Optical coherence tomography angiography in nonarteritic anterior ischemic optic neuropathy due to optic nerve head drus
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Optical coherence tomography angiography in nonarteritic anterior ischemic optic neuropathy due to optic nerve head drusen Gilda Cennamo 1
&
Daniela Montorio 2 & Piera Giunta 2 & Fausto Tranfa 2
Received: 17 March 2020 / Accepted: 28 May 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Optic nerve head drusen (ONHD) are typically benign hyaline and calcified concretions located within the optic nerve. Initially asymptomatic, they can increase slowly in size and number over time, and they can cause mechanical stress at the axons of the optic nerve and progressively lead to a loss of the visual field and papillary vascular changes. Here, we reported a rare case of a young patient with bilateral ONHD complicated by a nonarteritic anterior ischemic optic neuropathy (NAION) in the right eye. The aim of this case was to evaluate, using optical coherence tomography angiography (OCTA), the vascular network of the papillary region in both eyes in the presence of this ischemic event associated to ONHD. At OCTA examination, the whole papillary region revealed a general rarefaction of the vascular network, but it turned out to be greater in the right eye affected by nonarteritic anterior ischemic optic neuropathy than in fellow eye. Therefore, these findings demonstrated that ONHD may determine significant ischemic events of the optic nerve and OCTA represents a valid and noninvasive tool in the diagnosis and in the pathogenesis of these rare cases of NAION associated to ONHD in young patients. Keywords Optical coherence tomography angiography . Nonarteritic anterior ischemic optic neuropathy . Optic nerve head drusen
Optic nerve head drusen (ONHD) are typically benign hyaline and calcified concretions located within the optic nerve and are more prevalent in Caucasians and women [1]. They appear in childhood and are usually asymptomatic; indeed, the diagnosis is accidentally made during a routine eye examination [2]. The pathophysiology underlying ONHD may be associated to an inherited dysplasia of the disc, and based on anatomical location within the optic nerve, they can be superficial and deep [3]. ONHD may occur alone, without any other ocular disease, or in association with other syndromes such as retinitis pigmentosa, Usher, Joubert, and Alagille [4]. The drusen can increase slowly in size and number over time, and they can cause mechanical stress at the axons of the optic nerve leading progressively to a loss of visual field.
* Gilda Cennamo [email protected] 1
Department of Public Health, Eye Clinic, University of Naples Federico II, Via S. Pansini 5, 80133 Naples, Italy
2
Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
Cases of optic nerve ischemia, such as anterior ischemic optic neuropathy, occur rarely [2]. A detailed analysis of the retinal vascular network can be performed by the optical coherence tomography angiography (OCTA) that allows to detect the papillary vascular network alterations in the prese
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