By Sohan Singh Hayreh
"No attainment is ever ultimate" Vascular problems of the optic disc and nerve are vital not just to the ophthalmologist but additionally to the neurologist and the internist. To the 1st uniqueness team they symbolize one reason behind blindness or critical visible impairment; to the second one team the optic disc edema and optic atrophy noticeable in those issues can pose critical difficulties of prognosis, or provide indica tions of the involvement of the cerebral circulate; whereas to the final staff they're often indicative of systemic disorder, relatively of the cardiovas cular approach. contemporary advances in our wisdom of the blood offer of the optic nerve head have shed an important new mild at the topic. With the new creation of fluorescein fundus angiography, an additional measurement has been further to the research of the ocular and optic disc circulations, and we've got entered right into a new period within the knowing of ocular vascular issues "in vivo". within the pre-angiography period, postmortem injection experiences, even though very priceless, didn't thoroughly show the vascular development of the optic disc within the residing, in health and wellbeing, and sickness. The ophthalmoscope, definitely, has been precious in assessing optic disc lesions, yet couldn't supply us informa tion at the flow of the attention and optic disc "in vivo".
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Additional info for Anterior Ischemic Optic Neuropathy
21 (continued) b, c, d, e) Fluoresceinfundus angiograms. b) Retinal arterial phase showing no filling of the temporal half of the peripapillary choroid and the corresponding part of the optic disc, with patchy filling of the rest of the choroid. c) Retinal arteriovenous phase showing non-filling of superior temporal peripapillary choroid and patchy filling of upper half of the choroid. d) Retinal venous phase showing non-filling of superior temporal peripapillary choroid. Lower half of the optic disc stained with fluorescein and upper half (particularly superior temporal) shows minimal fluorescence.
Late phase showing non-fluorescence of the atrophic part with staining of the lower temporal part Optic Disc Changes 51 Fig. 23a-f. Right eye of a 59-year-old man with sudden loss of vision in lower field of right eye, visual acuity 6/6-part and superior temporal sectoral anterior ischemic optic neuropathy. He had developed venous stasis retinopathy in left eye 12 years previously. a) Fundus photograph taken 9 months before the onset of above complaint, showing normal optic disc on the right side.
I) Late phase (15 minutes) showing no staining of the optic disc but shows fluorescence of the peripapillary region (compare with Fig. e). j)J3 1h months after onset of the anterior ischemic optic neuropathy. Stereoscopic fundus photographs-showing cupping of the optic disc which is identical to that seen in Fig. f Optic Disc Changes 39 h g Fig. 16 (continued) 40 Optic Disc Changes a c b Fig. 17a-J. Right eye of a 71-year-old woman with temporal arteritis, right anterior ischemic optic neuropathy, cilioretinal artery occlusion, and no perception of light in that eye.
Anterior Ischemic Optic Neuropathy by Sohan Singh Hayreh