropathy: review of the literature. Surv Ophthalmol. 2005;50:15–26.
Newman NJ. Perioperative vision loss after nonocular surgeries. Am J Ophthalmol. 2008;145:604–10.
Worrell L, Rowe M, Petti G. Amaurosis: a complication of bilateral radical neck dissection. Am J Otolaryngol. 2002;23:56–9.
Buono LM, Foroozan R, Savino PJ, et al. Posterior ischemic optic neuropathy after hemodialysis. Ophthalmology. 2003;110:1216–8.
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Palkovacs, E.M., Golnik, K.C. (2020). Ischemic Optic Neuropathies: Update. In: Chhablani, P. (eds) Neuro-ophthalmic Disorders. Current Practices in Ophthalmology. Springer, Singapore. https://doi.org/10.1007/978-981-13-8522-3_3
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