Macular and Optic Disc Head Morphology on OCT and Visual Prognosis in Non-Arteritic Anterior Ischemic Optic Neuropathy

Author(s): Sema Kaya, Ibrahim Handokoa, Tanja Guthoffa, Marius Ringelsteinb,c, Orhan Aktasb, Gerd Geerlinga, Rainer Guthoffa.

Introduction: Non-arteritic anterior ischemic optic neuropathy (NAION) shows an acute painless unilateral visual loss due to a reduced perfusion of the optic nerve head (ONH). Aim of this study was to analyse ONH respective macula morphology after NAION by optical coherence tomography and the correlation to visual acuity.

Methods: In this observational study, 11 patients with NAION were assessed. Patients were examined in the acute (symptoms < 2 weeks) and chronic phase (interval of 6 weeks). The fellow eye served as control. Results: The peripapillary RNFL of the superior sectors showed the strongest thickness alterations in the acute phase (swelling) as well as in the chronic phase (decrease). Early alterations in the macula are the thickening of the RNFL, ganglion cell layer (GCL) and inner plexiform layer (IPL) of outer nasal and superior sectors. The mean thickness increase of the RNFL over all peripapillary regions correlated with initial visual acuity (Pearson correlation coefficient -0.797 at a P-value of 0.003).

Conclusion: The RNFL of the superior optic disc sectors presented the most severe edema in the acute phase and the most thickness loss after 6 weeks, suggesting the strongest affection by hypoxia in NAION. The peripapillary RNFL had the strongest correlation with initial visual acuity.