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Abstract #8922 Published in IGR 5-2
Ischemic optic neuropathy as the first manifestation of elevated cholesterol levels in young patients
Deramo VA; Sergott RC; Augsburger JJ; Foroozan R; Savino PJ; Leone AOphthalmology 2003; 110: 1041-1046; discussion 1046
PURPOSE: To investigate the relationship between idiopathic nonarteritic ischemic optic neuropathy (NAION) and serum lipid levels in patients ≤ 50 years of age. DESIGN: Case-control study. PARTICIPANTS: Thirty-seven consecutive patients with NAION and 74 age- and gender-matched comparison patients. METHODS AND MAIN OUTCOME MEASURES: Serum lipid levels and the presence of several historical diseases and exposures were abstracted from the medical records in cases and controls. RESULTS: The mean total cholesterol level was significantly increased in patients with NAION compared with controls (235.4 versus 204.0 mg/dl; p < 0.001). The odds ratio of having high blood cholesterol (≥ 240 mg/dl) with NAION was 3.3 (95% confidence interval, 1.4-7.8), and the likelihood increased when the comparison was restricted to nondiabetic patients. Diabetes mellitus was more common in cases than controls (p = 0.027), but systemic hypertension was not significantly different (p = 0.63). No patient (0 of 24) had a magnetic resonance imaging study consistent with optic neuritis or central nervous system demyelination. Visual improvement was uncommon. CONCLUSIONS: This study demonstrates that hypercholesterolemia is associated with NAION in younger patients. NAION may be the first manifestation of a lipid disorder, a previously unrecognized syndrome. These patients have experienced a focal, microvascular central nervous system ischemic event at a relatively young age. Aggressive treatment of lipid abnormalities in these patients may be warranted.
Dr. V.A. Deramo, Neuro-Ophthalmology Service, Wills Eye Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
Classification:
10 Differential diagnosis e.g. anterior and posterior ischemic optic neuropathy
