Clinical presentation of ischemic optic neuropathies

IF 0.9 Q4 OPHTHALMOLOGY

Expert Review of Ophthalmology Pub Date : 2023-05-04 DOI:10.1080/17469899.2023.2237193

N. Miller, A. Arnold

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引用次数: 0

Abstract

ABSTRACT Introduction Ischemic optic neuropathies (IONs) are the leading cause of sudden, permanent optic nerve-related visual loss. Areas covered There are three types of anterior and posterior (retrobulbar) IONs: nonarteritic, perioperative, and arteritic. In this review, we discuss the clinical manifestations, management, and prognoses – visual and systemic – of each type. A literature search was conducted via MEDLINE (PubMed) 1 January 1973 to 1 April 2023. Expert opinion There is no consistently beneficial treatment for the nonarteritic IONs. Patients who have experienced either spontaneous nonarteritic anterior ION (NAION) or an acute optic neuropathy following uncomplicated cataract surgery should be warned that they may have an increased risk of a similar event in their fellow eye if they undergo cataract surgery in that eye. Early recognition of perioperative ION after non-ocular surgery is crucial so that anemia and hypotension can be corrected as soon as possible, hopefully resulting in visual improvement. Finally, arteritic ION requires early recognition and timely treatment with systemic corticosteroids to prevent subsequent visual loss in the fellow eye as well as the many other complications of giant cell arteritis. The interleukin-6 inhibitor tocilizumab can be used to reduce both the dose of steroids and the duration steroids are needed.

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缺血性视神经病变的临床表现

摘要简介缺血性视神经病变（IONs）是突发性、永久性视神经相关视力丧失的主要原因。覆盖区域有三种类型的前部和后部（球后）IONs：非动脉性、围手术期和动脉性。在这篇综述中，我们讨论了每种类型的临床表现、治疗和预后——视觉和系统。文献检索通过MEDLINE（PubMed）于1973年1月1日至2023年4月1日进行。专家意见对非动脉炎性IONs没有一贯的有益治疗方法。在简单白内障手术后经历过自发性非动脉性前部ION（NAION）或急性视神经病变的患者应被警告，如果他们在另一只眼睛接受白内障手术，他们可能会增加发生类似事件的风险。非眼部手术后早期识别围手术期ION至关重要，这样贫血和低血压才能尽快得到纠正，有望改善视力。最后，动脉炎性ION需要早期识别并及时使用全身皮质类固醇进行治疗，以防止同伴眼睛随后的视力丧失以及巨细胞动脉炎的许多其他并发症。白细胞介素-6抑制剂tocilizumab可用于减少类固醇的剂量和所需类固醇的持续时间。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Ophthalmology Health Professions-Optometry

CiteScore

1.40

自引率

0.00%

发文量

期刊介绍： The worldwide problem of visual impairment is set to increase, as we are seeing increased longevity in developed countries. This will produce a crisis in vision care unless concerted action is taken. The substantial value that ophthalmic interventions confer to patients with eye diseases has led to intense research efforts in this area in recent years, with corresponding improvements in treatment, ophthalmic instrumentation and surgical techniques. As a result, the future for ophthalmology holds great promise as further exciting and innovative developments unfold.