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Impressum
Changes of the optic disc after arteritic anterior ischemic optic neuropathy
1Jonas J. B., 2Hayreh S. S.
1Universitäts-Augenklinik, Fakultät für Klinische Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; 2Department of Ophthalmology and Visual Sciences, University Hospitals & Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242-1091.
Purpose: To evaluate the appearance of the nerve head in patients
after giant cell arteritis induced arteritic anterior ischemic optic neuropathy
(AAION). Patients. The noncomparative clinical case series study comprised
29 patients who presented with unilateral (A-AION) and temporal artery
biopsy proven giant cell arteritis. Stereoscopic optic disc photographs,
taken of both the affected and unaffected eyes at the onset of the disease
and after a follow-up period of 20.10 ± 25.36 months (median, 11
months; range 2 to 102 months), were morphometrically evaluated. Main
outcome measures were size and shape of the optic disc, neuroretinal rim,
optic cup, and alpha zone and beta zone of parapapillary atrophy.
Results: In the eyes after A-AION, at the end of the study, the
neuroretinal rim was significantly (p=0.002) smaller, and the optic disc
cup area was significantly (0.001) larger than those of the contralateral
unaffected eyes. Alpha zone and beta zone of parapapillary atrophy did
not vary significantly (p>0.50).
Conclusions: A-AION, like glaucomatous optic neuropathy, results
in neuroretinal rim loss and optic disc cupping. However, in contrast
to glaucoma, A-AION is not associated with an enlargement of parapapillary
atrophy. The reasons and mechanisms responsible for these similarities
and dissimilarities are discussed. Marked clinical, morphologic and histopathologic
similarities in optic disc cupping and loss of neuroretinal rim between
A-AION and glaucomatous optic neuropathy are highly suggestive of a common
mechanism for the development of the two diseases, i.e. ischemia of the
optic nerve head.