Non-arteritic anterior ischaemic optic neuropathy and obstructive sleep apnoea.

Siddharth Madan, Maansi Sethi, Vidhi Bajpai, Rajiv Garg
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Abstract

Anterior ischaemic optic neuropathies (AIONs) are a common cause of permanent visual loss in the elderly population. The non-arteritic subtype has been intensively studied. While systemic associations such as hypertension and diabetes mellitus are commonly recognized and treated, others such as obstructive sleep apnoea (OSA) are largely overlooked in daily practice. A 60-year-old man who gave no history of any systemic illness presented to us 1 week following an uneventful cataract surgery with posterior chamber intraocular lens implantation in his right eye. The surgery was performed elsewhere by an eye-healthcare professional where the patient presented primarily with a history of progressively worsening diminution of vision in the same eye for 5 days and was diagnosed with a senile cataract. The postoperative visual gain was unsatisfactory; hence he sought another opinion. A diagnosis of non-arteritic AION (NAION) was established. Systemic evaluation revealed elevated diastolic blood pressure, dyslipidaemia and severe OSA. Prompt treatment with systemic steroids and simultaneous management of the accompanying systemic morbid conditions saved some useful vision in the affected eye. This also prevented involvement of the fellow unaffected eye. A comprehensive ocular examination with emphasis on systemic evaluation of the patient for coexisting illness is imperative before proceeding with any medical or surgical intervention. OSA is a definitive risk factor for the development of NAION, though it remains underdiagnosed and untreated. Cataract surgery has been shown to worsen underlying NAION. Systemic stabilization averts potentially blinding sequel in the unaffected eye of these patients.

非动脉炎性前部缺血性视神经病变和阻塞性睡眠呼吸暂停。
前部缺血性视神经病变(AION)是导致老年人永久性视力丧失的常见原因。人们对非动脉炎亚型进行了深入研究。虽然高血压和糖尿病等全身性疾病通常都能被识别和治疗,但阻塞性睡眠呼吸暂停(OSA)等其他疾病在日常实践中却大多被忽视。一名 60 岁的男子在接受右眼后房型人工晶体植入白内障手术一周后,无任何系统性疾病史,来我院就诊。手术是在其他地方由眼科保健专业人员进行的,患者主要表现为同一只眼睛的视力在 5 天内逐渐下降,被诊断为老年性白内障。术后视力恢复不理想,因此他寻求其他医生的意见。非动脉炎性视网膜缺损(NAION)诊断成立。全身评估显示舒张压升高、血脂异常和严重的 OSA。他及时接受了全身类固醇治疗,并同时治疗了伴随的全身病症,这才保住了患眼的部分视力。这也避免了未受影响的同侧眼睛受累。在采取任何医疗或手术干预措施之前,必须对患者进行全面的眼部检查,重点是对并存疾病进行系统评估。睡眠呼吸暂停是发生非结节性视网膜病变的一个明确的危险因素,但它仍未得到充分诊断和治疗。白内障手术已被证明会加重潜在的非内视性视网膜病变。系统性稳定可避免这些患者未受影响的眼睛出现可能致盲的后遗症。
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