AION - Non-arteritic Anterior Ischemic Optic Neuropathy - Following Intravitreal Injection (Also Wet AMD - Reticular Drusen)
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81-year-old woman has had injections in both eyes for wet age-related macular degeneration in the right eye, most recently treated April 21st of 2009 and the left eye was treated February 23rd of 2010. (2 weeks ago) Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision.
VISUAL ACUITY: Vision OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ afferent pupillary defect. The posterior chamber intraocular lens is in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. The macula is dry with patchy drusen.
OS: Vertical C/D ratio is 0.2. There is a whitening of the superior and inferior pole of the optic nerve and there is patchy pigment epithelial thickening centrally.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: FA shows slightly delayed choroidal and retinal filling in the left eye. The macula stains but does not leak. The right eye has a few staining drusen.
IMPRESSION:
1. ISCHEMIC OPTIC NEUROPATHY – LEFT EYE
2. ELEVATED INTRAOCULAR PRESSURE – LEFT EYE
3. WET AGE-RELATED MACULAR DEGENERATION – LEFT EYE
4. DRY AGE-RELATED MACULAR DEGENERATION – RIGHT EYE
DISCUSSION: I explained to the patient that unfortunately she has ischemic optic neuropathy. With her headaches and whitening of the nerve, there is a small possibility this could represent arteritic ischemic optic neuropathy. I am going to obtain a sedimentation rate and C-reactive protein on her within the next day or two. If those are high, she will need to be started on steroids and have a temporal artery biopsy. (these were negative)
In the meantime, I asked her to take Xalatan drops in the left eye once a day to normalize the intraocular pressure. I asked her to return here in one week for an intraocular pressure check. I would appreciate it if you could obtain a visual field test on her in the near future.
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 583 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection - Fellow eye - Reticular Pseudodrusen - Reticular Macular Disease667 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 494 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 655 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 584 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 468 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 444 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 506 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 420 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 425 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 406 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 418 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 472 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 439 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 498 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 501 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD
(0 votes)
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Non-arteritic Anterior Ischemic Optic Neuropathy following Intravitreal Injection 529 views81-year-old woman has had injections in both eyes for wet age-related macular degeneration. 2 weeks ago the left eye was treated. Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision. OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ APD
(0 votes)
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81-year-old woman has had injections in both eyes for wet age-related macular degeneration in the right eye, most recently treated April 21st of 2009 and the left eye was treated February 23rd of 2010. (2 weeks ago) Less than a week ago she noticed a change in vision in the left eye. She had a dull left frontal headache and noticed her vision was hazy as if there was a veil over the vision.
VISUAL ACUITY: Vision OD is 20/25, OS is 20/25. IOP: OD 18, OS 26. The left eye has a 3+ afferent pupillary defect. The posterior chamber intraocular lens is in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. The macula is dry with patchy drusen.
OS: Vertical C/D ratio is 0.2. There is a whitening of the superior and inferior pole of the optic nerve and there is patchy pigment epithelial thickening centrally.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: FA shows slightly delayed choroidal and retinal filling in the left eye. The macula stains but does not leak. The right eye has a few staining drusen.
IMPRESSION:
1. ISCHEMIC OPTIC NEUROPATHY – LEFT EYE
2. ELEVATED INTRAOCULAR PRESSURE – LEFT EYE
3. WET AGE-RELATED MACULAR DEGENERATION – LEFT EYE
4. DRY AGE-RELATED MACULAR DEGENERATION – RIGHT EYE
DISCUSSION: I explained to the patient that unfortunately she has ischemic optic neuropathy. With her headaches and whitening of the nerve, there is a small possibility this could represent arteritic ischemic optic neuropathy. I am going to obtain a sedimentation rate and C-reactive protein on her within the next day or two. If those are high, she will need to be started on steroids and have a temporal artery biopsy. (these were negative)
In the meantime, I asked her to take Xalatan drops in the left eye once a day to normalize the intraocular pressure. I asked her to return here in one week for an intraocular pressure check. I would appreciate it if you could obtain a visual field test on her in the near future.
