Abstract

P 160

Characteristic visual field changes in anterior ischemic optic neuropathy caused by panarteriitis nodosa

Thomas M. Dette
Abteilung für Augenheilkunde, Asklepios Klinik Altona, Hamburg

Objective
The diagnosis of Anterior Ischemic Optic Neuropathy caused by Panarteriitis nodosa is difficult. If misdiagnosed as classical Arteriitis temporalis, steroid medication alone may lead to blindness. Furthermore infarcts in other parts of the body may occur. Finally, the 5-year-survival rate in panarteriitis nodosa with steroid medication alone is only 48%, while it rises to 80% in a combination therapy with cyclophosphamid.
Visual field impairments are a diagnostic criterion in AION. Their importance in the differential diagnosis of arteriitis temporalis versus panarteriitis nodosa is evaluated. 
Methods
The case of a 67-year-old Caucasian male presenting with bilateral AION is discussed. If in addition to the unusual ophthalmological presentation other symptoms are included in the differential diagnosis, the diagnostic criteria of the American Rheumatologic Society can be applied and help to establish an early diagnosis and appropriate treatment.
Results
The patient presented with progressive visual disturbances of 4 weeks duration. Corrected visual acuity was 5/20 OD, 20/20 OS. The visual field of the right eye showed a circular constrictin with a small paracentral island preserved, a trough-shaped constriction up t0 30 ° in the left eye. A bilateral papilledema with peripapillary bleedings was present. The ESR was slightly elevated to 36 mm /h, CRP 1,7mg/l, Creatinin 3,3mg/dl. The biopsy of the temporal artery showed a floride vasculitis in an initial state without giant cells. Hypertension was present, and there were blisters of the skin, which healed without sequelae. The unusual clinical presentation led us to the diagnosis of a panarteriitis nodosa, we initiated a combination therapy of steroids and cyclophosphamid. A diagnostic angiography could not be performed because of the high creatinin level. Yet a thorough examination in a Rheumatology Department showed disseminated inflammations in numerous organ systems and thus established the diagnosis.
Visual acuity and visual fields were preserved, and no major vasculitc events occured.
Conclusions
The critical assesment of the visual fields in arteriitic AION can lead to the early suspected diagnosis of panarteriits nodosa and thus improve the diagnostic work up and help to intitute the adequate therapy.

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