Clinical spectrum of posterior ischemic optic neuropathy

PURPOSE: To describe the systemic and visual characteristics and prognosis in patients with posterior ischemic optic neuropathy (PION). DESIGN: Observational case series. METHODS: Retrospective chart review in a multicenter setting. Seventy-two p atients (98 eyes) with a clinical diagnosis of PION. Co-morbid systemic dis eases and visual function were recorded at both initial presentation and af ter mean visual follow-up of 4.1 years and systemic follow-up of 5.4 years. RESULTS: PION occurred in three main settings: in the perioperative period following a variety of surgical procedures (28 patients), associated with g iant cell (temporal) arteritis (6 patients), and associated with nonarterit ic systemic vascular disease (38 patients). Patients with perioperative and arteritic PION were more likely to have severe, bilateral visual loss that did not improve. Among eyes with nonarteritic PION, 34% experienced improv ement in vision, 28% remained stable, and 38% worsened. Among patients with nonarteritic PION, carotid artery disease and a history of stroke (with or without carotid artery disease) were both associated with a statistically significant increased risk of poor final visual outcome. CONCLUSIONS: There are three distinct subtypes of PION: perioperative, arte ritic, and nonarteritic. Patients with PION that is unassociated with surge ry should undergo an evaluation for systemic vascular diseases, including g iant cell arteritis, that may or may not be apparent at the time of vision loss. The visual prognosis for patients with perioperative or arteritic PIO N is poor, whereas that for nonarteritic PION is similar to that for patien ts with nonarteritic AION. (C) 2001 by Elsevier Science Inc. All rights res erved.