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J.G. McHenry, J.R. Younger; Optic Neuropathy and Alpha–2 Antiplasmin . Invest. Ophthalmol. Vis. Sci. 2006;47(13):731.
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We report 5 patients with optic neuropathy with elevated alpha–2 antiplasmin levels to show a previously unrecognized potential cause of ischemic optic neuropathy.
We reviewed the cases of 5 patients presenting to a University Eye Clinic with vision loss whose laboratory evaluation revealed an elevated alpha–2 fraction on their serum protein electrophoresis and subsequent elevated alpha–2 antiplasmin levels.
Patient age ranged from 45 to 76 years old. Three patients were female and 2 were male. Visual acuity ranged from 20/20 to counting fingers and visual field defects included paracentral, altitudinal and centrocecal defects. Although all patients showed gradual improvement on repeat visual fields, no defects completely resolved. All patients had signs and symptoms of ischemic optic neuropathy including painless visual loss with either optic disc pallor or segmental hemorrhage. Concurrent conditions included thyroid disease(1 patient) and ethambutal use in a patient whose central scotoma did not improve one year after discontinuing the medication.
Alpha–2 antiplasmin elevation may increase the risk of thrombosis. This may lead to ischemic complications in patients with already compromised ciliary circulation. Patients with ischemic optic neuropathy should be evaluated for alpha–2 antiplasmin elevation.
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