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case_images: Case on presentation. (A) Fundus photography reveals bilateral optic disc edema. (B) Visual fields with severe diffuse depression in the right eye (mean deviation -30.15 dB) and bi-arcuate defects in the left eye (mean deviation -20.2 dB). (C) OCT showing ganglion cell complex loss in both eyes and increased bilateral RNFL thickness of 104 microns in the right eye and 165 microns in the left eye, due to optic disc edema. (D) Top, Coronal T2 MRI image showing increased thickening of the anterior chiasmatic optic nerves with central T2 hyperintensity. Bottom, axial T1 postcontrast MRI imaging showing no optic nerve enhancement.
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case_images: Fundus exam showed sector optic disc edema OD and diffuse optic disc edema OS (Figure 1A). Humphrey visual field revealed advanced constriction and depression in both eyes (Figure 1B). Optical coherence tomography (OCT) revealed increased average retinal nerve fiber layer (RNFL) thickness of 104 mum OD and 164 mum OS and decreased average ganglion cell complex (GCC) thickness of 66 mum OD and 60 um OS (Figure 1C). T2 hyperintensity and possibly increased thickness of the optic nerves near the chiasm; no post-contrast enhancement in optic nerves or chiasm was observed (Figure 1D). These findings have been previously seen in toxic optic neuropathies rather than ischemic optic neuropathies.
case_images: Case on 4-month follow-up. (A) Visual fields showing bilateral improvement; right eye mean deviation -27.1 dB and left eye mean deviation -15.1 dB. (B) OCT showing improved disc edema bilaterally and ganglion cell complex thinning, right eye worse than left eye.
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case_images: Over 19 weeks, BCVA gradually improved to 20/70 OD and 20/30 OS, the visual field improved as well (Figure 2A), and the optic disc edema resolved. Repeat OCT after 17 weeks showed an average RNFL thickness of 68 microns OD and 80 microns OS (Figure 2B).