Endocrine Abstracts

Introduction: Non-arteritic anterior ischemic optic neuropathy (NOIAN) is acute ischemia of the optic nerve head. It is one of the most common causes of blindness in diabetic patients, especially in the elderly. Visual impairment in NAION may be due to deterioration in visual acuity (VA) and/or visual field (VF) loss.

Observation: 51-year-old female patient, diabetic for 14 years on insulin, not well controlled, and hypertensive for 15 years on treatment, who presented for one and a half months with a brutal and painless decrease in visual acuity of the right eye (RE), at the etiological investigation performed: fundus showed a drop in visual acuity in the (RE), with visual acuity in the left eye: 8/10th; normal papilla, flat retina, a few patchy haemorrhages at the posterior pole and punctiform, macula embedded in the chorioretinal anastomoses (ACR). Fluorescein angiography is in progress. Orbito-cerebral MRI: signal abnormalities in supratentorial white matter. Visual evoked potentials showed right axonal optic neuropathy. Lumbar puncture was normal. Biological workup revealed a slightly disturbed lipid profile and HBA1c 11.8%. Immunological tests revealed anti-SSA and anti-SSB autoantibodies, anti-native DNA antibodies, anti-phospholipid antibodies (IgG/IgM) and paraneoplastic antibodies. Serologies were negative. Patient received a bolus of 500 mg/day of Solumedrol for 3 days with slight improvement of decrease in visual acuity, responsible for major hyperglycemias suppressed by insulin therapy, with progressive attainment of optimal glycemic control, in order to avoid worsening of RE decrease in visual acuity and prevent contralateral damage.

Discussion et conclusion: Ischemic optic neuropathies include all vascular pathologies of the optic nerve. The classic distinction is between anterior ischemic optic neuropathy, in which there is papilledema, and posterior ischemic optic neuropathy, in which the optic disc appears normal. Non-arteritic acute anterior ischemic optic neuropathy is the most common form of ischemic optic nerve damage. Its exact physiopathology remains poorly understood. It is seen in patients with a papilla at risk (small and unexcavated). There is no effective preventive or curative treatment. In all cases of ischemic optic neuropathy, it is essential to eliminate an arteritic cause, both clinically and through further investigations. Treatment with methylprednisolone should then be started as a matter of urgency to limit visual decline and prevent damage to the adelphic eye. Optimal glycemic control remains an indispensable weapon in the prevention of NOIAN. When the condition has already set in, it can be stabilized or even corrected.