Nonarteritic anterior ischemic optic neuropathy following pars plana vitrectomy for macular hole treatment: case report

ABSTRACT Herein, we report a case of nonarteritic anterior ischemic optic neuropathy (NAION) following uneventful pars plana vitrectomy for macular hole treatment. A 56-year-old previously healthy woman presented with a full-thickness macular hole in right eye (OD) and small cup-to-disc ratios in both eyes. Five days after surgery, she noticed sudden painless loss of vision in OD and was found to have an afferent pupillary defect and intraocular pressure of 29 mmHg. Fundus examination showed right optic disc edema and the resolution of a macular hole with an inferior altitudinal visual field defect. Erythrocyte sedimentation rate, C-reactive protein levels, and general physical examination findings were normal. She was treated with hypotensive eyedrops and oral prednisone, resulting in mild visual improvement and a pale optic disc. A combination of face-down position and increased intraocular pressure due to a small optic disc cup were considered as potential mechanisms underlying NAION in the present case. Vitreoretinal surgeons should be aware of NAION as a potentially serious complication and be able to recognize associated risk factors and clinical findings.

摘要 本文报告1例黄斑裂孔治疗行顺利经平坦部玻璃体切除术后发生非动脉炎性前部缺血性视神经病变（nonarteritic anterior ischemic optic neuropathy，NAION）的病例。患者为56岁既往健康女性，右眼（OD）存在全层黄斑裂孔，双眼视杯视盘比均偏小。术后第5日，患者自觉右眼突发无痛性视力下降，检查发现其存在传入性瞳孔障碍，眼压为29 mmHg。眼底检查可见右眼视盘水肿，黄斑裂孔已闭合，同时存在下方象限性视野缺损。红细胞沉降率、C反应蛋白水平及全身体格检查结果均正常。予降眼压滴眼液联合口服泼尼松治疗后，患者视力轻度改善，视盘呈苍白色。本病例中，术后俯卧位联合因视杯偏小所致的眼压升高被认为是NAION发生的潜在机制。玻璃体视网膜外科医师应警惕NAION作为潜在严重并发症的可能，并能够识别相关危险因素及临床体征。