J Korean Ophthalmol Soc.  2011 Jun;52(6):753-758. 10.3341/jkos.2011.52.6.753.

A Case of Nonarteritic Anterior Ischemic Optic Neuropathy Following Acute Angle-Closure Glaucoma

• Shin JH
• Lee JW
• Choi HY

• KMID: 2214651
• DOI: http://doi.org/10.3341/jkos.2011.52.6.753

Abstract

PURPOSE
Nonarteritic anterior ischemic optic neuropathy (NAION) is believed to result from inadequate blood supply to the posterior ciliary arteries. To date, NAION in a patient with acute angle-closure glaucoma (AACG) has been reported in only two studies in the English literature. Thus, the authors report a case of NAION following AACG in a Korean patient.
CASE SUMMARY
A 59-year-old woman presented with a three-day history of acute ocular pain and decreased vision in her right eye; visual acuity was hand movement and the intraocular pressure (IOP) was 66 mm Hg in the right eye. Slit-lamp examination of the patient's right eye revealed diffuse corneal edema, shallow anterior chamber, and mid-dilated pupil. Gonioscopy revealed a grade 0 angle in the right eye, and a relative afferent pupillary defect was noted. Fundus photography showed disc hemorrhage and swelling of the optic disc. Fluorescein angiography demonstrated hyperfluorescence of the optic disc due to leakage. Visual evoked potential of the right eye at the initial visit showed a decreased amplitude of P100 compared with that of the left eye. A diagnosis of NAION following AACG was made. Laser iridotomy was successfully performed to the right eye. Two months later, IOP decreased from 66 to 21 mm Hg. However, visual acuity remained as hand movement and fundus examination revealed a pale optic disc.
CONCLUSIONS
NAION following AACG may be attributed to an acute IOP rise with resultant perfusion pressure decrease in the vessels which supply the optic nerve. The result obtained from the patient in the present study indicates that evaluation for NAION should be considered in AACG cases.

Keyword

Acute angle-closure glaucoma; Nonarteritic anterior ischemic optic neuropathy

MeSH Terms

Anterior Chamber
Ciliary Arteries
Corneal Edema
Evoked Potentials, Visual
Eye
Female
Fluorescein Angiography
Glaucoma, Angle-Closure
Gonioscopy
Hand
Hemorrhage
Humans
Intraocular Pressure
Middle Aged
Optic Nerve
Optic Neuropathy, Ischemic
Patient Rights
Perfusion
Photography
Pupil
Pupil Disorders
Vision, Ocular
Visual Acuity

Figure

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  Figure 1. Fundus photographs at the initial visit shows the optic disc edema with hemorrhage in the right eye (A) and cup-disc ratio of 0.34 in the left eye (B). Fluorescein angiographs revealed hyperfluorescence of the disc and hypofluorescence in the peripapillary area due to the blockage of disc hemorrhage at the early phase (C) and hyperfluorescence of the disc due to leakage at the late phase (D).

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  Figure 2. Visual evoked potential (VEP) shows that P100 amplitude of the right eye decreased compared with that of the left eye and P100 latency of the right eye was equal to that of the left eye.

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  Figure 3. (A) Pentacam image of the right eye before laser iridotomy shows anterior iris bowing. (B) Pentacam image of the right eye at 4 weeks after laser iridotomy. The chamber volume increased from 59 mm 3 to 79 mm 3, the depth of the anterior chamber increased from 1.35 mm to 1.71 mm after laser iridotomy.

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  Figure 4. Fundus photograph taken at 2 months revealed atrophy of the optic disc in the right eye. Visual acuity was hand movement and IOP measured 21 mm Hg in the right eye.

Reference

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