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Abstract #8923 Published in IGR 5-2
Pathogenesis of nonarteritic anterior ischemic optic neuropathy
Arnold ACJournal of Neuro-Ophthalmology 2003; 23: 157-163
Based on histopathology, electron microscopic corrosion cast studies, optic nerve blood flow studies, and clinical data, the pathogenesis of idiopathic nonarteritic ischemic optic neuropathy includes the following features: 1. structurally crowded optic discs are predisposed; 2. laminar and retrolaminar regions are the most common locations for infarction; 3. there is flow impairment in the prelaminar optic disc during the acute phase; 4. lack of consistent choroidal flow impairment and the retrolaminar location of infarcts suggest vasculopathy within or distal to the paraoptic branches of the posterior choroidal arteries; 5. diabetes is the most consistently identified vasculopathic risk factor; 6. impaired autoregulation of the disc circulation by atherosclerosis, with a possible contribution from serotonin and endothelin-mediated vasospasm, may play a role; and 7. progression may be caused by secondary cell death after the initial ischemic insult or compression from cavernous degeneration and mechanical axonal distortion.
Dr. A.C. Arnold, Jules Stein Eye Institute, 100 Stein Plaza, UCLA, Los Angeles, CA 90095-7005, USA. arnolda@ucla.edu
Classification:
10 Differential diagnosis e.g. anterior and posterior ischemic optic neuropathy
