Optic Nerve Head Microcirculation in Eyes with Vogt-Koyanagi-Harada Disease Accompanied by Anterior Ischemic Optic Neuropathy

Anterior ischemic optic neuropathy (AION) is infrequently complicated with Vogt-Koyanagi-Harada (VKH) disease. We quantitatively examined sequential changes in the morphology and circulation hemodynamics, using a C-scan of optical coherence tomography (OCT) and laser speckle flowgraphy (LSFG) in a patient with VKH disease accompanied by AION. A 65-year-old female complained of blurred vision in both of her eyes. The patient presented with optic disc swelling and remarkable choroidal thickening detected by OCT bilaterally. The diagnosis of VKH disease was established based on the presence of pleocytosis detected in the cerebrospinal fluid and hypofluorescent dark dots scattered all around the fundus, detected by indocyanine green angiography. Goldmann perimetry detected visual field defects, similar to superior altitudinal hemianopsia in the right eye and similar to inferior altitudinal hemianopsia in the left eye. The patient was suspected to have developed AION in both eyes. The patient received methylprednisolone pulse therapy, followed by oral prednisolone. With these treatments, the optic disc swelling disappeared. However, optic disc atrophy with visual field defects remained in both eyes. An OCT C-scan showed the ganglion cell complex (GCC) and circumpapillary retinal nerve fiber layer (cpRNFL) thickness getting thinner below the normal range, and LSFG showed the decrease in optic nerve head (ONH) tissue microcirculation. These results supported the occurrence of AION in this patient with VKH disease. The analysis of GCC and cpRNFL thickness and ONH microcirculation would be useful for supporting the occurrence of AION in a case of VKH disease.

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Optic Nerve Head Microcirculation in Eyes With Vogt-Koyanagi-Harada Disease Accompanied by Anterior Ischemic Optic Neuropathy: a Case Report

10.21203/rs.3.rs-292547/v1 ◽

2021 ◽

Author(s):

Yui Yamashita ◽

Yuki Hashimoto ◽

Kenichi Namba ◽

Kazuomi Mizuuchi ◽

Susumu Ishida

Keyword(s):

Optic Nerve ◽

Visual Field ◽

Optic Disc ◽

Optic Neuropathy ◽

Optic Nerve Head ◽

Visual Field Defects ◽

Ischemic Optic Neuropathy ◽

Optic Disc Swelling ◽

Vkh Disease ◽

Field Defects

Abstract Purpose: It has been reported that anterior ischemic optic neuropathy (AION) is an infrequent complication of Vogt-Koyanagi-Harada (VKH) disease; however, the physiological changes have not been understood. We quantitatively examined sequential changes in the morphology and circulation hemodynamics using an optical coherence tomography (OCT) C-scan and laser speckle flowgraphy (LSFG) in a patient with VKH disease accompanied by AION.Case presentation: A 65-year-old female complained of blurred vision in both of her eyes. She presented with optic disc swelling and remarkable choroidal thickening detected by OCT bilaterally. Indocyanine green angiography in the middle phase showed multiple hypofluorescent dark dots scattering around the fundus. With the use of Goldmann perimetry, bilateral visual field defects were detected; these were similar to those of inferior altitudinal hemianopsia. Pleocytosis was detected. The patient was diagnosed with VKH disease, suspected to be accompanied by AION in both eyes. She received methylprednisolone pulse therapy followed by oral prednisolone. With these treatments, optic disc swelling disappeared; however, optic disc atrophy with visual field defects remained in both eyes. An OCT C-scan showed the ganglion cell complex (GCC) and circumpapillary retinal nerve fiber layer (cpRNFL) thickness getting thinner below the normal range, and LSFG showed a decrease in optic nerve head tissue microcirculation during follow-up. These results supported the occurrence of AION in this patient with VKH disease.Conclusion: The analyses of GCC and cpRNFL thicknesses with an OCT C-scan and optic nerve head microcirculation with LSFG would be useful for supporting the occurrence of AION in cases of VKH disease.

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Significant correlations between optic nerve head microcirculation and visual field defects and nerve fiber layer loss in glaucoma patients with myopic glaucomatous disk

Clinical Ophthalmology ◽

10.2147/opth.s23204 ◽

2011 ◽

pp. 1721 ◽

Cited By ~ 10

Author(s):

Toru Nakazawa ◽

Yokoyama ◽

Naoko Aizawa ◽

Naoki Chiba ◽

Kazuko Omodaka ◽

...

Keyword(s):

Optic Nerve ◽

Visual Field ◽

Nerve Fiber ◽

Optic Nerve Head ◽

Visual Field Defects ◽

Fiber Layer ◽

Nerve Fiber Layer ◽

Field Defects

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Automated Perimetry in Glaucoma

Visual Fields ◽

10.1093/oso/9780195389685.003.0009 ◽

2010 ◽

Author(s):

Hylton R. Mayer ◽

Marc L. Weitzman

Keyword(s):

Optic Nerve ◽

Visual Field ◽

Nerve Fiber ◽

Optic Disc ◽

Structural Damage ◽

Visual Field Defects ◽

Fiber Layer ◽

Glaucomatous Damage ◽

Retinal Fibers ◽

Field Defects

Clinical experience and multiple prospective studies, such as the Collaborative Normal Tension Glaucoma Study and the Los Angeles Latino Eye Study, have demonstrated that the diagnosis of glaucoma is more complex than identifying elevated intraocular pressure. As a result, increased emphasis has been placed on measurements of the structural and functional abnormalities caused by glaucoma. The refinement and adoption of imaging technologies assist the clinician in the detection of glaucomatous damage and, increasingly, in identifying the progression of structural damage. Because visual field defects in glaucoma patients occur in patterns that correspond to the anatomy of the nerve fiber layer of the retina and its projections to the optic nerve, visual functional tests become a link between structural damage and functional vision loss. The identification of glaucomatous damage and management of glaucoma require appropriate, sequential measurements and interpretation of the visual field. Glaucomatous visual field defects usually are of the nerve fiber bundle type, corresponding to the anatomic arrangement of the retinal nerve fiber layer. It is helpful to consider the division of the nasal and temporal retina as the fovea, not the optic nerve head, because this is the location that determines the center of the visual field. The ganglion cell axon bundles that emanate from the nasal side of the retina generally approach the optic nerve head in a radial fashion. The majority of these fibers enter the nasal half of the optic disc, but fibers that represent the nasal half of the macula form the papillomacular bundle to enter the temporal-most aspect of the optic nerve. In contrast, the temporal retinal fibers, with respect to fixation, arc around the macula to enter the superotemporal and inferotemporal portions of the optic disc. The origin of these arcuate temporal retinal fibers strictly respects the horizontal retinal raphe, temporal to the fovea. As a consequence of this superior-inferior segregation of the temporal retinal fibers, lesions that affect the superotemporal and inferotemporal poles of the optic disc, such as glaucoma, tend to cause arcuateshaped visual field defects extending from the blind spot toward the nasal horizontal meridian.

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The Effects of Optic Nerve Head Tilt on Visual Field Defects in Myopic Normal Tension Glaucoma

Journal of Glaucoma ◽

10.1097/ijg.0000000000001182 ◽

2019 ◽

Vol 28 (4) ◽

pp. 341-346 ◽

Cited By ~ 1

Author(s):

Jae Hwan Choi ◽

Jong Chul Han ◽

Changwon Kee

Keyword(s):

Optic Nerve ◽

Visual Field ◽

Optic Nerve Head ◽

Head Tilt ◽

Normal Tension Glaucoma ◽

Visual Field Defects ◽

Field Defects

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Visual field defects in optic neuritis and anterior ischemic optic neuropathy: distinctive features

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s004170050062 ◽

1998 ◽

Vol 236 (3) ◽

pp. 188-192 ◽

Cited By ~ 38

Author(s):

J. Gerling ◽

J�rg Heinrich Meyer ◽

Guntram Kommerell

Keyword(s):

Visual Field ◽

Optic Neuritis ◽

Optic Neuropathy ◽

Anterior Ischemic Optic Neuropathy ◽

Visual Field Defects ◽

Ischemic Optic Neuropathy ◽

Distinctive Features ◽

Field Defects

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Retinal hemorrhages as one of complications of optic disc drusen during pregnancy

Medicinski pregled ◽

10.2298/mpns1406185t ◽

2014 ◽

Vol 67 (5-6) ◽

pp. 185-189

Author(s):

Marija Trenkic-Bozinovic ◽

Predrag Jovanovic ◽

Gordana Zlatanovic ◽

Dragan Veselinovic ◽

Aleksandra Aracki-Trenkic ◽

...

Keyword(s):

Visual Acuity ◽

Optic Nerve ◽

Visual Field ◽

Optic Disc ◽

Optic Nerve Head ◽

Ganglion Cells ◽

Therapeutic Interventions ◽

Visual Field Defects ◽

Retinal Hemorrhages ◽

Optic Disc Drusen

Introduction. Drusen of the optic nerve head are relatively benign and asymptomatic. They represent retinal hyaline corpuscles resulting from impaired axoplasmic transport of the retinal ganglion cells of optic nerve in front of the lamina cribrosa. They are usually detected accidentally, during a routine ophthalmologic examination. Most patients with optic disc drusen are not aware of the deterioration of their eyesight because of the slow progression of visual field defects. Damage in visual acuity due to optic disc drusen is rare. Case Report. A 27-year-old female patient in the sixth month of pregnancy visited an ophthalmologist because of a visual impairment described as the appearance of mist and shadows over her right eye. When first examined, her visual acuity in both eyes was 20/20. The retinal hemorrhages framing the bottom half of the optic nerve were seen. Complete laboratory and clinical testing as well as specific ophthalmic examinations (photofundus, computerized visual field, optical coherence tomography, and ultrasound) were performed to exclude systemic causes and they presented no risk for the pregnancy. Echosonographic examination confirmed the presence of bilateral optic nerve head drusen. Conclusion. Hemodynamic changes during pregnancy are possible factors for the development of optical disc and retinal hemorrhages. Since treatment of optic disc drusen is limited, recognition of optic nerve drusen as a cause of hemorrhage during pregnancy prevents unnecessary diagnostic and therapeutic interventions.

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Microcirculation at optic disc rim is correlated with visual field defects in cases of anterior ischaemic optic neuropathy

Clinical and Experimental Ophthalmology ◽

10.1111/j.1442-9071.2006.01253.x ◽

2006 ◽

Vol 34 (5) ◽

pp. 491-493

Author(s):

Shinsuke Yokoyama ◽

Itaru Kimura ◽

Hisao Ohde ◽

Kei Shinoda ◽

Yukihiko Mashima

Keyword(s):

Visual Field ◽

Optic Disc ◽

Optic Neuropathy ◽

Visual Field Defects ◽

Ischaemic Optic Neuropathy ◽

Anterior Ischaemic Optic Neuropathy ◽

Field Defects

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Local Relationship between Global-Flash Multifocal Electroretinogram Optic Nerve Head Components and Visual Field Defects in Patients with Glaucoma

Journal of Ophthalmology ◽

10.1155/2015/397495 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Chan Hee Moon ◽

Jungwoo Han ◽

Young-Hoon Ohn ◽

Tae Kwann Park

Keyword(s):

Optic Nerve ◽

Visual Field ◽

Optic Nerve Head ◽

Visual Field Defect ◽

Multifocal Electroretinogram ◽

Visual Field Defects ◽

Global Flash ◽

Field Defect ◽

Normal Controls ◽

Field Defects

Purpose. To investigate the local relationship between quantified global-flash multifocal electroretinogram (mfERG) optic nerve head component (ONHC) and visual field defects in patients with glaucoma.Methods. Thirty-nine patients with glaucoma and 30 normal controls were enrolled. The ONHC amplitude was measured from the baseline to the peak of the second positive deflection of the induced component. The ONHC amplitude was normalized by dividing ONHC amplitude by the average of seven largest ONHC amplitudes. The ONHC amplitude ratio map and ONHC deficiency map were constructed. The local relationship between the ONHC measurements and visual field defects was evaluated by calculating the overlap between the ONHC deficiency maps and visual field defect plots.Results.The mean ONHC amplitude measurements of patients with glaucoma (6.01±1.91 nV/deg2) were significantly lower than those of the normal controls (10.29±0.94 nV/deg2) (P<0.001). The average overlap between the ONHC deficiency map and visual field defect plot was 71.4%. The highest overlap (75.0%) was between the ONHC ratios less than 0.5 and the total deviations less than 5%.Conclusions.The ONHC amplitude was reduced in patients with glaucoma compared to that in normal controls. Loss of the ONHC amplitude from the global-flash mfERG showed a high local agreement with visual field defects in patients with glaucoma.

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