title: Simultaneous bilateral nonarteritic anterior ischemic optic neuropathy in a patient with a history of diffuse large B-cell lymphoma.
abstract: BACKGROUND
  Nonarteritic anterior ischemic optic neuropathy (NAAION) has a poorly understood etiology, and the onset of simultaneous bilateral NAAION in a patient <50 years without identifiable systemic risk factors is rare.
  
  
  METHODS
  We present the case of a patient with acute painless monocular vision loss and bilateral optic disc edema who subsequently developed painless vision loss in the fellow eye. The patient's history was significant for diffuse large B-cell lymphoma, and our pressing diagnostic concern was to determine if his vision loss and bilateral optic disc changes represented lymphomatous infiltrates. A complete ocular exam demonstrated findings consistent with simultaneous bilateral NAAION. After an extensive systemic workup for malignancy with central nervous system involvement, vasculitis, and other entities associated with NAAION, we determined that the patient's primary risk factor for developing bilateral ischemic optic neuropathies was his crowded optic discs.
  
  
  CONCLUSIONS
  This case supports the hypothesis that a crowded optic disc is a sufficient primary risk factor for developing NAAION.
authors.affiliation: Department of Ophthalmology, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: David B
authors.initials: DB
authors.lastname: Lazar
authors.affiliation: Department of Ophthalmology, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lemor
authors.affiliation: Department of Hematology/Oncology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Archie
authors.initials: A
authors.lastname: Brown
authors.affiliation: Department of Ophthalmology, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Nussdorf
keywords: Lymphoma; optic nerve; optic nerve diseases; optic neuropathy–ischemic; papilledema
references.citation: Acta Ophthalmol Scand. 2005 Aug;83(4):499-503
references.pmid: 16029279
references.citation: Arch Ophthalmol. 1996 Nov;114(11):1366-74
references.pmid: 8906027
references.citation: J Clin Neurosci. 2012 Oct;19(10):1445-7
references.pmid: 22898194
references.citation: Arch Ophthalmol. 1981 Jun;99(6):1030-40
references.pmid: 7236100
references.citation: Case Rep Ophthalmol. 2011 May;2(2):262-5
references.pmid: 21941503
references.citation: Klin Monbl Augenheilkd. 2013 Apr;230(4):430-1
references.pmid: 23629798
references.citation: Curr Opin Ophthalmol. 2002 Dec;13(6):357-61
references.pmid: 12441837