Journal of The Korean Ophthalmological Society (대한안과학회지)

The Korean Ophthalmological Society (대한안과학회)
권호 표지

Clinical Features of Anterior Ischemic Optic Neuropathy

앞허혈시신경병증의 임상양상

Park, Won-Chan;Chang, Bong-Leen
박원찬;장봉린

  • Published : 20030100
⟨ Previous Next ⟩

Abstract

Purpose : To analyze the clinical features of anterior ischemic optic neuropathy (AION) and to evaluate the visual prognosis Methods : Medical records of 52 eyes in 47 patients who were diagnosed with AION from January 1991 to December 2000 were retrospectively reviewed. The clinical features, associated systemic disease, visual fields findings, and fundus findings in the patients were analyzed. Results : The mean age of the patients was 55.9 years (20${\sim}$81 years). Twenty-six were men (55.3%) and 21 were women (44.7%). The initial visual acuity of less than 0.1 was 24 eyes (46.2%), that of 0.1 to 0.5 was 23 eyes (44.2%), and more than 0.5 was 5 eyes (9.6%). In seasonal onset, frequency of AION during the winter was 18 eyes (37.5%). As the associated systemic diseases, 15 had diabetes mellitus (31.9%),and 27 had hypertension (57.4%). In laboratory examination, erythrocyte sedimentation rate (ESR) was elevated in 4 patients (8.5%). In fundus examination, the optic disc swelling was found in 16 eyes (30.8%), and optic disc atrophy was found in 36 eyes (69.2%). In Goldmann perimetry, the altitudinal field defect was found in 23 eyes (44.2%), most commonly. The mean follow-up period was 1.7 years (2 months ${\sim}$ 9 years), and the visual acuity improved in 13 eyes (25.0%), worsened in 6 eyes (11.5%), and did not change in 33 eyes (63.5%) at the final follow-up. Conclusions : In conclusion, patients with AION showed various clinical features and overall visual prognosis is poor. Because AION is frequentely associated with systemic diseases, careful evaluation on the systemic disease is mandatory.

목적 : 앞허혈시신경병증 (Anterior Ischemic Optic Neuropathy:AION)으로 진단된 환자들에서의 임상 양상 및 시력 예후를 알아보고자 하였다. 대상과 방법 : 1991년부터 2000년까지 앞허혈시신경병증으로 진단받고 2개월 이상 추적 관찰 가능했던 47명 52안을 대상으로 후향적 조사로 발병시 임상양상 및 동반 전신질환과 시야검사, 안저소견 등을 분석하였다. 결과 : 대상 환자의 평균 연령은 55.9세(20${\sim}$81세)였고, 남자가 26명(55.3%), 여자가 21명(44.7%)이었다. 초진 당시 시력은 0.1 미만이 24안(46.2%), 0.1 이상 0.5 미만이 23안(44.2%), 그 이상인 경우가 5안(9.6%)이었고, 발생 계절은 겨울철 발생이 18안(37.5%)이었다. 관련된 전신질환으로는 당뇨가 15명(31.9%), 고혈압이 27명(57.4%)이었고 혈액검사상 ESR수치증가가 4명(8.5%)에서 관찰되었다. 안저검사상 시신경 유두부종을 보인 경우가 16안(30.8%)이었고, 시신경위축을 보인 경우는 36안(69.2%)이었다. 골드만시야검사상 수평시야결손이 23안(44.2%)으로 가장 많았다. 평균추적관찰기간은 1.7년(2달${\sim}$9년)이었고, 최종관찰시 시력향상(한천석시시력표상 2줄이상)은 13안(25.0%), 시력감소는 6안(11.5%)이었고 33안(63.5%)에서는 변화가 없었다. 결과 : 앞허혈시신경병증은 앞에서 보듯이 다양한 임상양상을 나타내고 대개는 시력예후가 나쁘다. 전신질환과 연관된 경우가 종종 있으므로 전신적 질환에 대한 검사를 충분히 시행하여야 한다.

Keywords

References

  1. Hayreh SS. Anterior ischemic optic neuropathy: I. Terminology and pathogenesis. Br J Ophthalmol 1974;58:955-63.
  2. Hayreh SS, Patricia A, Podhajsky P, Zimmerman MB. Nonarteritic anterior ischemic optic neuropathy: time of onset of visual loss. Am J Ophthalmol 1997;124:641-7. https://doi.org/10.1016/S0002-9394(14)70902-X
  3. Ellenberger C Jr, Ischemic optic neuropathy as a possible early complication of vascular hypertension. Am J Ophthalmol 1979;88: 1045-51.
  4. Hayreh SS, Podhajsky P, Zimmerman MB. Role of nocturnal arterial hypotension in optic nerve head ischemic disorders. Ophthalmologica 1999;213:76-96. https://doi.org/10.1159/000027399
  5. Landau K, Winterkorn JMS, Mailloux LU, et al. 24-Hour blood pressure monitoring in patients with anterior ischemic optic neuropathy. Arch Ophthalmol 1996;114:570-5. https://doi.org/10.1001/archopht.1996.01100130562012
  6. Bull GM. Meteorological correlates with myocardial and cerebral infarction and respiratory disease. Br J Prevent Soc Med 1973;27:108-13.
  7. Clark CV. Seasonal variation in incidence of brachial and femoral emboli. Br Med J 1983;287:1109.
  8. Bull GM, Brozovic M, Chakrabarti R, et al. Relationship of air temperature to various chemical, hematological, and haematostatic variables. J Clin Pathol 1979;32:16-20. https://doi.org/10.1136/jcp.32.1.16
  9. Keatinge WR, et al. Increase in platelet and red cell counts, blood viscosity, and arterial pressure during mild surface cooling: factors in mortality from coronary and cerebral thrombosis in winter. Br Med J 1984;289:1405-8. https://doi.org/10.1136/bmj.289.6456.1405
  10. Hayreh SS, Podhajsky P, Raman R, Zimmerman MB. Giant cell arteritis: Validity and reliability of various diagnostic criteria. Am J Ophthalmol 1997;123:285.
  11. Cullen JF. Et al. Occult temporal arteritis. A common cause of blindness in old age. Br J Ophthalmol. 1967;51:513-25.
  12. Beri M, Klugman MR, Kohler JA, Hayreh SS. Anterior ischemic optic neuropathy. VII. Incidence of bilaterality and various influencing factors. Ophthalmology 1987;94:1020-8.
  13. The ischemic optic neuropathy decompression trial (IONDT): design and methods. Control Clin Trials 1998;19:276-96. https://doi.org/10.1016/S0197-2456(98)00003-8
  14. The ischemic optic neuropathy decompression trial (IONDT): Characteristics of patients with nonarteritic anterior ischemic optic neuropathy eligible for the ischemic optic neuropathy decompression trial. Arch Ophthalmol 1996;114:1366-74. https://doi.org/10.1001/archopht.1996.01100140566007
  15. Ischemic Optic Neuropathy Decompression Trial: twenty-four-month update. Arch Ophthalmol 2000;118:793-8. https://doi.org/10.1001/archopht.118.6.793
  16. Caroll FD. Optic nerve complications of cataract extraction. Trans Am Acad Ophthalmol Otolaryngol 1973;77:623.
  17. Arnold AC. Annnnterior ischemic optic neuropathy following ocular pneumoplethysmography. J Clin Neuroophthalmol 1987;7:58-9.
  18. Siatkowski RM, Gass JDM, Glaser JS, et al. Fluorescein angiography in the diagnosis of giant cell arteritis. Am J Ophthalmol 1993;115:57.
  19. Ischemic Optic Neuropathy Decompression Trial: Characteristics of patients with nonarteritic anterior ischemic optic neuropathy eligible for the Ischemic Optic Neuropathy Decompression Trial. Arch Ophthalmol 1996;114:1366-74. https://doi.org/10.1001/archopht.1996.01100140566007
  20. Hayeh SS, Zimmerman MB, Podhajsky P, et al. Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders. Am J Ophthalmol 1994;117:603-24. https://doi.org/10.1016/S0002-9394(14)70067-4
  21. Hayreh SS, Joos KM, Podhajsky PA, et al. Systemic disease associated with nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol 1994;118:766-80. https://doi.org/10.1016/S0002-9394(14)72557-7
  22. Johnson LN, Botelho PJ, Kuo HC. Is smoking a risk factor for NAION (nonarteritic anterior ischemic optic neuropathy)? Ophthalmology 1994;101:1322-4.
  23. Hayreh SS, Podhajsky P. Visual field defects in anterior ischemic optic neuropathy. Doc Ophthalmol Proc Ser 1979;19:53-71.
  24. Kline LB. Progression of visual defects in ischemic optic neuropathy. Am J Ophthalmol 1988;15;106:199-203.
  25. 전복관, 김동섭, 고명규. 앞허혈시신경병증의 임상양상. 대한안과학회지 1999;40:222-9.
  26. Hayreh SS. Role of nocturnal arterial hypotension in the development of ocular manifestations of systemic arterial hypertension. Curr Opin Ophthalmol 1999;10:474-82. https://doi.org/10.1097/00055735-199912000-00017
  27. Hayreh SS. Anterior ischemic optic neuropathy: IV. Occurrence after cataract extraction. Arch Ophthalmol 1980;98:1410-6.
  28. Boghen DR, Glaser JS. Ischaemic optic neuropathy. The clinical profile and history. Brain 1975;98:689-708. https://doi.org/10.1093/brain/98.4.689
  29. Arnold AC, Hepler RS. Natural history of nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol 1994;14:66-9.