J Korean Ophthalmol Soc.  2012 Jan;53(1):180-185. 10.3341/jkos.2012.53.1.180.

A Case of Non-Arteritic Anterior Ischemic Optic Neuropathy after Bilateral Selective Neck Dissection

• Park S
• Rho S
• Chung SA

• KMID: 2215263
• DOI: http://doi.org/10.3341/jkos.2012.53.1.180

Abstract

PURPOSE
To report a case of non-arteritic anterior ischemic optic neuropathy after bilateral selective neck dissection.
CASE SUMMARY
A 48-year-old man presented with a visual field defect in his right eye 11 days after bilateral selective neck dissection. His corrected visual acuity in the right eye was 20/20; fundus photographs revealed a segmental optic disc swelling in the superior half of the right eye, and the Humphrey visual field test showed an inferior altitudinal defect in the right eye, corresponding to the disc swelling. The fluorescein angiography revealed a delayed filling on the superior half of the optic disc in the right eye. The diagnosis was non-arteritic anterior ischemic optic neuropathy. Orbital and brain MRIs showed an increase in caliber of the right optic nerve, but no other mass or enhanced lesion was noted. After 3 months, the patient's visual acuity and visual field were maintained, but segmental atrophy developed on the superior half of the right optic disc.
CONCLUSIONS
With the risk factors of ischemic optic neuropathy, the possibility of postoperative visual impairment or field defect should be considered after a selective head and neck surgery.

Keyword

Anterior ischemic optic neuropathy; Field defect; Neck dissection

MeSH Terms

Atrophy
Brain
Eye
Fluorescein Angiography
Head
Humans
Middle Aged
Neck
Neck Dissection
Optic Nerve
Optic Neuropathy, Ischemic
Orbit
Risk Factors
Vision Disorders
Visual Acuity
Visual Field Tests
Visual Fields

Figure

• 

  Figure 1 Cervical lymph node: division of cervical neck lymph nodes by levels. Level I= submental and submandibular group; level II= upper jugular group; level III = middle jugular group; level IV = lower jugular group; level V = posterior triangular group; level VI = anterior compartment group; level VII = superior mediastinal group.

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  Figure 2 (A) Fundus photographs show an optic disc swelling at the superior half of the right eye. (B) Fluorescein angiography shows a delayed filling and leakage on the superior half of the optic disc in the right eye. (C) Humphrey visual field test reveals inferior altitudinal field defect of the right eye, respecting the horizontal meridian.

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  Figure 3 Axial and coronal view of orbital MRI (Gd enhanced) show mild increase in caliber of the right optic nerve (indicated by the white arrows). No mass lesion or abnormal enhancement is observed in the brain and optic nerve.

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  Figure 4 Three months after surgery, segmental atrophy is observed on the superior half of the right optic disc (A). There is no change in the inferior altitudinal field defect of the right eye (B).

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