Coagulation abnormalities in ischaemic optic neuropathy.
The aetiology of non-arteritic ischaemic optic neuropathy (ION) is multifactorial with local anatomical and systemic haemodynamic abnormalities both playing a role. A careful search for treatable vascular disease risk factors is required to allow rational therapy, to optimise the visual prognosis and to allow new insights into pathogenesis. We describe 7 cases in which there was an associated thrombophilic (prothrombotic) state; 4 had deficiencies of the physiological anticoagulants proteins C and S and antithrombin III and 2 had anti-phospholipid antibody (lupus anticoagulant) syndromes. A further patient had reduced levels of the physiological fibrinolytic agent tissue plasminogen activator (t-PA). In 5 patients other risk factors for small vessel occlusive disease were also present, and 4 had recurrent episodes of ION in the same eye. The visual prognosis in these patients may be improved by anticoagulation with warfarin.
Department of Neuro-Ophthalmology, National Hospital for Neurology and Neurosurgery, London, UK.
J F
JF
Acheson
M D
MD
Sanders
D000328:Adult; D000368:Aged; D020152:Antithrombin III Deficiency; D001778:Blood Coagulation Disorders / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D016682:Lupus Coagulation Inhibitor / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009900:Optic Nerve / Q000098:blood supply; D009901:Optic Nerve Diseases / Q000097:blood* / Q000209:etiology; D011379:Prognosis; D020151:Protein C Deficiency; D018455:Protein S Deficiency; D010959:Tissue Plasminogen Activator / Q000378:metabolism; D014859:Warfarin / Q000627:therapeutic use
D016682:Lupus Coagulation Inhibitor; D014859:Warfarin; D010959:Tissue Plasminogen Activator