Elsevier

American Journal of Ophthalmology

Volume 205, September 2019, Pages 43-49
American Journal of Ophthalmology

Original Article
Choroidal Vascular Changes in Arteritic and Nonarteritic Anterior Ischemic Optic Neuropathy

https://doi.org/10.1016/j.ajo.2019.03.028Get rights and content

Purpose

To compare choroidal vascularity index (CVI) in patients with arteritic anterior ischemic optic neuropathy (A-AION), nonarteritic anterior ischemic optic neuropathy (NA-AION), and control subjects.

Design

Retrospective cross-sectional study.

Methods

This study was conducted at the Ophthalmology Unit of the S.Orsola-Malpighi University Hospital (Bologna, Italy). Macular and optic nerve head optical coherence tomography (OCT) scans of 20 patients with A-AION secondary to giant cell arteritis (biopsy-proven), 20 patients with NA-AION, and 20 control subjects were acquired with Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany). Images were binarized using ImageJ software, and total choroid area (TCA), luminal area (LA), and stromal area (SA) were segmented. The main outcome measure was CVI, defined as the ratio of LA to TCA.

Results

Patients with A-AION showed a significantly lower macular and peripapillary CVI compared to both patients with NA-AION (respectively, 67.17 ± 2.35 vs 69.66 ± 4.18, P = .048; 63.51 ± 3.29 vs 67.67 ± 3.07, P < .001) and control subjects (respectively, 67.17 ± 2.35 vs 70.00 ± 2.95, P = .021; 63.51 ± 3.29 vs 68.69 ± 3.19, P = .002). Conversely, no significant difference in macular and peripapillary CVI was found between patients with NA-AION and controls (respectively, P = .942 and P = .570). After adjustment for age, the difference of peripapillary CVI among groups remained statistically significant (P < .001), while the difference in macular CVI did not (P = .060).

Conclusions

Macular and peripapillary CVI are reduced in patients with A-AION. These parameters may be useful to quantitatively evaluate choroidal vascular dysfunction in A-AION, serving as a new additional diagnostic tool to distinguish A-AION from NA-AION.

Section snippets

Methods

This retrospective cross-sectional study included patients with acute A-AION and NA-AION visited at the Neuro-ophthalmology Service of our Institution (S.Orsola-Malpighi University Hospital, Bologna, Italy) during the period between January 1, 2015 and October 31, 2018. Inclusion criteria for both groups were age older than 60 years, sudden onset of unpainful monocular vision loss associated with optic disc edema and altitudinal and/or central visual field defects, and complete medical records

Results

Overall, 20 patients with A-AION, 20 patients with NA-AION, and 20 control subjects were included in the study. The demographic and clinical characteristics of patients and controls are reported in Table 1. There were no significant differences in sex distribution and IOP among the 3 groups (respectively, P = .410 and P = .492). Mean age was not significantly different in patients with A-AION and controls (P = .359), while patients with NA-AION were significantly younger than patients with

Discussion

The first crucial step in patients older than 60 years old presenting features of AION is to rule out GCA, given the potential for catastrophic bilateral loss of vision and systemic vasculitic sequelae. The immediate treatment of GCA with intensive high-dose corticosteroid may prevent visual loss but is not without risk. Therefore, the accuracy of the criteria used to establish or exclude the diagnosis is essential to minimize medication morbidities.22 However, the specificity of the currently

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