Anterior Ischemic Optic Neuropathy by Sohan Singh Hayreh

By Sohan Singh Hayreh

"No attainment is ever ultimate" Vascular issues of the optic disc and nerve are very important not just to the ophthalmologist but additionally to the neurologist and the internist. To the 1st strong point team they characterize one reason behind blindness or serious visible impairment; to the second one workforce the optic disc edema and optic atrophy visible in those problems can pose severe difficulties of prognosis, or supply indica­ tions of the involvement of the cerebral circulate; whereas to the final team they're often indicative of systemic disorder, quite of the cardiovas­ cular procedure. contemporary advances in our wisdom of the blood provide of the optic nerve head have shed an important new gentle at the topic. With the hot creation of fluorescein fundus angiography, an additional measurement has been further to the examine of the ocular and optic disc circulations, and we have now entered right into a new period within the knowing of ocular vascular issues "in vivo". within the pre-angiography period, postmortem injection stories, even if very worthwhile, didn't thoroughly demonstrate the vascular trend of the optic disc within the dwelling, in overall healthiness, and illness. The ophthalmoscope, definitely, has been priceless in assessing optic disc lesions, yet couldn't provide us informa­ tion at the stream of the attention and optic disc "in vivo".

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If the process is sudden, it produces anterior ischemic optic neuropathy with infarction of the optic nerve head and retrolaminar region. If it is chronic (as in glaucoma and 10wtension glaucoma), it produces slow degeneration of neural tissue in the optic nerve head and retrobulbar region, resulting in cupping of the optic disc and cavernous degeneration of the retrolaminar optic nerve. Part II The Clinical Picture of Anterior Ischemic Optic Neuropathy A clinical description of anterior ischemic optic neuropathy, based on my own studies and what is revealed by a review of the literature on the subject, is presented and discussed in this section.

Nasal part of normal color. j, k, 1) Fluoresceinfundus angiograms. j) Retinal arterial phase showing filling of nasal half of the choroid (supplied by the medial posterior ciliary artery) and optic disc, with temporal part of the choroid (supplied by the lateral posterior ciliary artery) empty. Fluorescence of temporal part of the optic disc due to previous injection of fluorescein for Fig. b-e. k) Retinal venous phase showing filling of the whole choroid, with nasal normal part of the optic disc less fluorescent.

Prognosis is also poor in patients with arteriosclerotic anterior ischemic optic neuropathy who do not receive corticosteroid therapy, but it is better than for temporal arteritis. Visual acuity during follow-up No change Improve- Deteriment oration 64% 50% 9% 42% 27% 8% The data indicate that in anterior ischemic optic neuropathy due to temporal arteritis, the chance that vision will improve is much less than the chances it will deteriorate compared to anterior ischemic optic neuropathy due to no temporal arteritis.

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