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A case of unexpected visual improvement after systemic corticosteroid therapy

Poster Details

First Author: S.Baghrizabehi SLOVENIA

Co Author(s):    T. Robi?              

Abstract Details



Purpose:

To present a case of 74 year-old female with poor visual acuity bilaterally as consequence of NAAION atrophy in left and persisting NAAION optic disc edema in right eye. On right eye excessive vision deterioration followed 1 month after emerging disc edema. Patient was treated with systemic corticosteroids because of rapid dicrease of vision acuity from 20/40 to 20/200 on right eye due to oedema.

Setting:

Depof ophthalmology Rakican

Methods:

Blood investigations were normal, octopus G2 visual field presented faint light perception only in upper nasal quadrant, on left eye severe decrease of light sensitivity in nasal lower quadrant. CT and MRI showed vascular leucopathy and excluded an intracranial mass. Patient was treated with metronidazole 1g/day i.v. for 3 days and 80 mg perorally decreasig for 10 mg every week.

Results:

Three days after treatment with metronidazole i.v., disc edema on right eye decreased and vision improved from 20/200 to 20/25, on left eye with disc atrophy vision improved from 20/70 to 20/40. Optic disc swelling markedly decreased by the first week and resolved to the end of second week.

Conclusions:

NAAION is due to ischemia of the optic nerve head, which is primarily supplied by the posterior ciliary artery circulation. Ischemia of axons in NAAION results in axoplasmic flow stasis, which in turn causes axoplasmic accumulation and consequent axonal swelling in the optic nerve head; that manifests as ODE. Although steroids are commonly used in numerous ocular disorders, including selected ocular vascular disorders, it is important to emphasize that the main purpose of the steroids in various ocular vascular disorders is to reduce retinal and optic disc edema. The exact mechanism by which steroids act in all these conditions is not known, it seems most probable that they alter capillary permeability and reduce fluid leakage.

Financial Disclosure:

NONE

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