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Case Report
Bilateral irreversible visual loss due to arteritic anterior optic ischemic neuropathy
1 Professor, Department of Ophthalmology, “Iuliu HaÈ›ieganuâ€, Cluj-Napoca, Cluj, Romania
2 Senior ophthalmologist, Department of Ophthalmology, Emergency County Hospital, Cluj-Napoca, Cluj, Romania
3 Assistant Professor, Department of Ophthalmology, “Iuliu Hațieganu†University of Medicine and Pharmacy, Cluj-Napoca, Cluj, Romania
Address correspondence to:
Simona Delia Nicoară
8, V. BabeÈ™ Street, Cluj-Napoca, Cluj, 400012,
Romania
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Article ID: 100054Z06SN2018
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How to cite this article
Nicoară SD, Damian I. Bilateral irreversible visual loss due to arteritic anterior optic ischemic neuropathy. Case Rep Int 2018;7:100054Z06SN2018.ABSTRACT
Introduction: Anterior optic ischemic neuropathy (AOIN) is the most frequent cause of visual loss in giant cell arteritis (GCA). As blindness is rarely reversible, the main therapeutic goal is to prevent bilateral disease by immediate initiation of high-dose intravenous steroids. Approximately, one third of patients present with bilateral visual impairment.
Case Report: A 77-year-old patient, came to the Ophthalmology Emergency Room for sudden loss of vision in the left eye (OS) to no light perception (NLP) with two days duration and significant narrowing of the visual field in the right eye (OD) with 10 hours duration. Fundus examination revealed swelling and pallor of the optic disc in both eyes (OU). Laboratory examination showed elevated ESR (56 mm/h) and CRP (5.24 mg/dl). Temporal artery biopsy (TAB) proved granulomas and fibrosis within the vessel wall. Immediate Methylprednisolon 1gm was administered intravenously for five days, followed by oral Prednisone 1mg/kg for four weeks with tapering of 10 mg per month. The patient was put on diabetic and low sodium regimen. During the 3rd day of treatment, vision OD dropped to NLP. Despite continuing systemic steroid therapy, vision remained unchanged. Two months following discharge, the patient died from myocardial infarction.
Conclusion: Irreversible bilateral blindness occurred in a patient with arteritic AOIN, while he was on systemic steroids, probably due to late presentation, when vision was already affected bilaterally.
Keywords: Arteritic anterior optic ischemic neuropathy, Bilateral blindness, Horton disease
SUPPORTING INFORMATION
Author Contributions
Simona Delia Nicoară - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ioana Damian - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this case report.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2018 Simona Delia Nicoară et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
