앞허혈시신경병증의 임상양상과 시력예후인자

Abstract

Purpose : To analyze the clinical features of anterior ischemic optic neuropathy (AION) and to find the visual prognostic factors. Methods : Medical records of 64 eyes of 50 patients who were diagnosed as having AION were retrospectively reviewed and the clinical features with visual prognostic factors of AION including the age of onset, sex, associated systemic disease, past medical history, social history, hematologic finding, 24-hour blood pressure monitoring, visual acuity, visual field findings, fundus findings, and color vision, were analyzed. Results : The mean age of the patient's was 59.8 years (range, 36-80 years of age). Twenty-six were men (52.0%) and 24 were women (48.0%). The initial visual acuity was worse than 0.1 in 24 eyes (43.8%), 0.1 to 0.5 in 18 eyes (28.1%), and better than 0.5 in 22 eyes (34.4%). Patients with better initial visual acuity showed the better final visual acuity (P=0.000, r=0.945). Four or less ishihara color plates were recognized in 27 eyes (45.8%) out of 59 eyes, 5 to 10 ishihara color plates were recognized in 4 eyes (6.8%), 11 or more ishihara color plates were recognized in 28 eyes (47.4%). Patients with better color vision showed better final visual acuity (P=0.000, r=0.598). There were 30 patients (60.0%) with associated systemic disease Among them 21 patients (42.0%) had Hypertension. Nine patients (18.0%) with a mean age of 50.6 years were smokers. Four patients developed AION after a cataract operation. There were 17 (68.0%) out of 25 patients with an increased level of cholesterol. Four patients whose 24-hour blood pressure was monitored showed that their blood pressure at night was lower than that in the day time. A cup disc ratio less than 0.2 was observed in 30 contralateral eyes (65.2%) of 46 patients with unilateral AION. An altitudinal field defect was the most common visual field defects, and funduscopic examination showed optic disc edema, hemorrhage or pallor. Conclusions : Hypertension and high blood cholesterol level were associated with the poorer final visual outcome and the initial visual acuity as well as the color vision were correlated with the final visual acuity.