Anterior Ischemic Optic Neuropathy by Sohan Singh Hayreh

By Sohan Singh Hayreh

"No attainment is ever ultimate" Vascular problems of the optic disc and nerve are very important not just to the ophthalmologist but in addition to the neurologist and the internist. To the 1st uniqueness crew they signify one reason behind blindness or serious visible impairment; to the second one staff the optic disc edema and optic atrophy visible in those issues can pose severe difficulties of analysis, or provide indica­ tions of the involvement of the cerebral stream; whereas to the final crew they're usually indicative of systemic ailment, quite of the cardiovas­ cular procedure. contemporary advances in our wisdom of the blood offer of the optic nerve head have shed an important new gentle at the topic. With the new introduction of fluorescein fundus angiography, an additional measurement has been extra to the learn of the ocular and optic disc circulations, and now we have entered right into a new period within the realizing of ocular vascular issues "in vivo". within the pre-angiography period, postmortem injection reports, even supposing very important, didn't thoroughly display the vascular development of the optic disc within the dwelling, in wellbeing and fitness, and disorder. The ophthalmoscope, definitely, has been precious in assessing optic disc lesions, yet couldn't supply us informa­ tion at the stream of the attention and optic disc "in vivo".

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Angiograms five days later showed a similar filling pattern. 38 Optic Disc Changes e d f Fig. 16. (continued) f, g, h,i) 38 days after Fig. a---e. t) Stereoscopic fundus photographs showing cupping of the optic disc and temporal peripapillary chorioretinal degeneration. g, h and i) Fluoresceinfundus angiograms. g) Retinal arteriovenous phase showing complete choroidal filling but no filling of the optic disc and degenerated part of the peripapillary region. h) Retinal venous phase showing the same as in Fig.

In the group with non-arteritic anterior ischemic optic neuropathy, this time interval has been reported as weeks or months [505], a few months [399], one year [35], several weeks to one year [61], 2 weeks to 17 years [388], one month to 7 years [73], and 15 years [201]. In my series, in the group with temporal arteritis involvement of the two eyes was simultaneous in one patient; after an interval of two days and several days in three patients; more-or-less simultaneous in one patient with arteriosclerotic anterior ischemic optic neuropathy, and after one day in one patient.

A) Fundus photograph showing white swelling of lower part of the optic disc with normal color of the upper part, and cilioretinal artery occlusion, with retinal edema of upper half of the retina. b and c) Fluoresceinfundus angiograms. b) Retinal arteriovenous phase showing filling of the retinal vessels in lower half of the retina by the patent central retinal artery, with non-filling of the vessels in upper half of the retina supplied by the cilioretinal artery (irregular fluorescein sludging due to an earlier injection of fluorescein), and no filling of the optic disc in spite of this being the second consecutive injection of fluorescein.

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