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Abstract #18390 Published in IGR 3-3
Ipsilateral recurrence of nonarteritic anterior ischemic optic neuropathy
Hayreh SS; Podhajsky PA; Zimmerman BAmerican Journal of Ophthalmology 2001; 132: 734-742
PURPOSE: To report the prevalence of recurrence of nonarteritic anterior ischemic optic neuropathy (NA-AION) in the same eye, and possible contributing risk factors. DESIGN: Cohort study. STUDY POPULATION: The study included 594 consecutive patients (829 eyes) with a diagnosis of NA-AION and a follow-up of at least two months after the onset of NA-AION, examined in the Ocular Vascular Clinic since 1973. Simple progression of visual loss during an episode of NA-AION was not considered a fresh episode. INTERVENTION OR OBSERVATIONAL PROCEDURES: Each patient underwent ophthalmic evaluation, including visual acuity, visual fields with a Goldmann perimeter, intraocular pressure (IOP), and slit-lamp and ophthalmoscopic evaluation at the initial visit and at each follow-up visit. The patients also underwent systemic evaluation; some had echocardiography (166 patients) and 24-hour ambulatory blood pressure (BP) monitoring; the latter was investigated in 80 patients (17 with and 63 without recurrence of NA-AION) who consented to participate in this study, which was started in 1989. While optic disc edema was present, the patients were followed every two to three weeks. Once the optic disc edema had resolved, they were followed up after three and six months, and then at yearly intervals, unless they had some new visual complaint. MAIN OUTCOME MEASURES: Prevalence of a fresh episode of NA-AION in the same eye, and comparison of ocular and systemic risk factors between patients with and without recurrence of NA-AION in the same eye. RESULTS: Of the 594 patients (829 eyes) in the study, recurrence of NA-AION in the same eye occurred in 45 (53 eyes) with a median follow-up of 3.1 years (range, two months to 30.5 years) from the first onset of NA-AION. The Kaplan-Meier survival curve showed the cumulative percentage of recurrence of NA-AION from the first to the second episode at three months to be 1.0 ± 0.5% (SE), at six months 2.7 ± 0.6&, at one year 4.1 ± 0.9%, and at two years 5.8 ± 1.1%. There was no significant association between recurrence of NA-AION and the systemic conditions that were examined, except for nocturnal arterial hypotension. Overall, patients with a recurrence of NA-AION had a significantly lower mean night-time minimum diastolic BP (p = 0.003) and greater mean percentage drop during sleep in diastolic BP (p = 0.011) than those with no recurrence of NA-AION; all other measures of nocturnal hypotension were not significantly predictive. CONCLUSIONS: Recurrence of NA-AION in the same eye is uncommon (6.4%). This study indicates that nocturnal diastolic arterial hypotension may be a risk factor; however, since this is a multifactorial disease, other so far unknown risk factors may also play a role. The role of various risk factors which may contribute to the recurrence of NA-AION is discussed.
Dr S.S. Hayreh, Department of Ophthalmology, University Hospitals & Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242-1091, USA. sohan-hayreh@uiowa.edu
Classification:
13 Therapeutic prognosis and outcome