Abstract
Purpose :
To describe cases of embolic ischemic optic neuropathy (ION) detected by Orbital Color Doppler Imaging (OCDI).
Methods :
The study design is retrospective patient chart review and analysis.
A computerized search was performed to identify all patients with ION seen at the Neuro-ophthalmology Service, Wills Eye Hospital, Philadelphia between 2010 and present. It is our practice to perform OCDI in patients with ION with atypical features including absence of disc edema in the affected eye or ‘disc at risk” in the contralateral eye. We identified 38 patients who underwent OCDI and reviewed their clinical records.
Results :
Twelve patients had positive finding of embolus on CDI. The average age was 69.3 years (median 70, range 44-92). All patients presented with sudden onset, unilateral vision loss except for one patient who had sudden realization of a preexisting visual loss. There was prior history of transient vision loss in the same eye (17%) and nonarteritic anterior ischemic optic neuropathy (NAION) in the contralateral eye (8%). Optic disc edema typical for NAION was noted at presentation (83%), but only one patient had disc at risk in the contralateral eye. Five patients were evaluated for giant cell arteritis prior to OCDI and had negative temporal artery biopsies. OCDI revealed retrobulbar embolus in the central retinal artery (CRA) (92%) and embolus anterior to the optic disc (8%). All patients were referred for stroke work up following diagnosis. Atrial fibrillation was detected in one patient, requiring long term anticoagulation
Conclusions :
Contrary to conventional wisdom, we have found CRA embolus in patients with IONs. OCDI is an important imaging modality that can help detect embolus in the retrobulbar course of the artery. The detection of embolus should be followed by evaluation of the embolic source to reduce the risk of subsequent hemispheric stroke.
This is a 2020 ARVO Annual Meeting abstract.