J Korean Ophthalmol Soc.  2019 Dec;60(12):1374-1379. 10.3341/jkos.2019.60.12.1374.

Nonarteritic Anterior Ischemic Optic Neuropathy with an Atypical Visual Field Defect

• Song DH
• Lee JE

• KMID: 2466199
• DOI: http://doi.org/10.3341/jkos.2019.60.12.1374

Abstract

PURPOSE
To report a case of nonarteritic anterior ischemic optic neuropathy (NA-AION) with an atypical visual field defect after intraocular surgery.
CASE SUMMARY
A 61-year-old male presented with a visual field defect in his right eye 1 day after uneventful cataract surgery with pars plana vitrectomy for epiretinal membrane. His best-corrected visual acuity (BCVA) in the right eye was 20/400 with a relative afferent pupillary defect. A color vision test revealed failure only in the right eye. A slit-lamp examination revealed no abnormality in the anterior part of the eyes. A fundoscopic examination also revealed no abnormality in the posterior part of the eyes, including the optic disc. The Humphrey visual field test revealed a nasal vertical defect in the right eye. Orbital and brain magnetic resonance imaging were normal. After 14 days from the initial symptom, fundus photography and optical coherence tomography revealed an optic disc swelling and splinter hemorrhage. Fluorescein angiography revealed a delayed filling on the temporal half of the optic disc and inferotemporal peripapillary choroid. A diagnosis of NA-AION was made. The patient was treated with oral steroids and aspirin. After 3 months, the BCVA was 20/125. The visual field defect was maintained and segmental atrophy developed on the superior and inferior sides of the right optic disc.
CONCLUSIONS
AION may present as vertical hemianopsia. With the risk factors of ischemic optic neuropathy, the possibility of AION should be considered in the differential diagnoses of postoperative visual impairments or field defects after intraocular surgery.

Keyword

Cataract surgery; Ischemic optic neuropathy; Visual field; Vitrectomy

MeSH Terms

Aspirin
Atrophy
Brain
Cataract
Choroid
Color Vision
Diagnosis
Diagnosis, Differential
Epiretinal Membrane
Fluorescein Angiography
Hemianopsia
Hemorrhage
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Optic Neuropathy, Ischemic*
Orbit
Photography
Pupil Disorders
Risk Factors
Steroids
Tomography, Optical Coherence
Vision Disorders
Visual Acuity
Visual Field Tests
Visual Fields*
Vitrectomy
Aspirin
Steroids

Figure

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  Figure 1 Postoperative ophthalmic examinations performed 1 week after onset of visual field loss. (A) Ultrawide fundus photographshows that the epiretinal membrane was removed and there was no apparent edema or hyperemia of right optic disc. (B) Humphreyvisual field test demonstrates a nasal visual field defect respecting the vertical meridian in his right eye.

• 

  Figure 2 Postoperative ophthalmic examinations performed 1 week after onset of visual field loss. (A) Ultrawide fundus photographshows that the epiretinal membrane was removed and there was no apparent edema or hyperemia of right optic disc. (B) Humphreyvisual field test demonstrates a nasal visual field defect respecting the vertical meridian in his right eye.

• 

  Figure 3 Postoperative ophthalmic examinations performed 1 week after onset of visual field loss. (A) Ultrawide fundus photographshows that the epiretinal membrane was removed and there was no apparent edema or hyperemia of right optic disc. (B) Humphreyvisual field test demonstrates a nasal visual field defect respecting the vertical meridian in his right eye.

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