scholarly journals Left orbital compartment syndrome and right anterior ischemic optic neuropathy in a patient with severe burns despite non-aggressive fluid resuscitation

2021 ◽  
Vol 7 ◽  
pp. 205951312110066
Author(s):  
Achmed Pircher ◽  
Sebastian Holm ◽  
Fredrik Huss
Keyword(s):  
Compartment Syndrome ◽  
Optic Neuropathy ◽  
Fluid Resuscitation ◽  
Surgical Intervention ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy ◽  
Aggressive Fluid Resuscitation ◽  
Facial Burns ◽  
The Right ◽  
Early Surgical Intervention

Introduction: Ophthalmological complications such as orbital compartment syndrome (OCS) and ischemic optic neuropathy are rare complications in patients with burns and have been described in patients where aggressive fluid resuscitation was performed. While OCS requires urgent surgical intervention, no current treatment is established to treat, or prevent, ischemic optic neuropathy in patients with burns. Methods: The authors report a case of a 38-year-old woman with flame burns including the periorbital regions who developed OCS on the left side and anterior ischemic optic neuropathy (AION) on the right side despite non-aggressive fluid resuscitation. Immediate lateral canthotomy combined with inferior cantholysis was performed on the left side. Discussion and Conclusion: OCS and AION need to be considered as potential complications even in critically ill patients with facial burns who do not receive aggressive fluid resuscitation. Whether an early surgical intervention will lower the risk of AION development is, however, speculative. Lay Summary Ophthalmological complications such as orbital compartment syndrome and ischemic optic neuropathy are rare complications in patients with burns and have been described in patients where aggressive fluid resuscitation was performed. We present a case of a critically ill patient with severe facial burns who developed orbital compartment syndrome on the left side and anterior ischemic optic neuropathy on the right side even though our patient did not receive aggressive fluid resuscitation. Our case is particular because both of these rare complications are seen in a single patient and neither received aggressive fluid resuscitation. The fact that the patient did not develop ischemic optic neuropathy on the side where the lateral canthotomy was performed (only on the side where the patient had orbital compartment syndrome), this case might raise the discussion of whether an early surgical intervention might lower the risk of ischemic optic neuropathy development in patients with facial burns.

scholarly journals Nonarteritic Anterior Ischemic Optic Neuropathy following COVID-19 Vaccination: Consequence or Coincidence

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Rika Tsukii ◽  
Yuka Kasuya ◽  
Shinji Makino
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Optic Disc ◽  
Optic Neuropathy ◽  
Visual Field Defect ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy ◽  
Optic Disc Swelling ◽  
The Right ◽  
Field Defect

To report a patient with nonarteritic anterior ischemic optic neuropathy (NA-AION) occurring soon after the COVID-19 vaccination. A 55-year-old woman presented with a 4-day history of inferior visual field disturbance in the right eye 7 days after receiving the first dose of Pfizer-BioNTech COVID-19 vaccine. Examination revealed a best-corrected visual acuity of 20/20 in both eyes. A relative afferent pupillary defect was observed in the right eye. Fundoscopy revealed diffuse optic disc swelling in the right eye, which was prominent above the optic disc. Goldmann visual field testing identified an inferior altitudinal visual field defect with I/2 isopter in the right eye. Although typical complete inferior visual field defect was not detected, a diagnosis of NA-AION was made. The patient was followed without any treatment. During the 2-month follow-up period, the optic disc swelling was gradually improved, and visual acuity was maintained 20/20; however, the optic disc looked diffusely pale in the right eye. Although it is uncertain whether the development of NA-AION after COVID-19 vaccination was consequential or coincidental, we speculate that the close temporal relationship with COVID-19 vaccination suggests the possibility of vasculopathy on the microvascular network of optic nerve head as background of inflammatory or immune-mediated element to the timing of the onset of NA-AION. The aim of this case report is to present this biological plausibility and to elucidate potential ophthalmological complications.

scholarly journals Anterior ischemic optic neuropathy after transvenous coiling of dural arteriovenous fistulas: A case report

2019 ◽  
Author(s):  
Kazuyuki Majima ◽  
Kyoko Fujita ◽  
Shigeru Miyachi ◽  
Motohiro Kamei
Keyword(s):  
Visual Acuity ◽  
Optic Disc ◽  
Optic Neuropathy ◽  
Coil Embolization ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy ◽  
Intraoperative Complication ◽  
Chorioretinal Atrophy ◽  
Nasal Defect ◽  
The Right

Abstract Background A dural arteriovenous fistula (dAVF) is defined as an abnormal arteriovenous direct connection in the dura mater, with the cavernous sinus (CS) being one of the most common locations. Transarterial or transvenous embolization remains the first-line treatment for most dAVF, although these procedures are associated with rare sight-threatening ophthalmic complications. We report a case of nonarteritic anterior ischemic optic neuropathy (nAION) following successful treatment of dAVF with a coil embolization. Case presentation A 76-year-old woman complained of conjunctival hyperemia in both eyes 1 month prior to visiting our hospital. She was diagnosed with bilateral dAVF based on magnetic resonance angiography (MRA). On ophthalmic examination, her best-corrected visual acuity (BCVA) was 0.8 in the right eye and 0.7 in the left. Intraocular pressure was 27 mmHg in the right and 24 mmHg in the left. Extraocular movements were limited in all directions. Slit lamp examination disclosed red eyes with dilated corkscrew vessels. Funduscopic examination revealed normal findings in both eyes except a partial chorioretinal atrophy in the left eye. Goldmann perimetry revealed an inferior nasal defect corresponding to the chorioretinal atrophy in the left eye and normal visual field in the right eye. Transvenous coil embolization of the right CS was performed. The dAVF was completely embolized and there was no intraoperative complication. Follow-up brain MRA showed no evidence of residual dural fistula. Ten days after embolization, she developed double vision and visual disturbance in the right eye. Her right BCVA was 0.8. Fundus examination revealed pallor papilledema and splinter hemorrhages at the optic disc edge in her right eye. Fluorescein angiography showed hypofluorescence around the optic disc and a nasal lesion in the early phase. Goldman perimetry revealed lower altitudinal hemianopsia in the right eye. From these findings, nAION was diagnosed. During hospitalization, her right BCVA decreased to 0.08. Ten months later, funduscopy revealed right temporal optic disc pallor without edema, and her right visual acuity remained at 0.08. Conclusions We report a case of nAION after embolization of dAVF located in CS. This complication should be considered after embolization for dAVF.

scholarly journals Presumed clomiphene-induced optic neuropathy: A case report

2021 ◽  
Author(s):  
Yousef Alizadeh ◽  
Zahra Moravvej ◽  
Yaser Khakpour ◽  
Ebrahim Azaripour ◽  
Mitra Akbari ◽  
...  
Keyword(s):  
At Risk ◽  
Visual Acuity ◽  
Optic Neuropathy ◽  
Clomiphene Citrate ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy ◽  
Acute Visual Loss ◽  
Estrogen Receptor Ligand ◽  
Sudden Decrease ◽  
The Right

Background: Clomiphene citrate is an estrogen receptor ligand with mixed agonistic–antagonistic properties used for the treatment of female and male infertility. Various visual disturbances and several irreversible visual outcomes have been associated with clomiphene citrate. In this report, we present a patient with presumed clomiphene-induced optic neuropathy. Case: A 33-yr-old man with acute visual loss of the right eye was referred to Amiralmomenin Hospital, Rasht, Iran in November 2018. His only medication was clomiphene citrate 100 mg daily, taken for 2 wk for fertility issues. The patient presented with a sudden decrease of visual acuity in the right eye on the 14th day of starting the treatment and subsequently developed complete loss of inferior visual field within a few days. On examination, the visual acuity was 6/20 in the right and 20/20 in the left eyes, with a right relative afferent pupillary defect and decreased red color saturation. The fundus examination revealed optic disc swelling with venous dilation in the right eye and a normal left fundus with a crowded disc (disc-at-risk). The patient was evaluated for systemic disorders, all of which were normal. Findings were suggestive of non-arteritic anterior ischemic optic neuropathy most likely due to clomiphene. Conclusion: As clomiphene may increase blood viscosity, it is hypothesized that reduced flow in a posterior ciliary artery in conjunction with the disc-at-risk contributes to the anterior ischemic optic neuropathy. It is advised that patients with disc-at-risk be aware of the possible non-arteritic anterior ischemic optic neuropathy and those experiencing visual symptoms while taking clomiphene be examined promptly for evidence of optic nerve injury. Key words: Clomiphene citrate, Optic neuropathy, Visual acuity, Ischemia.

scholarly journals Altered Brain Functional Connectivity at Resting-State in Patients With Non-arteritic Anterior Ischemic Optic Neuropathy

2021 ◽  
Vol 15 ◽  
Author(s):  
Pengbo Zhao ◽  
Han Lv ◽  
Pengde Guo ◽  
Yan Su ◽  
Ming Liu ◽  
...  
Keyword(s):  
Visual Field ◽  
Functional Connectivity ◽  
Optic Neuropathy ◽  
Resting State ◽  
Brain Regions ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy ◽  
Healthy Controls ◽  
Central Visual Field ◽  
The Right

Purpose: To investigate the possible changes in functional connectivity (FC) in patients with non-arteritic anterior ischemic optic neuropathy (NAION) using resting-state functional MRI (fMRI).Methods: Thirty-one NAION patients and 31 healthy controls were recruited and underwent resting-state fMRI scans. Regions of interest (ROIs) were defined as bilateral Brodmann’s area 17 (BA17). FC analysis was performed between the ROIs and the rest of the brain regions, and the between group comparisons of FC were performed. We conducted correlation analysis between the FC changes and the clinical variables in NAION patients.Results: Compared with healthy controls, patients with NAION showed significantly decreased FC between the left BA17 and the right inferior frontal gyrus, left caudate nucleus. As for the right BA17, patients exhibited significantly increased FC with the left olfactory gyrus and decreased FC with the right superior frontal gyrus (SFG), right insula. Moreover, FC values between the right insula and the right BA17 were positively correlated with the right side of mean sensitivity in the central visual field (r = 0.52, P < 0.01) and negatively correlated with the right side of mean defect in the central visual field (r = −0.55, P < 0.01).Conclusion: Our study indicated that patients with NAION showed significantly abnormal functional reorganization between the primary visual cortex and several other brain regions not directly related to visual function, which supports that NAION may not only be an ophthalmic disease but also a neuro-ophthalmological disease.

scholarly journals Anterior ischemic optic neuropathy as a rare manifestation of COVID-19: a case report

2022 ◽  
Author(s):  
Khodayar Golabchi ◽  
Alireza Rezaee ◽  
Davood Aghadoost ◽  
Maryam Hashemipour
Keyword(s):  
Case Report ◽  
Optic Neuropathy ◽  
Vision Loss ◽  
Past History ◽  
Sudden Onset ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy ◽  
Ocular Manifestations ◽  
Rare Manifestation ◽  
The Right

Aim: A variety of manifestations in different organs could be associated with severe COVID-19; for example, ocular manifestations. Case report: A 52-year-old male complaining of sudden onset unilateral painless vision loss in the right eye for 1 month (started just 1 week after COVID-19 remission) came to the ophthalmology clinic. On further evaluations, he was diagnosed with anterior ischemic optic neuropathy (AION). Considering his past history and the result of evaluations, the hypothesis of association between AION and COVID-19 was proposed. Results & discussion: Ocular and neurologic manifestations of COVID-19 are more likely to happen in patients with more severe conditions. Complications occur secondary to two basic mechanisms including severe inflammatory response and hypercoagulable state. Conclusion: Our findings indicated that non-arteritic AION is another manifestation of microangiopathic/thrombotic events which may occur in the course of COVID-19.

scholarly journals Non-arteritic anterior ischemic optic neuropathy with Cilioretinal artery occlusion: a case report

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ya-Yun Yang ◽  
Ming-Shan He
Keyword(s):  
Intravitreal Injection ◽  
Optic Neuropathy ◽  
Retinal Ischemia ◽  
Artery Occlusion ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy ◽  
Cilioretinal Artery Occlusion ◽  
Cilioretinal Artery ◽  
Retinal Artery ◽  
The Right

Abstract Background To describe a peculiar case of concurrent non-arteritic anterior ischemic optic neuropathy (NAION) and cilioretinal arteries occlusion (CLRAO) without other causative agents which responded well to intravenous and intravitreal injection of corticosteroids. Case presentation A 41-year-old woman presented with painless vision loss in the right eye for 1 week. Fundus examinations showed marked disc swelling, flame-shaped hemorrhage over the superior nerve fiber area, and well-demarcated retinal ischemia superior to the fovea in the right eye. Under the impression of NAION with branch retinal artery occlusion, the patient was treated with intravenous and intravitreal injection of corticosteroids. Two months later, as the disc swelling and retinal ischemia resolved, we found that the occluded artery was the cilioretinal artery and not the ordinary branch retinal artery. Conclusions CLRAO may be concomitant with the setting of NAION, the physicians should be aware that CLRAO may be misinterpreted as BRAO owing to profound disc edema during the early stages of the disease.

Blood rheology in acute anterior ischemic optic neuropathy

1991 ◽  
Vol 11 (6) ◽  
pp. 623-634 ◽  
Author(s):  
B. Bertram ◽  
A. Hoberg ◽  
O. Arend ◽  
S. Wolf ◽  
F. Jung ◽  
...  
Keyword(s):  
Optic Neuropathy ◽  
Blood Rheology ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy

scholarly journals Protective Effects of Oroxylin A on Retinal Ganglion Cells in Experimental Model of Anterior Ischemic Optic Neuropathy

Antioxidants ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 902
Author(s):  
Jia-Ying Chien ◽  
Shu-Fang Lin ◽  
Yu-Yau Chou ◽  
Chi-Ying F. Huang ◽  
Shun-Ping Huang
Keyword(s):  
Retinal Ganglion Cells ◽  
Optic Neuropathy ◽  
Ganglion Cells ◽  
Ischemic Injury ◽  
Anterior Ischemic Optic Neuropathy ◽  
Heme Oxygenase 1 ◽  
Related Factor ◽  
Ischemic Optic Neuropathy ◽  
Retinal Ganglion ◽  
Oroxylin A

Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common cause of acute vision loss in older people, and there is no effective therapy. The effect of the systemic or local application of steroids for NAION patients remains controversial. Oroxylin A (OA) (5,7-dihydroxy-6-methoxyflavone) is a bioactive flavonoid extracted from Scutellariae baicalensis Georgi. with various beneficial effects, including anti-inflammatory and neuroprotective effects. A previous study showed that OA promotes retinal ganglion cell (RGC) survival after optic nerve (ON) crush injury. The purpose of this research was to further explore the potential actions of OA in ischemic injury in an experimental anterior ischemic optic neuropathy (rAION) rat model induced by photothrombosis. Our results show that OA efficiently attenuated ischemic injury in rats by reducing optic disc edema, the apoptotic death of retinal ganglion cells, and the infiltration of inflammatory cells. Moreover, OA significantly ameliorated the pathologic changes of demyelination, modulated microglial polarization, and preserved visual function after rAION induction. OA activated nuclear factor E2 related factor (Nrf2) signaling and its downstream antioxidant enzymes NAD(P)H:quinone oxidoreductase (NQO-1) and heme oxygenase 1 (HO-1) in the retina. We demonstrated that OA activates Nrf2 signaling, protecting retinal ganglion cells from ischemic injury, in the rAION model and could potentially be used as a therapeutic approach in ischemic optic neuropathy.

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