Korean J Ophthalmol.  2009 Mar;23(1):59-61. 10.3341/kjo.2009.23.1.59.

The Effect of an Intravitreal Triamcinolone Acetonide Injection for Acute Nonarteritic Anterior Ischemic Optic Neuropathy

Affiliations
  • 1Department of Ophthalmology, Kyungpook National University, School of Medicine, Daegu, Korea. byjun424@hotmail.com

Abstract

The purpose of this case report is to evaluate the visual outcome of an intravitreal triamcinolone acetonide injection (IVTA) as a treatment for a patient with acute nonarteritic anterior ischemic optic neuropathy (NAION). A 65-year-old male patient with severe visual loss due to acute NAION was treated with 4 mg/0.1mL IVTA. Fundus examination and measurements of the patient's best-corrected visual acuity and visual field were performed before and after the injection at 2 weeks, 1 month, 3 months, and 6 months. The best-corrected visual acuity changed from 0.05 before the injection to 0.16 at 2 weeks, 0.3 at 1 month, and 0.4 at 3 months and at the final visit. Optic disc swelling had markedly decreased at 1 week postoperatively and disappeared at 2 weeks after the injection. The clinical course of this patient suggests that an IVTA may be effective in increasing visual acuity following an acute NAION. A large randomized controlled trial is needed to assess the efficacy of IVTA as a treatment for NAION.

Keyword

Best-corrected visual acuity; Intravitreal triamcinolone acetonide injection (IVTA); Nonarteritic anterior ischemic optic neuropathy (NAION); Optic disc edema

MeSH Terms

Acute Disease
Aged
Diagnosis, Differential
Fluorescein Angiography
Follow-Up Studies
Fundus Oculi
Glucocorticoids/*administration & dosage
Humans
Injections
Male
Ophthalmic Solutions
Optic Neuropathy, Ischemic/*drug therapy/pathology/physiopathology
Triamcinolone Acetonide/*administration & dosage
Visual Acuity
Visual Fields
Vitreous Body

Figure

  • Fig. 1 A fundus photograph at the time of diagnosis demonstrates optic disc swelling with a flame-shaped hemorrhage. The optic disc swelling involved the whole disc, with the exception of the superior zone.

  • Fig. 2 Intravenous fluorescein angiogram. The early phase of an intravenous fluorescein angiogram showed a segmental perfusion delay in the optic disc.

  • Fig. 3 Visual field plotted by Goldmann perimeter at the time of diagnosis. A diffuse cecocentral scotoma was observed.

  • Fig. 4 A fundus photograph at 3 months after the IVTA injection demonstrates a segmental pale neuroretinal rim (5 o'clock-11 o'clock) which corresponds with the previous segmental perfusion delay seen with the fluorescein angiogram.


Cited by  1 articles

A Case of Acute Nonarteritic Anterior Ischemic Optic Neuropathy in Patient on Hemodialysis
Ae Young Kwak, Gyu Ah Kim, Jung Bum Choi
J Korean Ophthalmol Soc. 2013;54(12):1960-1965.    doi: 10.3341/jkos.2013.54.12.1960.


Reference

1. Repka MX, Savino PJ, Schatz NJ, Sergott RC. Clinical profile and long-term implications of anterior ischemic neuropathy. Am J Ophthalmol. 1983. 96:478–483.
2. Martin TJ, Corbett JJ. Neuro-ophthalmology: The requisites in ophthalmology. 2000. 1st ed. St Louis: Mosby;62–67.
3. Beck RW, Savino PJ, Repka MX, et al. Optic disc structure in anterior ischemic optic neuropathy. Ophthalmology. 1984. 91:1334–1337.
4. Kim DH, Hwang JM. Risk factors for Korean patients with anterior ischemic optic neuropathy. J Korean Ophthalmol Soc. 2007. 48:1527–1531.
5. Beck RW, Hayreh SS, Podhajsky PA, et al. Aspirin therapy in nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol. 1997. 123:212–217.
6. Kaderli B, Avci R, Yucel A, et al. Intravitreal triamcinolone improves recovery of visual acuity in nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol. 2007. 27:164–168.
7. Jonas JB, Spandau UH, Harder B, Sauder G. Intravitreal triamcinolone acetonide for treatment of acute nonarteritic anterior ischemic optic neuropathy. Graefes Arch Clin Exp Ophthalmol. 2007. 245:749–750.
8. Hayreh SS, Zimmerman MB. Nonarteritic anterior ischemic optic neuropathy: Natural history of visual outcome. Ophthalmology. 2008. 115:298–305.
9. Knox DL, Kerrison JB, Green WR. Histopathologic studies of ischemic optic neuropathy. Trans Am Ophthalmol Soc. 2000. 98:203–220.
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