title: Management of ischemic optic neuropathies.
abstract: Ischemic optic neuropathies (IONs) consist primarily of two types: anterior ischemic optic neuropathy (AION) and posterior ischemic optic neuropathy (PION). AION comprises arteritic AION (A-AION: due to giant cell arteritis) and non-arteritic AION (NA-AION: due to other causes). PION consists of arteritic PION (A-PION: due to giant cell arteritis), non-arteritic PION (NA-PION: due to other causes), and surgical PION (a complication of several systemic surgical procedures). These five types of ION are distinct clinical entities etiologically, pathogenetically, clinically and from the management point of view. In the management of AION, the first crucial step with patients aged 50 and over is to identify immediately whether it is arteritic or not because A-AION is an ophthalmic emergency and requires urgent treatment with high-dose steroid therapy to prevent any further visual loss in one or both eyes. Patients with NA-AION, when treated with systemic corticosteroid therapy within first 2 weeks of onset, had significantly better visual outcome than untreated ones. Systemic risk factors, particularly nocturnal arterial hypotension, play major roles in the development of NA-AION; management of them is essential in its prevention and management. NA-PION patients, when treated with high-dose systemic steroid therapy during the very early stages of the disease, showed significant improvement in visual acuity and visual fields, compared to untreated eyes. A-PION, like A-AION, requires urgent treatment with high-dose steroid therapy to prevent any further visual loss in one or both eyes. There is no satisfactory treatment for surgical PION, except to take prophylactic measures to prevent its development.
authors.affiliation: Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, IA, USA. sohan-hayreh@uiowa.edu
authors.forename: Sohan Singh
authors.initials: SS
authors.lastname: Hayreh
mesh_terms: D004305:Dose-Response Relationship, Drug; D004632:Emergency Medical Services; D013700:Giant Cell Arteritis / Q000150:complications; D006801:Humans; D018917:Optic Neuropathy, Ischemic / Q000145:classification / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D011183:Postoperative Complications; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage; D014786:Vision Disorders / Q000209:etiology / Q000503:physiopathology; D014792:Visual Acuity / Q000187:drug effects; D014794:Visual Fields / Q000187:drug effects
chemical_list: D013256:Steroids