NON ARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROPATHY; DOES ANTICOAGULATION HELP?
AbstractBackground: Non Arteritic Anterior Ischemic Optic Neuropathy (NAION) is the most common acute optic neuropathy in patients over 50 years of age. This study was conducted to determine the beneficial effects of anticoagulation with Heparin and Warfarin in patients with NAION presenting within 4 weeks of onset of symptoms Methods: A prospective, interventional, pilot study was conducted in Eye- A unit of Khyber Teaching Hospital from July 2010 onwards on patients with NAION presenting within 4 weeks of onset of symptoms. Patients underwent complete ophthalmological examination including Snellen’s visual acuity (latter converted to Log MAR), pupil examination, fundus examination and automated Humphrey visual field analysis. Hematologic tests, Thrombophilia screening, Echocardiography and carotid Doppler ultrasound were carried on patients. All patients were anticoagulated with Heparin and Warfarin after obtaining informed written consent. Patients were examined at 1 Month, 3 months and 6 months’ time period. Primary parameter measured was improvement in visual acuity. Results: Total number of patients in our study was 24. Regarding visual outcome total number of patients having significant improvement of visual acuity in our study was 16 (66.6%), while 4 (16.7%) patients had marginal improvement of visual acuity. Three (12.5%) patients maintained stable visual acuity of 6/6 throughout the study period in presence of thrombophilic disorders. One patient (4.1%) suffered a decline in visual acuity compared to VA at baseline presentation. Conclusions: Anticoagulation using heparin and warfarin does benefit patients with NAION presenting within 4 weeks of onset of symptoms. In our study a higher proportion of patients experienced significant improvement of visual acuity following anticoagulation as compared to the highest reported spontaneous improvement in such patients.Keywords: Non Arteretic Anterior Ischemic Optic Neuropathy; Anticoagulation; Warfarin
Arnold AC. Ischemic optic neuropathy. In: Miller NR, Newman NJ, Biousse V, Kerrison JB. Walsh & Hoyt’s Clinical Neuro-Ophthalmology, 6th edition, Vol 1. Baltimore : Lippincott Williams & Wilkins,2005:349-84
Miller NR. Current Concepts in the Diagnosis, Pathogenesis, and Management of Nonarteretic Anterior Ischemic Optic Neuropathy. J Neuroophthalmol.2011;31:e1-e3
S J Byung, C Y Bo, K Y Jung. The Effect of an Intravitreal Triamcinolone Acetonide Injection for Acute Nonarteritic Anterior Ischemic Optic Neuropathy. Korean J Ophthalmol.2009;23:59-61
Neuro-ophthalmology: Optic nerve Anatomy. In: Kanski JJ, Bowling B. Clinical Ophthalmology A systematic approach, 7th edition. Edinburg, London, New York, Oxford, Philadelphia, St Louis, Sydney, Toronto. Elsevier Saunders,2011:783-859
Hiraoka M, Inoue K, Ninomiya T, et al. Ischaemia in the Zinn–Haller circle and glaucomatous optic neuropathy in macaque monkeys. Br J Ophthalmol.2012. doi:10.1136/bjophthalmol-2011-300831
Acheson F J, Sanders M D. Coagulation Abnormalities in Ischemic Optic Neuropathies. Eye. 1994;8:89-92
Brian RY, Hampton R, Edsel I, Simon KL, Lance LB. Anterior Ischemic Optic Neuropathy [Medscape website]. Jan 03, 2014. Available at: http://emedicine.medscape.com/article/1216891-clinical#a0218. Accessed April 2, 2015
Hayreh SS, Zimmerman MB. Non Arteritic Anterior Ischemic Optic Neuropathy: Natural history of visual outcome. Ophthalmology.2008;115:298-305
The Ischemic Optic Neuropathy Decompression Trial Research Group. Optic nerve decompression surgery for Non Arteritic Anterior Ischemic Optic Neuropathy (NAION) is not effective and may be harmful. JAMA.1995;273:625-321. Arnold AC. Ischemic optic neuropathy. In: Miller NR, Newman NJ, Biousse V, Kerrison JB, edotors. Walsh & Hoyt’s Clinical Neuro-Ophthalmology, 6th ed. I. Philadelphia: Lippincott Williams & Wilkins; 2005. p.349–384.
Pahor A, Pahor D. [Clinical Findings in Patients with Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION) Under 50 Years of Age]. Klin Monbl Augenheilkd 2016;233(1):66–71.
Miller NR. Current concepts in the diagnosis, pathogenesis, and management of nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol 2011;31(2):e1–3.
Sohn BJ, Chun BY, Kwon JY. The effect of an intravitreal triamcinolone acetonide injection for acute nonarteritic anterior ischemic optic neuropathy. Korean J Ophthalmol 2009;23(1):59–61.
Wilhelm H, Beisse F, Ruther K. [Non-Arteritic Ischemic Optic Neuropathy (NAION)]. Klin Monbl Augenheilkd 2015;232(11):1260–9.
Neuro-ophthalmology: Optic nerve Anatomy. In: Kanski JJ, Bowling B, editors. Clinical Ophthalmology A systematic approach, 7th ed. New York, Elsevier Saunders; 2011. p.783–859.
Hiraoka M, Inoue K, Ninomiya T, Takada M. Ischaemia in the Zinn-Haller circle and glaucomatous optic neuropathy in macaque monkeys. Br J Ophthalmol 2012;96(4):597–603.
Acheson JF, Sanders MD. Coagulation abnormalities in ischaemic optic neuropathy. Eye (Lond) 1994;8( Pt 1):89–92.
Zotz RB, Finger C, Scharf RE, Unsold R. Associations between thrombophilic risk factors and determinants of atherosclerosis and inflammation in patients with non-arteritic anterior ischaemic optic neuropathy. Hamostaseologie 2016;36(1):46–54.
Yao F, Wan P, Su Y, Liao R, Zhu W. Impaired systemic vascular endothelial function in patients with non-arteritic anterior ischaemic optic neuropathy. Graefes Arch Clin Exp Ophthalmol 2016;254(5):977–81.
Lacharme T, Almanjoumi A, Aptel F, Khayi H, Pepin JL, Baguet JP, et al. Twenty-four-hour rhythm of ocular perfusion pressure in non-arteritic anterior ischaemic optic neuropathy. Acta Ophthalmol 2014;92(5):e346–52.
Hayreh SS, Joos KM, Podhajsky PA, Long CR. Systemic diseases associated with nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol 1994;118(6):766–80.
Andrew A Dahl. Anterior Ischemic Optic Neuropathy Clinical Presentation: History, Physical, Causes [Internet]. [cited 2015 April 2]. Available from: http://emedicine.medscape.com/article/1216891-clinical#a0218
Hayreh SS, Zimmerman MB, Podhajsky P, Alward WL. Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders. Am J Ophthalmol 1994;117(5):603–24.
Hayreh SS, Podhajsky P, Zimmerman MB. Role of nocturnal arterial hypotension in optic nerve head ischemic disorders. Ophthalmologica 1999;213(2):76–96.
Hayreh SS, Zimmerman MB. Nonarteritic anterior ischemic optic neuropathy: clinical characteristics in diabetic patients versus nondiabetic patients. Ophthalmology 2008;115(10):1818–25.
Hayreh S. Acute ischemic disorders of the optic nerve: pathogenesis, clinical manifestations, and management. Ophthalmol Clin N Am 1996;9:407–42.
Hayreh SS. Non-arteritic anterior ischemic optic neuropathy versus cerebral ischemic stroke. Graefes Arch Clin Exp Ophthalmol 2012;250(9):1255–60.
Hayreh SS. Non-arteritic anterior ischaemic optic neuropathy and phosphodiesterase-5 inhibitors. Br J Ophthalmol 2008;92(12):1577–80.
Optic nerve decompression surgery for nonarteritic anterior ischemic optic neuropathy (NAION) is not effective and may be harmful. The Ischemic Optic Neuropathy Decompression Trial Research Group. JAMA 1995;273(8):625–32.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.