Abstract：
OBJECTIVE: To determine the frequency and severity of further visual loss experienced by patients within ten weeks from diagnosis of acute nonarteritic anterior ischemic optic neuropathy (NAION).
METHODS: Retrospective case series.
METHODS: Electronic medical records (EMR) at an academic neuro-ophthalmology practice were searched for diagnosis of \"NAION\" and all identified charts were reviewed to determine eligibility. Patients diagnosed with acute NAION between February 2014 and December 2023 who presented within four weeks of symptom onset and were seen in follow-up within ten weeks were included. Clinically significant decline in best corrected visual acuity (BCVA) and peripheral VF were defined as decline of BCVA ≥2 Snellen lines and decrease of ≥2 decibels (dB) in mean deviation (MD) on perimetric testing.
RESULTS: Forty-nine eyes met inclusion and exclusion criteria. Sixty-seven percent of patients were male and average age at presentation was 66 years. Twenty-two percent of eyes demonstrated worsening of BCVA by ≥2 lines. Of these, 55% worsened by ≥4 lines and 27% by ≥8 lines. In 27% of eyes MD on perimetry worsened by ≥2 dB and in 18% by ≥4 dB. In total, 41% of eyes demonstrated clinically significant worsening of BCVA or VF.
CONCLUSIONS: Subacute deterioration of BCVA and/or VF following acute NAION is not uncommon while optic disc edema is present, with sizeable proportion of patients experiencing dramatic visual decline. Deterioration in visual function within the first 10 weeks of presentation does not exclude the diagnosis of NAION and further investigations should only be performed if additional clinical features are discordant with this diagnosis.
METHODS: Retrospective case series.
METHODS: Electronic medical records (EMR) at an academic neuro-ophthalmology practice were searched for diagnosis of \"NAION\" and all identified charts were reviewed to determine eligibility. Patients diagnosed with acute NAION between February 2014 and December 2023 who presented within four weeks of symptom onset and were seen in follow-up within ten weeks were included. Clinically significant decline in best corrected visual acuity (BCVA) and peripheral VF were defined as decline of BCVA ≥2 Snellen lines and decrease of ≥2 decibels (dB) in mean deviation (MD) on perimetric testing.
RESULTS: Forty-nine eyes met inclusion and exclusion criteria. Sixty-seven percent of patients were male and average age at presentation was 66 years. Twenty-two percent of eyes demonstrated worsening of BCVA by ≥2 lines. Of these, 55% worsened by ≥4 lines and 27% by ≥8 lines. In 27% of eyes MD on perimetry worsened by ≥2 dB and in 18% by ≥4 dB. In total, 41% of eyes demonstrated clinically significant worsening of BCVA or VF.
CONCLUSIONS: Subacute deterioration of BCVA and/or VF following acute NAION is not uncommon while optic disc edema is present, with sizeable proportion of patients experiencing dramatic visual decline. Deterioration in visual function within the first 10 weeks of presentation does not exclude the diagnosis of NAION and further investigations should only be performed if additional clinical features are discordant with this diagnosis.
摘要：
目的：确定患者在诊断为急性非动脉炎性前部缺血性视神经病变后10周内进一步视力丧失的频率和严重程度。（NAION）。
方法：回顾性病例系列。
方法：在神经眼科学术实践中搜索电子病历（EMR）以诊断“NAION”，并审查所有确定的图表以确定合格性。包括在2014年2月至2023年12月之间诊断为急性NAION的患者，这些患者在症状发作后四周内出现，并在十周内进行随访。最佳矫正视力（BCVA）和外周VF的临床显着下降被定义为BCVA≥2Snellen线的下降和在周边测试中平均偏差（MD）的下降≥2分贝（dB）。
结果：49只眼符合纳入和排除标准。67%的患者为男性，就诊时平均年龄为66岁。22％的眼睛显示BCVA恶化≥2行。其中,55%恶化≥4行，27%恶化≥8行。在27％的眼睛中，视野检查MD恶化≥2dB，在18％恶化≥4dB。总的来说,41%的眼睛表现出临床上显著的BCVA或VF恶化。
结论：急性NAION后BCVA和/或VF的亚急性恶化并不少见，同时存在视盘水肿，相当比例的患者经历了严重的视力下降。在出现的前10周内，视功能的恶化并不排除NAION的诊断，只有在其他临床特征与该诊断不一致的情况下，才应进行进一步的检查。
方法：回顾性病例系列。
方法：在神经眼科学术实践中搜索电子病历（EMR）以诊断“NAION”，并审查所有确定的图表以确定合格性。包括在2014年2月至2023年12月之间诊断为急性NAION的患者，这些患者在症状发作后四周内出现，并在十周内进行随访。最佳矫正视力（BCVA）和外周VF的临床显着下降被定义为BCVA≥2Snellen线的下降和在周边测试中平均偏差（MD）的下降≥2分贝（dB）。
结果：49只眼符合纳入和排除标准。67%的患者为男性，就诊时平均年龄为66岁。22％的眼睛显示BCVA恶化≥2行。其中,55%恶化≥4行，27%恶化≥8行。在27％的眼睛中，视野检查MD恶化≥2dB，在18％恶化≥4dB。总的来说,41%的眼睛表现出临床上显著的BCVA或VF恶化。
结论：急性NAION后BCVA和/或VF的亚急性恶化并不少见，同时存在视盘水肿，相当比例的患者经历了严重的视力下降。在出现的前10周内，视功能的恶化并不排除NAION的诊断，只有在其他临床特征与该诊断不一致的情况下，才应进行进一步的检查。
