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PHOTO ESSAY
Year : 2022  |  Volume : 2  |  Issue : 4  |  Page : 995-996

Non-arteritic ischemic optic neuropathy because of occlusion of the temporal short posterior ciliary artery from thrombotic emboli


Department of Vitreo-Retina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India

Date of Submission05-Apr-2022
Date of Acceptance22-Jun-2022
Date of Web Publication11-Oct-2022

Correspondence Address:
Dr. Anirban Chakrabarti
Department of Vitreo-Retinal Services, Aravind Eye Hospital, Anna Nagar, Madurai - 625 020, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_857_22

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  Abstract 


Keywords: Anterior ischemic optic neuropathy, embolic occlusion, fundus fluorescein angiography, non-arteritic anterior ischemic optic neuropathy, short posterior ciliary artery occlusion


How to cite this article:
Kannan NB, Chakrabarti A, Mishra C, Baliga G, Arumugam KK. Non-arteritic ischemic optic neuropathy because of occlusion of the temporal short posterior ciliary artery from thrombotic emboli. Indian J Ophthalmol Case Rep 2022;2:995-6

How to cite this URL:
Kannan NB, Chakrabarti A, Mishra C, Baliga G, Arumugam KK. Non-arteritic ischemic optic neuropathy because of occlusion of the temporal short posterior ciliary artery from thrombotic emboli. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Nov 27];2:995-6. Available from: https://www.ijoreports.in/text.asp?2022/2/4/995/358192



A 58-year-old hypertensive male presented with sudden onset painless, defective vision in the left eye (LE) for 1 week. He gave no history of headache, jaw claudication, scalp tenderness, and transient visual obscuration. His best corrected visual acuity was 6/12 in the right eye (RE), with hand movement close to face (HM – CF) in LE. On fundus examination, RE was normal [Figure 1]a. LE revealed blurring of the temporal disc margin with pallor and disc edema. A small area of whitening was seen along the infero-temporal arcade [Figure 1]b. Optical coherence tomography (OCT) showed normal foveal contour in RE [Figure 1]c and hyper-reflective inner layers along the infero-temporal arcade in LE [Figure 1]d. Fundus fluorescein angiography (FFA) revealed marked filling delay of the temporal choroidal hemisphere that is supplied by the temporal short posterior ciliary artery [Figure 2]a,[Figure 2]b,[Figure 2]c,[Figure 2]d. Blood investigations revealed a normal blood count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). The lipid profile was raised. Carotid Doppler showed reduced flow in the left internal carotid artery compared to the right side. Echocardiography revealed a dilated left atrium and ventricle with global hypokinesia of the left ventricle. He was diagnosed as a case of non-arteritic anterior ischemic optic neuropathy (NA-AION) because of occlusion of the temporal short posterior ciliary artery, probably from thrombotic emboli.
Figure 1: (a and b): Wide-angle fundus photo showing RE normal fundus with a healthy disc and macula, LE blurring of the temporal disc margin with pallor and disc edema. A small area of whitening is seen along the infero-temporal arcade (marked by circle). (c and d): Optical coherence tomography (OCT) showing normal foveal contour in RE. LE foveal contour is normal with well-demarcated retinal layers on OCT. However, hyper-reflective inner layers along the infero-temporal arcade are seen, which correspond to the area of whitening of the retina in LE [Figure 1]b

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Figure 2: (a-d): FFA showing a delay of arm-to-retina time, a marked filling delay of the temporal choroidal hemisphere that is supplied by the temporal short posterior ciliary artery. On FFA, the cilioretinal artery supplies the infero-temporal part of the macula. Its filling is delayed, which leads to retinal whitening along the infero-temporal arcade. However, it fills earlier than the temporal choroidal hemisphere [Figure 2]a. This is probably because of its supply from the nasal short posterior ciliary artery

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  Discussion Top


There is an occlusion of the temporal short posterior ciliary artery leading to filling delay of the temporal choroidal hemisphere. We diagnosed this case as NA-AION because CRP and ESR were within normal limits. Symptoms of arteritic AION associated with giant cell arteritis (GCA) were absent.[1] Embolic occlusion of the short posterior ciliary artery from a thrombotic source is the proposed causative factor of NA-AION in this case. NA-AION because of transient hypo-perfusion of the optic nerve head circulation does not cause such massive vision loss.[2],[3] Echocardiography findings corroborated our suspicion of a thrombotic event in the body.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hayreh SS, Podhajsky PA, Zimmerman B. Ocular manifestations of giant cell arteritis. Am J Ophthalmol 1998;125:509-20.  Back to cited text no. 1
    
2.
Hayreh SS. Ischemic optic neuropathy. Prog Retin Eye Res 2009;28:34-62.  Back to cited text no. 2
    
3.
Hayreh SS. Management of ischaemic optic neuropathies. Indian J Ophthalmol 2011;59:123-36.  Back to cited text no. 3
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