Clinical and ultrasonographic features in anterior ischemic optic neuropathy

Dragos Cătălin  Jianu; Silviana Nina Jianu; Mihnea Munteanu; Ligia Petrica

doi:10.2298/VSP150810356J

Dragos Cătălin Jianu University of Medicine and Pharmacy, Department of Neurology, Timisoara, Romania
Silviana Nina Jianu University of Medicine and Pharmacy, Department of Ophthalmology, Timisoara, Romania
Mihnea Munteanu University of Medicine and Pharmacy, Department of Ophthalmology, Timisoara, Romania
Ligia Petrica University of Medicine and Pharmacy, Department of Internal Medicine-Nephrology, “Victor Babes” Timisoara, Romania

DOI: https://doi.org/10.2298/VSP150810356J

Keywords: optic neuropathy, ischemic;, risk factors;, giant cell arteritis;, diagnosis, differential;, ultrasonography, doppler, color.

Abstract

Background/Aim. Anterior ischemic optic neuropathy (AION) represent a segmental infarction of the optic nerve head which is supplied by the posterior ciliary arteries. There are two types of AION: non-arteritic (NA-AION and arteritic (A-AION), due to giant cell arteritis (GCA). The aim of this study was to investigate the clinical features and ultrasound characteristics of the orbital vessels and superficial temporal and carotid arteries, in patients with unilateral acute AION in order to help differentiate newly diagnosed NA-AION from A-AION. Methods. In this prospective comparative, observational study, 62 consecutive patients with clinical suspicion of unilateral acute AION were examined at admission and in the first two months of evolution, following a protocol including color Doppler imaging (CDI) of the orbital vessels. Results. We found 12 patients with A-AION, all of them with biopsy-confirmed disease, and 50 patients with NA-AION. A-AION patients presented a combination of a history of amaurosis fugax before acute, painless, and severe vision loss in the affected eye, and a diffuse pale optic disc edema. In these patients, CDI of the orbital vessels indicated high resistance index (RI), with severe diminished blood flow velocities in all orbital vessels, in both orbits. In the NA-AION patients, none of these clinical symptoms were found and blood velocities and RI in posterior ciliary arteries were preserved. Typical sonographic feature in temporal arteritis as part of GCA was the „dark halo” sign. Conclusions. The ultrasound investigations enable prompt differentiation between NA-AION and A-AION.

References

Biousse V, Newman NJ. Ischemic Optic Neuropathies. N Engl J Med 2015; 372(25): 2428‒36.

Hayreh SS. Ischemic optic neuropathies-where are we now?. Graefes Arch Clin Exp Ophthalmol 2013; 251(8): 1873‒84.

Hayreh SS. Ischaemic optic neuropathy. Indian J Ophthal¬mol 2000; 48(3): 171‒94.

Hayreh SS. Management of ischemic optic neuropathies. In-dian J Ophthalmol 2011; 59(2): 123‒36.

Arnold AC. Ischemic optic neuropathy. In: Ianoff M, Duker JS, editors. Ophtalmology. 2nd ed. . St. Louis: Mosby; 2004. p. 1268‒72

Collignon-Robe NJ, Feke GT, Rizzo JF 3rd. Optic nerve head circulation in nonarteritic anterior ischemic optic neuropathy and optic neuritis. Ophthalmology 2004; 111(9): 1663‒72.

Gonzalez-Gay MA, Garcia-Porrua C, Llorca J, Hajeer AH, Branas F, Dababneh A. Visual manifestations of giant cell arteritis: Trends and clinical spectrum in 161 patients. Medicine (Balti-more) 2000; 79(5): 283‒92.

Martínez-Valle F, Solans-Laqué R, Bosch-Gil J, Vilardell-Tar¬rés M. Aortic involvement in giant cell arteritis. Autoim¬mun Rev 2010; 9(7): 521‒4.

Beck RW, Servais GE, Hayreh SS. Anterior ischemic optic neu-ropathy. IX. Cup-to-disc ratio and its role in patho¬genesis. Ophthalmology 1987; 94(11): 1503‒8.

Jianu DC, Jianu SN, Petrica L, Muresanu DF, Popescu BO, Focsa MA. Anterior ischemic optic neuropathies: clinical and ultra-sonographic characteristics in arteritic versus nonarteritic forms. Am J Neuroprot Neuroreg 2012; 4(2): 154‒62.

Jianu DC, Jianu SN, Petrica L. Color Doppler imaging of retro-bulbar vessels findings in large giant cell arteritis with eye in-volvement. J US China Med Sci 2011; 8(2): 99–108.

Jianu DC, Jianu SN. The role of Color Doppler Imaging in the study of optic neurophaties. In: Jianu DC, Jianu SN, editors. Color Doppler Imaging. Neuro-ophthalmological correlations. Timisoara, Romania: Mirton; 2010. p. 154‒74.

Jianu DC, Jianu SN, Petrica L, Serpe M. Large giant cell arteri¬tis with eye involvement. In: Amezcua-Guerra, edi¬tor. Advances in the diagnosis and treatment of vasculitis. Rijeka, Croatia: In-tech; 2011. p. 311‒30.

Jianu DC, Jianu SN. Giant cell arteritis and arteritic ante¬rior ischemic optic neuropathies. In: Sakkas LI, Katsiari C, editors. Updates in the diagnosis and treatment of vascu¬litis. Rijeka, Croatia: Intech; 2013. p. 111‒30.

van Stavern GP, Newman NJ. Opticneuropathies: an over¬view. Ophthalmol Clin North Am 2001; 14(1): 61‒71, viii.

Melson MR, Weyand CM, Newman NJ, Biousse V. The diagno¬sis of giant cell arteritis. Rev Neurol Dis 2007; 4(3): 128‒42.

Singh AG, Kermani TA, Crowson CS, Weyand CM, Matte¬son EL, Warrington KJ. Visual manifestations in giant cell arteritis: Trend over 5 decades in a population-based co¬hort. J Rheumatol 2015; 42(2): 309‒15.

Hayreh SS, Podhajsky PA, Zimmerman B. Occult giant cell arteritis: ocular manifestations. Am J Ophthalmol 1998; 125(4): 521‒6.

Pichot O, Gonzalvez B, Franco A, Mouillon M. Color Dop¬pler ul-trasonography in the study of orbital and ocular vascular dis-eases. J Fr Ophtalmol 1996; 19(1): 19‒31. (French)

Lieb WE, Cohen SM, Merton DA, Shields JA, Mitchell DG, Gold-berg BB. Color Doppler imaging of the eye and orbit. Tech-nique and normal vascular anatomy. Arch Ophthal¬mol 1991; 109(4): 527‒31.

Tranquart F, Aubert-Urena AS, Arsene S, Audrierie C, Ros¬sazza C, Pourcelot L. Echo-Doppler couleur des arteres ciliaires post-erieures dans la neuropathie optique ischemi¬que anterieure ai-gue. JEMU 1997; 18(1): 68‒71.

Gonzalez-Gay MA. The diagnosis and management of pa¬tients with giant cell arteritis. J. Rheumatol 2005; 32(7): 1186‒8.

Hayreh SS, Podhajsky PA, Raman R, Zimmerman B. Giant cell arteritis: validity and reliability of various diagnostic criteria. Am J Ophthalmol 1997; 123(3): 285‒96.

Dasgupta B1, Borg FA, Hassan N, Alexander L, Barraclough K, Bourke B, et al. BSR and BHPR guidelines for the man-agementof giant cell arteritis. Rheumatology (Oxford) 2010; 49(8): 1594‒7.

Hayreh SS, Joos KM, Podhajsky PA, Long CR. Systemic dis¬eases associated with nonarteritic anterior ischemic optic neuropa-thy. Am J Ophthalmol 1994; 118(6): 766‒80.

Schmidt WA, Kraft HE, Vorpahl K, Völker L, Gromnica-Ihle EJ. Color duplex ultrasonography in the diagnosis of tem¬poral ar-teritis. N Engl J Med 1997; 337(19): 1336‒42.

Schmidt WA. Takayasu and temporal arteritis. In: Baumgartner RW, editor. Handbook on Neurovascular Ultrasound. Basel: Karger; 2006; 2: 96‒104.