Arteritic anterior ischemic optic neuropathy with positive myeloperoxidase antineutrophil cytoplasmic antibody

Background Myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) is related to smallvessel vasculitis. There have been some reports of optic nerve involvements with increased values of MPO-ANCA. We report two cases of anterior ischemic optic neuropathy (AION) in which ANCA-associated vascul...

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Bibliographic Details
Published in:Japanese journal of ophthalmology 2010-07, Vol.54 (4), p.344-348
Main Authors: Shichinohe, Natsuko, Shinmei, Yasuhiro, Nitta, Takuya, Chin, Shinki, Yamada, Yosuke, Kase, Manabu
Format: Article
Language:English
Subjects:
Aged
Angiography
Antibodies, Antineutrophil Cytoplasmic - blood
Arterioles
Arteritis - diagnosis
Arteritis - drug therapy
Arteritis - immunology
Biopsy
Capillaries
Choroid - blood supply
Clinical Investigation
Fluorescein Angiography
Glucocorticoids - therapeutic use
Humans
Male
Medicine
Medicine & Public Health
Methylprednisolone - therapeutic use
Ophthalmology
Optic Disk - blood supply
Optic Neuropathy, Ischemic - diagnosis
Optic Neuropathy, Ischemic - drug therapy
Optic Neuropathy, Ischemic - immunology
Peroxidase - blood
Prednisolone - therapeutic use
Retinal Vessels
Temporal Arteries - pathology
Visual Acuity
Visual Fields
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Summary:Background Myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) is related to smallvessel vasculitis. There have been some reports of optic nerve involvements with increased values of MPO-ANCA. We report two cases of anterior ischemic optic neuropathy (AION) in which ANCA-associated vasculitis was suspected to be responsible for the pathogenesis. Cases A 66-year-old man and a 72-year-old man had ocular symptoms of AION in both eyes with positive MPO-ANCA. Observations Both patients showed high erythrocyte sedimentation rate, C-reactive protein, and MPOANCA values at first. Temporal artery biopsies were negative for temporal arteritis, whereas small-vessel vasculitis was found only in the latter patient. Visual dysfunctions remained unchanged after steroid pulse therapy, although laboratory data returned to normal levels after the treatment. Fluorescein angiography revealed selective occlusion of capillaries, arterioles, and precapillaries in the retina and choroid as well as in the optic disc. Conclusions The identical characteristics of the angiographic findings of both eyes in the two cases indicated that the obliteration of small vessels in the intraocular arterial system was closely related to MPO-ANCA-associated vasculitis.
ISSN:0021-5155
1613-2246
DOI:10.1007/s10384-010-0831-z