<?xml version="1.0" encoding="UTF-8"?>
<article article-type="research-article" dtd-version="1.3" xml:lang="en">
  <front>
    <journal-meta>
      <journal-title-group>
        <journal-title>Czech and Slovak Ophthalmology</journal-title>
      </journal-title-group>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">156</article-id>
      <article-id pub-id-type="doi">10.31348/2020/15</article-id>
      <article-categories>
        <subj-group>
          <subject>Original article</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Non-Arteritic Anterior Ischaemic Optic Neuropathy: Treatment and Risk Factors</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Kalábová</surname>
            <given-names>Silvie</given-names>
          </name>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Marešová</surname>
            <given-names>Klára</given-names>
          </name>
          <contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-9973-3145</contrib-id>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Karhanová</surname>
            <given-names>Marta</given-names>
          </name>
          <contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0879-3055</contrib-id>
        </contrib>
      </contrib-group>
      <pub-date date-type="pub" publication-format="electronic">
        <day>1</day>
        <month>10</month>
        <year>2020</year>
      </pub-date>
      <issue>2</issue>
      <elocation-id>4</elocation-id>
      <abstract>
        <p>Aim: To ascertain whether various therapeutic procedures in non-arteritic anterior ischaemic optic neuropathy (NAION) have an impact on the resulting visual acuity of the affected eye. To assess the prevalence of risk factors that accompany this disease according to the literature. Methods: The retrospective study enrolled 55 eyes of 53 patients (41 men, 12 women) with an age range of 46 to 85 years (mean 64.9; median 64.0) who were hospitalized at the Department of Ophthalmology of the Faculty of Medicine and Dentistry and the University Hospital in Olomouc with the diagnosis of NAION between 2005 and 2016, and who received systemic treatment with intravenous vasodilators, either alone or in combination with intravenous corticosteroids. Central visual acuity (CVA) prior to treatment and immediately after its termination was evaluated. CVA was measured using the Snellen chart and is presented in decimal values. Using medical history data and medical records, the presence of systemic disease, namely hypertension, type 2 diabetes mellitus, and hypercholesterolaemia, was studied in these patients and evaluated for a possible association with NAION. Results: In the group of patients who were treated with intravenous vasodilators, the resulting CVA improved by 0.083 on average. In the group of patients who, in addition to vasodilator therapy, also received treatment with corticosteroids, the resulting CVA improved by only 0.03 on average. Although there was a more prominent improvement in CVA in the group treated with intravenous vasodilators alone, this difference was not statistically significant. At least one risk factor was found in the vast majority of the patients (96%). Eighty percent of the patients had hypertension, 43.6% of them were treated for diabetes mellitus, and 72.7% of the patients took drugs for hypercholesterolaemia. A combination of all these conditions was found in 36.4% of the patients. The proportion of smokers and past smokers did not exceed that of non-smokers. Conclusion: The mean improvement in the resulting CVA in patients after systemic therapy with vasodilators alone was greater than in those treated with a combination of vasodilators and corticosteroids; however, this difference was not statistically significant. In most patients in the group, at least one systemic risk factor was noted, most frequently hypertension. The prevalence rate of systemic risk factors was comparable to that reported in the literature.</p>
      </abstract>
      <kwd-group>
        <kwd>non-arteritic anterior ischaemic optic neuropathy</kwd>
        <kwd>vasodilators</kwd>
        <kwd>corticosteroids</kwd>
        <kwd>risk factors</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <back>
    <ref-list>
      <title>References</title>
      <ref id="R5799">
        <mixed-citation>Al-Zubidi, N. et al.: Systemic corticosteroids in nonarteritic ischemic optic neuropathy. Indian J Ophthalmol, 62(10);2014: 1022–1024.</mixed-citation>
      </ref>
      <ref id="R5800">
        <mixed-citation>in their study also determined a similarly high number of incidences of sleep apnoea in patients with NAION, regardless of sex. By contrast, Cestari et al. [5] determined that obstructive sleep apnoea has no connection with the occurrence of NAION. Obstructive sleep apnoea is therefore more common in patients with anterior ischaemic optic neuropathy, but is not a direct risk factor in the occurrence of the pathology, but contributes to the pathology together with other risk factors. In our study we did not focus on these other potential risk factors. Predisposing morphological risk factors for the occurrence of NAION include the appearance of optic nerve drusens and a small papilla with small or virtually disappeared excavation and a markedly visible nerve fibre layer (“crowded disc” or “disc at risk”) [9]. In our study, although the average size of the optic nerve papilla in patients with NAION was within the limits of the norm, we nevertheless verified small papilla in 25 % of eyes a</mixed-citation>
      </ref>
      <ref id="R5801">
        <mixed-citation>Atkins, EA., Beau, BB., Newman, NJ., Biousse, V.: Treatment of Nonarteritic Anterior Ischemic Optic Neuropathy, Surv Ophthalmol,55(1);2010:47–63.</mixed-citation>
      </ref>
      <ref id="R5802">
        <mixed-citation>Biousse, V., Newman, NJ.: Ischemic optic neuropathies. N Engl J Med,372;2015:2428–2436.</mixed-citation>
      </ref>
      <ref id="R5803">
        <mixed-citation>Cestari, DM., Gaier, ED., Bouzika P. et al.: Demographic, systemic and ocular factors associated with non-arteritic anterior ischemic optic neuropathy. Ophthalmology,123(12);2016: 2446–2455.</mixed-citation>
      </ref>
      <ref id="R5804">
        <mixed-citation>Dickersin, K., Li, T.: Surgery for nonarteritic anterior ischemic optic neuropathy. Cochrane Database Syst Rev,12(3);2015: CD001538.</mixed-citation>
      </ref>
      <ref id="R5805">
        <mixed-citation>Foulds, WS.: Visual disturbances in systemic disorders: optic neuropathy and systemic disease. Trans Ophthalmol Soc UK,89; 1970:125–46.</mixed-citation>
      </ref>
      <ref id="R5806">
        <mixed-citation>Gaier, ED., Turon, N.: The enigma of nonarteritic anterior ischemic optic neuropathy, Curr Opin Ophthalmol,27(6);2016: 498–504.</mixed-citation>
      </ref>
      <ref id="R5807">
        <mixed-citation>Hauptvogelová, M., Šustykevičová, Z.: Non-arteritická predná ischemická optická neuropatia pri drúzách zrakového nervu. Cesk Slov Oftalmol,66 (4);2010:184–187.</mixed-citation>
      </ref>
      <ref id="R5808">
        <mixed-citation>Hayreh, SS., Zimmerman, MB.: Non-arteritic anterior ischemic optic neuropathy: role of systemic corticosteroid therapy. Graefes Arch Clin Exp Ophthalmol,246(7);2008:1029–46.</mixed-citation>
      </ref>
      <ref id="R5809">
        <mixed-citation>Hayreh, SS.: Anterior ischemic optic neuropathy. III. Treatment, prophylaxis and differential diagnosis. Br J Ophthalmol,58(12); 1974:981–9.</mixed-citation>
      </ref>
      <ref id="R5810">
        <mixed-citation>Newman, JN. et al.: (Research group):Characteristics of patients with nonarteritic anterior ischemic optic neuropathy eligible for the Ischemic Optic Neuropathy Decompression Trial. Arch Ophthalmol,114;1996:1366–1374.</mixed-citation>
      </ref>
      <ref id="R5811">
        <mixed-citation>Kaufman, D. et al. (Research group): Ischemic optic neuropathy decompression trial: twenty-four-month update. Arch Ophthalmol,118;2000:793–798.</mixed-citation>
      </ref>
      <ref id="R5812">
        <mixed-citation>Jirásková,N., Studnička, J., Rozsíval, P.: Papiledém a ischemický edém terče optiku, Čas Lék Čes,151;2012:527–530.</mixed-citation>
      </ref>
      <ref id="R5813">
        <mixed-citation>Jirásková, N., Rozsíval, P.: Výsledky 62 dekompresí obalů zrakového nervu,Cesk Slov Oftalmol,3;1999:136–144.</mixed-citation>
      </ref>
      <ref id="R5814">
        <mixed-citation>Jirásková, N.: Neurooftalmologie, minimum pro praxi, Triton, 2001,26–30 s.</mixed-citation>
      </ref>
      <ref id="R5815">
        <mixed-citation>Kuchynka, P. et al.: Oční lékařství, Grada, 2007,262 s.</mixed-citation>
      </ref>
      <ref id="R5816">
        <mixed-citation>Kuchynka, P. et al.: Oční lékařství, Grada, 2007,513–514 s.</mixed-citation>
      </ref>
      <ref id="R5817">
        <mixed-citation>Palombi, K., Renard, E., Levy, P. et al.: Nonarteritic anterior ischaemic optic neuropathy is nearly systematicaly associated with obstructive sleep apnoea. Br J Ophthalmol,90;2006: 879–882.</mixed-citation>
      </ref>
      <ref id="R5818">
        <mixed-citation>Pazderová, M., Novák, J.: Změny v tloušťce nervových vláken u non-arteritické formy AION na OCT,Cesk Slov Oftalmol,65(3); 2009:87–90.</mixed-citation>
      </ref>
      <ref id="R5819">
        <mixed-citation>Rebolleda, G., Pérez-López, M., Casas-LLera, P.: Visual and anatomical outcomes of non-arteritic anterior ischemic optic neuropathy with high-dose systemic corticosteroids. Graefes Arch Clin Exp Ophthalmol,251;2013:255–60.</mixed-citation>
      </ref>
      <ref id="R5820">
        <mixed-citation>Steigerwalt, RD., Cesarone, MR., Belcaro, G.: Arteritic anterior ischemic optic neuropathy treated with intravenous prostaglandin E1 and steroids.Int J Angiol, 19(3);2010:113–115.</mixed-citation>
      </ref>
      <ref id="R5821">
        <mixed-citation>Špinar, J., Lábrová, R.: Dapagliflozin a studie DECLARE – budoucnost léčby diabetes mellitus, Kardiol Rev Int Med,18(2);2016:119–124.</mixed-citation>
      </ref>
      <ref id="R5822">
        <mixed-citation>Štejfa, M.: Progresivní kontinuum – hypertenze, ischemická choroba srdeční, srdeční selhání a náhrada srdeční funkce, Kardiol Rev Int Med,13(1);2011:7–8.</mixed-citation>
      </ref>
      <ref id="R5823">
        <mixed-citation>Žák, A. a kolektiv: Ateroskleróza: Nové pohledy, Grada, 2011,96 s.</mixed-citation>
      </ref>
    </ref-list>
  </back>
</article>
