2017 Volume 34 Issue 1 Pages 54-60
We report a case of posterior ischemic optic neuropathy (PION) caused by giant cell arteritis (GCA) with concurrent advanced glaucoma in an 81-year-old man with a long-standing history (25 years) of advanced open angle glaucoma. On visual field test, the visual acuity of the left eye was noted to have decreased to light perception, but the patient did not complain of any visual defect. There was pupillary fibrin membrane formation, posterior synechia, and rubeosis iridis in the left eye. Relative afferent pupillary defect (RAPD) was not clearly observed, and the optic disc showed no change except the optic atrophy due to glaucoma. Blood examination revealed elevated inflammatory markers. Contrast-enhanced magnetic resonance imaging showed contrast-enhancement and edema in the wall of aorta, carotid artery and intracranial artery, suggesting GCA, which was definitively diagnosed via temporal artery biopsy. The patient was treated with steroid pulse therapy; there was no improvement in visual acuity of the left eye, while the right eye showed no deterioration. We concluded that ocular ischemia, caused by GCA, led to PION. On the basis of this report, we suggest that when a sudden deterioration of visual acuity is noted on examination, despite the lack of vision related symptoms, GCA-induced PION should be suspected, especially in individuals older than the age of 50.
