1
|
Mai K, Su R, Basalely A, Castellanos LJ, Singer P, Pomeranz HD, Verma R, Sethna CB. Anterior and posterior ischemic optic neuropathy in a child with focal segmental glomerulosclerosis on hemodialysis. Pediatr Nephrol 2024; 39:1771-1774. [PMID: 38197957 DOI: 10.1007/s00467-023-06252-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Ischemic optic neuropathy (ION) is exceedingly rare in children on dialysis, resulting from poor perfusion of the optic nerve, and presents as sudden acute painless vision loss. CASE-DIAGNOSIS/TREATMENT We report the case of a 3-year-old male with stage 5 chronic kidney disease (CKD 5) due to focal segmental glomerulosclerosis (FSGS) status post-bilateral nephrectomy on chronic hemodialysis who had acute loss of vision several hours after a hemodialysis session. Earlier that day, he had a drop in blood pressure intra-dialysis to 89/67 mmHg, with at home blood pressures ranging 90/60 to 150/100 mmHg. The patient was treated with tight blood pressure control to maintain blood flow and prevent blood pressure lability, received high-dose corticosteroids with a corticosteroid taper, and placed on high-dose erythropoietin for neuroprotective effect. He regained partial vision beginning approximately 1 month after presentation. CONCLUSIONS The exact cause of our patient's simultaneous bilateral anterior and posterior ION, confirmed via MRI and fundoscopic examination, is unclear; however, is likely secondary to a combination of fluctuating blood pressure, anemia, anephric status, and hemodialysis. This highlights the need for close blood pressure monitoring, management of anemia, and more diligent ophthalmologic screening in pediatric patients on chronic hemodialysis.
Collapse
Affiliation(s)
- Katherine Mai
- Division of Pediatric Nephrology, Cohen Children's Medical Center, New Hyde Park, NY, USA.
| | - Rina Su
- Division of Ophthalmology, Northwell Eye Institute, Northwell Health, Great Neck, NY, USA
| | - Abby Basalely
- Division of Pediatric Nephrology, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Laura J Castellanos
- Division of Pediatric Nephrology, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Pamela Singer
- Division of Pediatric Nephrology, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Howard D Pomeranz
- Division of Ophthalmology, Northwell Eye Institute, Northwell Health, Great Neck, NY, USA
| | - Rashmi Verma
- Division of Ophthalmology, Northwell Eye Institute, Northwell Health, Great Neck, NY, USA
| | - Christine B Sethna
- Division of Pediatric Nephrology, Cohen Children's Medical Center, New Hyde Park, NY, USA
| |
Collapse
|
2
|
Miro Quesada JJ, Carvajal Rico W, Toncel Churio O, Montoya Llano L, Duran Rubio J. Neuropatía óptica asociada con lesión de Dieulafoy. REPERTORIO DE MEDICINA Y CIRUGÍA 2020. [DOI: 10.31260/repertmedcir.01217372.985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo: describir el caso de un paciente del Hospital de San José de Bogotá con hemorragia del tracto digestivo superior secundaria a lesión de Dieulafoy, que presentó cuadro compatible con neuropatía óptica anterior isquémica no arterítica (NOIANA). Se hace una revisión narrativa y búsqueda sistemática de la literatura para determinar las características clínicas, demográficas, tratamiento y pronóstico visual de los pacientes con NOIANA. Materiales y métodos: reporte de caso, revisión narrativa y búsqueda sistemática de la literatura en las bases de datos Medline (vía Ovid) y Embase de NOIANA secundaria a hipovolemia. Se analizaron las variables sociodemográficas, clínicas, diagnóstico, condiciones asociadas, tratamiento y pronóstico visual. El análisis estadístico se realizó mediante frecuencias absolutas y relativas. Resultados: la mejoría de agudeza visual final en los pacientes que presentaron un episodio de NOIANA es incierta. En 42% hubo algún tipo de mejoría de la agudeza visual, independiente del tratamiento recibido. Menos del 50% de los casos clínicos reportados incluidos en este estudio que recibieron tratamiento con corticoides intravenosos mejoraron la visión. Discusión: la NOIANA por choque hipovolémico es una entidad infrecuente y poco reportada que puede generar cambios irreversibles en la agudeza visual, por lo que es importante sospecharla y detectarla para dar un manejo oportuno. Este caso de NOIANA es uno de los pocos descritos como secundarios a hemorragia digestiva y el primero asociado con lesión de Dieulafoy.
Collapse
|
3
|
Anterior Ischemic Optic Neuropathy in a Child Receiving Chronic Hemodialysis. Case Rep Nephrol 2020; 2020:7012586. [PMID: 32257471 PMCID: PMC7102483 DOI: 10.1155/2020/7012586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 11/18/2022] Open
Abstract
Anterior ischemic optic neuropathy (AION) occurs due to hypoperfusion of the optic nerve and is a rare complication in patients receiving maintenance dialysis. To date, AION has only been reported in 22 children, all of whom were receiving peritoneal dialysis. We report the first case of AION in a 2-year 11-month-old child receiving chronic hemodialysis secondary to polycystic kidney disease from a phosphomannomutase 2 gene mutation. This case highlights the consideration for frequent blood pressure monitoring and ophthalmic screening in a certain cohort of children receiving chronic dialysis.
Collapse
|
4
|
Optic Disc Drusen Associated Anterior Ischemic Optic Neuropathy: Prevalence of Comorbidities and Vascular Risk Factors. J Neuroophthalmol 2020; 40:356-361. [DOI: 10.1097/wno.0000000000000885] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
5
|
Should a Hypercoagulable Work-Up Be Performed on Young Patients With Nonarteritic Anterior Ischemic Optic Neuropathy? J Neuroophthalmol 2019; 39:523-528. [DOI: 10.1097/wno.0000000000000840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
6
|
Koh KL, Sonny Teo KS, Chong MF, Wan Hitam WH. Non-arteritic anterior ischaemic optic neuropathy secondary to menorrhagia in a young healthy woman. BMJ Case Rep 2018; 2018:bcr-2018-225113. [PMID: 29950366 DOI: 10.1136/bcr-2018-225113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Non-arteritic anterior ischaemic optic neuropathy (NAION) may develop due to severe anaemia and hypotension which is seen in acute blood loss. The devastating visual loss is often irreversible. We report a case of NAION in a 20-year-old healthy woman, who presented on the third day of a heavy menstrual cycle with hypovolaemic shock. On day 2 of admission, she had sudden right eye blurring of vision at the superior field on awakening from sleep. Funduscopy revealed a pale and swollen right optic disc. There was a dense right superior altitudinal visual field defect. Her haemoglobin level was low (3.6 g/dL), but she refused blood transfusion due to her religious belief (Jehovah's Witness) and opted for conservative management. She later developed right optic atrophy with persistent visual field defect despite an improved haemoglobin level of 10.5 g/dL.
Collapse
Affiliation(s)
- Koon-Ling Koh
- Ophthalmology Department, Universiti Sains Malaysia - Health Campus, Kubang Kerian, Malaysia
| | - Khairy Shamel Sonny Teo
- Ophthalmology Department, Universiti Sains Malaysia - Health Campus, Kubang Kerian, Malaysia
| | - Mei-Fong Chong
- Ophthalmology, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia
| | - Wan-Hazabbah Wan Hitam
- Ophthalmology Department, Universiti Sains Malaysia - Health Campus, Kubang Kerian, Malaysia
| |
Collapse
|
7
|
Jacqueline M. S. Winterkorn, MD, PhD: Master of Neuro-Empathology. J Neuroophthalmol 2017; 37:e6-e8. [DOI: 10.1097/wno.0000000000000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Al-Kaabi A, Haider AS, Shafeeq MO, El-Naggari MA, El-Nour I, Ganesh A. Bilateral Anterior Ischaemic Optic Neuropathy in a Child on Continuous Peritoneal Dialysis: Case report and literature review. Sultan Qaboos Univ Med J 2016; 16:e504-e507. [PMID: 28003901 DOI: 10.18295/squmj.2016.16.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/16/2016] [Accepted: 07/19/2016] [Indexed: 11/16/2022] Open
Abstract
Non-arteritic anterior ischaemic optic neuropathy (NAION) is a serious complication of continuous peritoneal dialysis (CPD) which can lead to poor vision and blindness. We report a five-year-old girl who had undergone a bilateral nephrectomy at the age of one year and was on home CPD. She was referred to the Paediatric Ophthalmology Unit of Sultan Qaboos University Hospital, Muscat, Oman, in 2013 with acute bilateral vision loss, preceded by a three-day history of poor oral intake. At presentation, the patient had severe systemic hypotension. An ophthalmological examination revealed severe bilateral visual impairment and NAION. She was treated with intravenous methylprednisolone and normal saline boluses. At a five-month follow-up, the visual acuity of the right eye had improved but vision in the left eye remained the same. Acute bilateral blindness due to NAION while on CPD is a rare condition in childhood. Paediatricians should be aware of this complication in order to ensure prompt management.
Collapse
Affiliation(s)
| | - Agha S Haider
- Department of Opthamology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mohammed O Shafeeq
- Orthopaedics Residency Programs, Oman Medical Specialty Board, Muscat, Oman
| | | | - Ibtisam El-Nour
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Anuradha Ganesh
- Department of Opthamology, Sultan Qaboos University Hospital, Muscat, Oman
| |
Collapse
|
9
|
Di Zazzo G, Guzzo I, De Galasso L, Fortunato M, Leozappa G, Peruzzi L, Vidal E, Corrado C, Verrina E, Picca S, Emma F. Anterior ischemic optical neuropathy in children on chronic peritoneal dialysis: report of 7 cases. Perit Dial Int 2016; 35:135-9. [PMID: 25904772 DOI: 10.3747/pdi.2013.00330] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Anterior ischemic optic neuropathy (AION) is characterized by infarction of the optic nerve head due to hypoperfusion of the posterior ciliary arteries and causes sudden blindness in adults on chronic dialysis, but has rarely been described in children. Unlike adults, children do not have comorbidities related to aging. METHODS We retrospectively analyzed data of 7 children on nocturnal continuous cycling peritoneal dialysis (CCPD) who developed AION identified within the Italian Registry of Pediatric Chronic Dialysis. We also summarized data from 10 cases reported in the literature. RESULTS Our 7 patients suffered from acute onset bilateral blindness. Their mean age was 3.2 years and chronic hypotension had been observed prior the AION in 3 of the 7 children. Low systolic blood pressure (SBP) was associated with higher risk of developing AION according to statistical analysis. None recovered completely. In total, 11 out of 16 experienced a partial recovery and no clear evidence emerged favoring specific treatments. CONCLUSIONS Hypotensive children treated with CCPD are at increased risk of developing AION, which often results in irreversible blindness.
Collapse
Affiliation(s)
- Giacomo Di Zazzo
- Department of Nephrology and Urology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Isabella Guzzo
- Department of Nephrology and Urology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Lara De Galasso
- Department of Nephrology and Urology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Michele Fortunato
- Department of Ophthalmology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanna Leozappa
- Department of Nephrology and Urology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Licia Peruzzi
- Nephrology, Dialysis and Transplantation Unit, Regina Margherita University Hospital, Turin, Italy
| | - Enrico Vidal
- Department of Pediatrics, Pediatric Nephrology, Dialysis and Transplantation Unit, University of Padua, Italy
| | - Ciro Corrado
- Pediatric Nephrology Unit, G. Di Cristina Children's Hospital, Palermo, Italy
| | - Enrico Verrina
- Nephrology, Dialysis and Transplantation Unit, Giannina Gaslini Institute, Genoa, Italy
| | - Stefano Picca
- Department of Nephrology and Urology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Emma
- Department of Nephrology and Urology, Bambino Gesù Children's Hospital, Rome, Italy
| |
Collapse
|
10
|
Chang YS, Weng SF, Chang C, Wang JJ, Su SB, Huang CC, Wang JY, Jan RL. Risk of Nonarteritic Anterior Ischemic Optic Neuropathy Following End-Stage Renal Disease. Medicine (Baltimore) 2016; 95:e3174. [PMID: 27015205 PMCID: PMC4998400 DOI: 10.1097/md.0000000000003174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
To investigate the risk of nonarteritic anterior ischemic optic neuropathy (NAION) following end-stage renal disease (ESRD).A retrospective, nationwide, matched cohort study.ESRD patients identified by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 585.The study cohort included 93,804 ESRD patients registered with the Taiwan National Health Insurance Research Database between January 2000 and December 2009. An age- and sex-matched control group comprised 93,804 patients (case:control = 1:1) selected from the Taiwan Longitudinal Health Insurance Database 2000. Information for each patient was collected from the index date until December 2011. The incidence and risk of NAION were compared between the ESRD and control groups. The adjusted hazard ratio (HR) for NAION after adjustment for potential confounders was obtained by a Cox proportional hazard regression analysis. A Kaplan-Meier analysis was used to calculate the cumulative incidence rate of NAION.The incidence of NAION following ESRD.In total, 133 ESRD patients (0.14%) and 51 controls (0.05%) had NAION (P < 0.001) during the follow-up period, leading to a significantly elevated risk of NAION in the ESRD patients compared with the controls (incidence rate ratio = 3.14, 95% confidence interval [CI] = 2.11-4.67). After adjustment for potential confounders including diabetes mellitus, hypertension, hypotension, hyperlipidemia, and 2-way interaction terms between any 2 factors, ESRD patients were 3.12 times more likely to develop NAION than non-ESRD patients in the full cohort (adjusted HR = 3.12, 95% CI = 2.10-4.64). Additionally, patients with hypertension and hyperlipidemia showed higher incidence rates of NAION in the ESRD group compared with the controls: 2.31 (95% CI = 1.40-3.82) for hypertension and 2.72 (95% CI = 1.14-6.50) for hyperlipidemia.ESRD increased the risk of NAION, which is an interdisciplinary emergency. Close collaboration between nephrologists and ophthalmologists is important in NAION management following ESRD to prevent fellow eye involvement.
Collapse
Affiliation(s)
- Yuh-Shin Chang
- From the Department of Ophthalmology (YSC), Department of Medical Research (JJW), Department of Anesthesiology (JJW), Department of Occupational Medicine, Chi Mei Medical Center (SBS), Graduate Institute of Medical Science, College of Health Science, Chang Jung Christian University (YSC), Department of Child Care and Education, Southern Taiwan University of Science and Technology (CCH), Graduate Institute of Clinical Medicine, National Cheng Kung University (JYW, RLJ), Department of Pediatrics, Chi Mei Medical Center, Liouying, Tainan (RLJ), Department of Leisure, Recreation, and Tourism Management, Tainan (SBS, CCH), Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung (SFW), and Department of Education, University of Taipei, Taipei, Taiwan (CC)
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Pahor D, Pahor A. Gesichtsfelddefekte bei der Erstuntersuchung von Patienten mit nichtarteriitischer anterioren ischämischen Optikusneuropathie. SPEKTRUM DER AUGENHEILKUNDE 2015. [DOI: 10.1007/s00717-015-0268-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
12
|
Marechal M, Michel S, El-Chehab H, Fenolland JR, Delbarre M, Zerrouk R, Marill AF, Rosenberg R, May F, Renard JP. Neuropathie optique ischémique bilatérale. Forme clinique rare. J Fr Ophtalmol 2015; 38:e101-6. [DOI: 10.1016/j.jfo.2014.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/07/2014] [Accepted: 07/07/2014] [Indexed: 10/23/2022]
|
13
|
Medina MA, Moore DA, Cairns BA. A case series: bilateral ischemic optic neuropathy secondary to large volume fluid resuscitation in critically ill burn patients. Burns 2014; 41:e19-23. [PMID: 25406887 DOI: 10.1016/j.burns.2014.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/01/2014] [Accepted: 08/11/2014] [Indexed: 11/24/2022]
Abstract
Ischemic optic neuropathy (ION) in the trauma setting is a rare and devastating condition associated with systemic hypotension, massive volume resuscitation, and sepsis. The objective of this case series is to highlight a potential correlation between severe burn and ischemic optic neuropathy. We present three patients with total body surface area (TBSA) thermal injury burns ranging from 57 to 68% treated at the North Carolina Jaycee Burn Center that developed bilateral ischemic optic neuropathy during their hospital stay. Each patient required greater than 25 L of crystalloid fluid within 24 h after admission, suffered multiple bouts of sepsis, and required extended pressor support. We postulate that ischemic optic neuropathy develops as a result of the interplay between the patient's systemic pathophysiology, i.e. shock, sepsis and the continued need for large volume fluid resuscitation. Current treatments of ION have not proven to be effective, except for possibly limiting fluid resuscitation. In the few cases of refractory burn shock, the incidence of this condition is unlikely to be readily improved. However, it is important for clinicians to be aware of this devastating complication and consider early ophthalmology involvement in the care of severely burned patients.
Collapse
Affiliation(s)
- Miguel A Medina
- Johns Hopkins Department of Plastic Surgery, 601 N Caroline Street, Baltimore, MD 21205, United States; Division of Trauma, University of North Carolina School of Medicine, Doris Duke Research Fellow, 101 Manning Drive, Chapel Hill, NC 27514, United States
| | - Danier A Moore
- Division of Trauma, University of North Carolina School of Medicine, T32 Trauma Research Fellow, 101 Manning Drive, Chapel Hill, NC 27514, United States
| | - Bruce A Cairns
- University of North Carolina School of Medicine, Director of North Carolina Jaycee Burn Center, 101 Manning Drive, Chapel Hill, NC 27514, United States.
| |
Collapse
|
14
|
Anterior ischemic optic neuropathy in pediatric peritoneal dialysis: risk factors and therapy. Pediatr Nephrol 2014; 29:1249-57. [PMID: 24488506 DOI: 10.1007/s00467-013-2747-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 12/02/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Sudden blindness caused by anterior ischemic optic neuropathy (AION) is a rare complication for patients undergoing peritoneal dialysis (PD). Prognosis is generally poor, with AION commonly resulting in permanent visual loss. METHODS We first describe four case reports of children with AION during PD treatment. We then review ten additional AION cases reported in the literature and compare these 14 affected patients with a control cohort of 59 non-affected patients in the Vienna PD registry. RESULTS Significant risk factors for AION were identified as median age (4 vs. 27 months; p < 0.001), autosomal recessive polycystic kidney disease (28.6 vs. 3.4%; p = 0.01), anephric status (53.8 vs. 6.8%; p < 0.001) and low to normal blood pressure evidenced by the number of patients having to be treated with antihypertensive medications (14.3 vs. 62.7%; p = 0.01). Severe hypovolemia was reported in 50% of all cases. Outcome was visual loss with optic atrophy in nine patients; five patients had a good visual outcome. The major difference in treatment was a rapid bolus of saline within 12 h after the initial symptoms. CONCLUSIONS Young age, autosomal recessive polycystic kidney disease, anephric status and hypotension are substantial risk factors for AION. Early hospitalization with vascular refilling within a few hours following onset of blindness leads to improved visual outcome.
Collapse
|
15
|
Szmuk P, Steiner JW, Pop RB, You J, Weakley DR, Swift DM, Sessler DI. Intraocular pressure in pediatric patients during prone surgery. Anesth Analg 2013; 116:1309-13. [PMID: 23558834 DOI: 10.1213/ane.0b013e31828d3730] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intraoperative intraocular pressure (IOP) in the prone position and IOP changes over time have not been evaluated in pediatric surgical patients. We sought to determine time-dependent changes in IOP in children undergoing surgery in prone position. METHODS Thirty patients undergoing neurosurgical procedures in prone position were included. Using a pulse-mode pneumatonometer, IOP was measured in supine position after induction and before emergence of anesthesia and in prone position before the start and after the end of surgery. IOP changes over time in the prone position were assessed with a linear mixed model (i.e., random slope and intercept model) to adjust for the within-patient correlation. RESULTS IOP in prone position increased by an average of 2.2 mm Hg per hour (P < 0.001). Sixty-three percent of patients (95% confidence interval [CI], 46%-81%) had at least 1 IOP value exceeding 30 mm Hg, and 13% (95% CI, 1%-25%) had at least 1 IOP value exceeding 40 mm Hg while prone. Mean IOP increased 7 mm Hg (95% CI, 6-9) during the position change from supine to prone (P < 0.001) and decreased 10 mm Hg (95% CI, 9-12) after changing the position from prone back to supine (P < 0.001). CONCLUSIONS Changing position from supine to prone significantly increases IOP in anesthetized pediatric patients. Moreover, the IOP continued to increase during surgery and reached potentially harmful values, especially when combined with low mean arterial blood pressures that are common during major surgery.
Collapse
Affiliation(s)
- Peter Szmuk
- Department of Anesthesiology and Pain Medicine, University of Texas Southwestern Medical Center Dallas and Children's Medical Center at Dallas, 1935 Medical District Drive, Dallas, TX 75235, USA.
| | | | | | | | | | | | | |
Collapse
|
16
|
Kwak AY, Kim GA, Choi JB. A Case of Acute Nonarteritic Anterior Ischemic Optic Neuropathy in Patient on Hemodialysis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.12.1960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ae Young Kwak
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Siloam Eye Hospital, Seoul, Korea
| | - Gyu Ah Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Siloam Eye Hospital, Seoul, Korea
| | | |
Collapse
|
17
|
Bawazir A, Gharebaghi R, Hussein A, Hazabbah Wan Hitam W. Non-arteritic anterior ischaemic optic neuropathy in Malaysia: a 5 years review. Int J Ophthalmol 2011; 4:272-4. [PMID: 22553660 DOI: 10.3980/j.issn.2222-3959.2011.03.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 03/12/2011] [Indexed: 11/02/2022] Open
Abstract
AIM To evaluate the clinical presentations and visual outcomes of non-arteritic anterior ischaemic optic neuropathy (NAION). METHODS A retrospective study was conducted involving 18 consecutive patients (20 eyes) with NAION attending Hospital Universiti Sains Malaysia from January 2005 until December 2009. RESULTS Most patients were Malay (94.4%), and followed by Chinese (5.6 %). The female-to-male ratio was 3.5:1. The age of patients ranged from 36 to 85 years (mean, 57.1 years). The main risk factors in systemic diseases were hypertension (55.5%), diabetes mellitus (44.4%), and ischaemic heart disease (11.1%). Most patients (77.8%) presented with acute loss of vision while gradual onset was in 22.3% of cases. Majority had visual acuity worse than 1/60 (80%). The most common fundoscopic findings were peripapillary splinter haemorrhage (90%), sectorial swollen optic disc (60%) and hyperemic disc (60%). During follow up, 20% of the patients showed stabilization in visual acuity, and 80% showed worsening of vision. CONCLUSION Majority of patients with NAION presented with acute poor vision involving middle-aged and elderly individuals. Hypertension and diabetes mellitus were among the main risk factors involved. NAION can lead to permanent visual loss despite treatment.
Collapse
Affiliation(s)
- Abdulrahman Bawazir
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | | | | | | |
Collapse
|
18
|
Cakmakli G, Kurne A, Güven A, Serdaroğlu A, Topaloğlu H, Teber S, Anlar B. Childhood optic neuritis: the pediatric neurologist's perspective. Eur J Paediatr Neurol 2009; 13:452-7. [PMID: 18945627 DOI: 10.1016/j.ejpn.2008.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 09/09/2008] [Accepted: 09/10/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND Optic neuritis in children may be an isolated, usually postinfectious event, or the symptom of a more widespread disorder. AIM To investigate the etiological spectrum of optic neuritis in children in association with diagnostic findings and follow-up results. METHODS We retrospectively examined the records of 31 children aged 4-15 (mean 9.7+/-2.9) years in whom isolated optic neuritis was the presenting neurological symptom. RESULTS Monophasic bilateral optic neuritis was the most common presentation (45%), followed by the unilateral (32%) and recurrent (22%) forms. Initial cranial MRI was abnormal in 12/31 patients. During a mean follow-up of 2.2 years (6 months-15 years), 6/14 bilateral cases, 9/10 unilateral and 5/7 recurrent cases were diagnosed with various disorders including total eight with MS. The MS group tended to start with unilateral optic neuritis, was older (mean 11.6+/-1.5 vs. 8.8+/-2.9 years), and included more girls than the other groups. CONCLUSIONS Optic neuritis in children is frequently part of a systemic or neurological disorder even in the presence of normal cranial imaging. These patients should be evaluated and followed-up in pediatric neurology clinics.
Collapse
Affiliation(s)
- Gül Cakmakli
- Hacettepe University Faculty of Medicine, Department of Neurology, Ankara, Turkey
| | | | | | | | | | | | | |
Collapse
|
19
|
Anterior ischemic optic neuropathy due to abdominal hemorrhage after laparotomy for uterine myoma. Arch Gynecol Obstet 2009; 281:157-60. [PMID: 19430942 DOI: 10.1007/s00404-009-1109-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 04/23/2009] [Indexed: 01/03/2023]
Abstract
INTRODUCTION This retrospective observational case report describes a very rare but dreadful ocular complication due to severe blood loss in association with a major surgical procedure. It is the first time that this complication is reported in gynecological surgery. CASE REPORT A previously healthy 41-year-old woman underwent hysterectomy because of large uterine myomas. Postoperatively, she was found to be severely anemic (hemoglobin 7.2 g/dl), but refused blood transfusion. Thirty-six hours after the first operation, relaparotomy was performed with extraction of a 1.5 l blood clot from the abdominal cavity. When she woke up from general anesthesia, the woman complained of visual loss in her left eye. At the time of visual loss, the hemoglobin level was 5.2 g/dl and the patient agreed to infusion of packed red blood cells. Ophthalmic examination revealed in the left eye an anterior ischemic optic neuropathy (AION). The optic disk was small, swollen and hyperemic (visual acuity at 8/10 with a superior altitudinal visual field defect). The right eye also had a small optic disk with a small cup (disk at risk), but no functional impairment. Despite blood transfusion, the left eye did not show any recovery and the optic disk had a pale appearance when examined after 3 years. CONCLUSION Development of AION in this case was due to severe blood loss accompanied by head-down surgery in an eye with so-called "disk at risk". Meticulous management of perioperative systemic hypotension and early correction of anemia may reduce the risk of perioperative visual loss.
Collapse
|
20
|
Shidara K, Wakakura M, Kawaguchi S. Optic Neuropathy Mimicking Normal Tension Glaucoma Associated with Internal Carotid Artery Hypoplasia. Neuroophthalmology 2009. [DOI: 10.1080/01658100902718189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
21
|
|
22
|
Parisi V, Coppola G, Ziccardi L, Gallinaro G, Falsini B. Cytidine-5'-diphosphocholine (Citicoline): a pilot study in patients with non-arteritic ischaemic optic neuropathy. Eur J Neurol 2008; 15:465-74. [PMID: 18325025 DOI: 10.1111/j.1468-1331.2008.02099.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Our work evaluates visual function before and after treatment with cytidine-5-diphosphocholine (Citicoline) in patients with non-arteritic ischaemic optic neuropathy (NION). METHODS Twenty-six patients in which at least 6 months elapsed from NION, were randomly divided into two age-similar groups: 14 patients had Citicoline (Cebrolux-Tubilux, Italy, 1600 mg/diem for 60 days, followed by a 120-day period of wash out, days 60-180) (T-NION); 12 patients had no treatment during the same period (NT-NION). At day 180, in T-NION a second period of treatment (days 181-240) followed by a wash-out (days 241-360) was performed. Fourteen age-matched healthy subjects provided normative data. In all patients, pattern-electroretinogram (PERG), visual evoked potentials (VEPs) and visual acuity (VA) measurements were performed at baseline and at days 60 and 180. In T-NION, further measurements were achieved at days 240 and 360. RESULTS At baseline, NT-NION and T-NION patients showed abnormal PERGs and VEPs, and reduced VA, compared to controls. At the end of treatment (days 60 and 240), T-NION patients showed improvement (P < 0.01) of PERGs, VEPs parameters and VA, compared to pre-treatment values. After wash out, functional improvements persisted compared to baseline. No changes in NT-NION patients were observed. CONCLUSIONS Our results suggest a beneficial effect of oral Citicoline in NION.
Collapse
Affiliation(s)
- V Parisi
- Department of Neurophysiology of Vision and Neurophthalmology, G.B. Bietti Eye Foundation-IRCCS, Rome, Italy.
| | | | | | | | | |
Collapse
|
23
|
Preechawat P, Bruce BB, Newman NJ, Biousse V. Anterior ischemic optic neuropathy in patients younger than 50 years. Am J Ophthalmol 2007; 144:953-60. [PMID: 17854756 DOI: 10.1016/j.ajo.2007.07.031] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 07/17/2007] [Accepted: 07/24/2007] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize anterior ischemic optic neuropathy (AION) in patients younger than 50 years. DESIGN Retrospective study. METHODS Records of all AION patients seen between 1989 and 2006 were reviewed. Patients younger than 50 years when initial visual loss occurred were included. RESULTS Of 727 consecutive patients with AION, 169 (23%) were younger than 50 years (median, 43 years; range, 13 to 49 years; 58% men; 93% White). Involvement was unilateral in 59% of patients and bilateral in 41%. At least one cardiovascular risk factor was found in 74% of patients. Hypercoagulable states and vasculitis were found in 8%. An underlying small or anomalous optic disk was found in 92% of eyes (210/230). Isolated disk anomalies (without systemic risk factors) were present in 26% of eyes. Final visual acuities were 20/40 or better in 64% of eyes and 20/200 or worse in 22%. Among patients with bilateral involvement, final visual acuity was similar in the two eyes in 70% of patients. Anemia and type I diabetes were associated significantly with fellow eye involvement. Recurrent AION in the same eye occurred in 6% of patients. CONCLUSIONS AION in younger patients is not uncommon and represents 23% of AION patients in a tertiary neuro-ophthalmic service. Except for giant cell arteritis, ocular and systemic risk factors and associated disorders are similar to those described in older AION patients. Younger AION patients have better visual acuity outcomes but a higher risk of fellow eye involvement than older AION patients.
Collapse
Affiliation(s)
- Pisit Preechawat
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
| | | | | | | |
Collapse
|
24
|
Sivaswamy L, Vanstavern GP. Ischemic optic neuropathy in a child. Pediatr Neurol 2007; 37:371-2. [PMID: 17950426 DOI: 10.1016/j.pediatrneurol.2007.06.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 05/30/2007] [Accepted: 06/21/2007] [Indexed: 11/28/2022]
Abstract
Nonarteritic ischemic optic neuropathy is a rare event in childhood, occurring mostly in the setting of major surgical procedures or hypovolemia. We report on a child who presented with this unusual complication during the course of therapy with sildenafil citrate, which is gaining acceptance as a treatment modality for pulmonary hypertension in the pediatric age group. The ocular complications of this drug have been widely reported in the adult literature, but there are sparse reports, if any, in the pediatric age group. The likely pathophysiology of this condition is reviewed, as are the other ophthalmologic complications of this drug.
Collapse
Affiliation(s)
- Lalitha Sivaswamy
- Department of Pediatrics and Neurology, Children's Hospital of Michigan, Detroit, Michigan 48201, USA.
| | | |
Collapse
|
25
|
Cleper R, Goldenberg-Cohen N, Kornreich L, Krause I, Davidovits M. Neurologic and ophthalmologic complications of vascular access in a hemodialysis patient. Pediatr Nephrol 2007; 22:1377-82. [PMID: 17487512 DOI: 10.1007/s00467-007-0491-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 03/12/2007] [Accepted: 03/16/2007] [Indexed: 11/26/2022]
Abstract
Patients on long-term hemodialysis undergo multiple interventions, including insertion of central catheters and arteriovenous anastomoses for creation of vascular access. The need for high-flow vessels to maintain hemodialysis efficiency leads to wear on the central veins and consequent stenosis and occlusion. In addition to local signs of impaired venous drainage, abnormal venous flow patterns involving the upper chest, face, and central nervous system might develop. We describe the first pediatric case of devastating intracranial hypertension presenting with visual loss in the eye contralateral to a high-flow vascular access in a patient on long-term hemodialysis. The literature on this rare complication of hemodialysis is reviewed.
Collapse
Affiliation(s)
- Roxana Cleper
- Department of Pediatric Nephrology, Schneider Children's Medical Center of Israel, Petah Tiqwa 49202, Israel.
| | | | | | | | | |
Collapse
|
26
|
Abstract
PURPOSE OF REVIEW Nonarteritic anterior ischemic optic neuropathy remains a disease that is poorly understood in many aspects. The clinical presentation may diverge significantly from the classic unilateral, painless, sudden vision loss affecting patients over the age of 50 years. This variability might make nonarteritic anterior ischemic optic neuropathy hard to differentiate from optic neuritis and arteritic ischemic optic neuropathy. The course of nonarteritic anterior ischemic optic neuropathy is also variable, often sequentially affecting the other eye. RECENT FINDINGS Visual recovery has been reported, but it is not the rule. Multiple risk factors have been proposed, including crowded disc, atherosclerosis, diabetes, hyperlipidemia, hypertension, hypotension, hemoconcentration, hemodilution, and hypercoagulable states. The optic nerve damage in nonarteritic anterior ischemic optic neuropathy appears to result from a perfusion insufficiency in the short posterior ciliary arteries leading to infarction of the retrolaminar portion of the optic disc. The underlying mechanisms are still unclear, however. Multiple medical and surgical treatment options have been investigated, including optic nerve sheath decompression, standard and megadose corticosteroids, levodopa, carbidopa, hyperbaric oxygen, and neuroprotective agents, but no proven effective treatment is currently available. SUMMARY Intense investigations in humans and animals are under way. Hopefully these studies will enhance our understanding of the risk factors and pathophysiology of nonarteritic anterior ischemic optic neuropathy and aid in developing new strategies for prevention and treatment.
Collapse
Affiliation(s)
- Michaela Kunz Mathews
- Department of Ophthalmology, University of Maryland, Baltimore, Maryland 21201, USA.
| |
Collapse
|
27
|
Kim JS, Deputy S, Vives MT, Aviles DH. Sudden blindness in a child with end-stage renal disease. Pediatr Nephrol 2004; 19:691-3. [PMID: 15052465 DOI: 10.1007/s00467-004-1447-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2003] [Revised: 01/23/2004] [Accepted: 01/26/2004] [Indexed: 11/27/2022]
Abstract
Continuous peritoneal dialysis (CPD) is the preferred modality for renal replacement therapy in children with end-stage renal disease. Anterior ischemic optic neuropathy (AION) is a rare complication in patients on CPD. AION is characterized by ischemic injury of the optic nerve caused by hypoperfusion of the posterior ciliary arteries. It presents with acute visual loss and disc swelling, without additional neurological findings. We report a 2-year-old child with end-stage renal disease on CPD who developed AION. He was dehydrated and received intravenous fluid on admission. Additional treatment included methylprednisolone and levodopa. On his 3rd admission day, his pupils became reactive to light and his vision showed improvement. The improvement in vision might be due to the early detection and aggressive treatment of hypotension. It is difficult to demonstrate whether steroids or levodopa played a role in the improvement of his vision. Prospective studies to evaluate the effectiveness of levodopa in the treatment of AION are warranted in this potentially devastating condition.
Collapse
Affiliation(s)
- Jung Sue Kim
- Department of Pediatrics, LSU Health Sciences Center and Children's Hospital, New Orleans, USA
| | | | | | | |
Collapse
|
28
|
Foroozan R, Buono LM, Savino PJ. Optic disc structure and shock-induced anterior ischemic optic neuropathy. Ophthalmology 2003; 110:327-31. [PMID: 12578776 DOI: 10.1016/s0161-6420(02)01736-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To describe a patient who developed unilateral shock-induced anterior ischemic optic neuropathy (SIAION) after gastrointestinal hemorrhage followed by presumed idiopathic nonarteritic anterior ischemic optic neuropathy (NAION) in the fellow eye. DESIGN Retrospective, observational case report and literature review. METHODS The case history of an 80-year-old man who developed SIAION, followed by NAION in the fellow eye, was reviewed. All previously reported cases of SIAION were reviewed. MAIN OUTCOME MEASURES Neuro-ophthalmic examination, including visual acuity, funduscopy, and automated perimetry. RESULTS An 80-year-old man, with a history of gastrointestinal bleeding from a duodenal ulcer, was hospitalized and received four units of packed red blood cells after he was found to be severely anemic (hemoglobin 6.7 g/dl). Three days later he complained of loss of vision of the right eye. Neuro-ophthalmic examination 2 weeks later disclosed a visual acuity of counting fingers at 6 inches in the right eye and 20/40 in the left eye, with a right relative afferent pupillary defect and a superior altitudinal visual field defect. Funduscopy revealed optic disc edema with a temporal parapapillary hemorrhage in the right eye and a small optic disc, with no cup, in the left eye. A diagnosis of SIAION secondary to anemia was made. Six weeks later he developed a new inferior altitudinal visual field defect in the left eye and diffuse optic disc swelling. He had no signs or symptoms of giant cell arteritis or polymyalgia rheumatica, his hemoglobin at this time was 11.9 g/dl, and the Westergren erythrocyte sedimentation rate was 6 mm/hour. CONCLUSIONS Our patient developed optic disc swelling of the right eye after an episode of gastrointestinal hemorrhage (SIAION). The disc swelling in the left eye occurred 8 weeks later, when his hemoglobin had increased to 11.9 g/dl. The timing of the ischemic optic neuropathies suggests that the acute anemia led to involvement of the first but not the second eye. The configuration of the optic disc may have predisposed not only to the second event (NAION) but also to the first episode (SIAION).
Collapse
Affiliation(s)
- Rod Foroozan
- Neuro-Ophthalmology Service, Wills Eye Hospital, Thomas Jefferson University, 900 Walnut Street, Philadelphia, PA 19107, USA
| | | | | |
Collapse
|