Background Antiphospholipid syndrome is an autoimmune disease characterised by venous and arterial relapsing thrombosis, recurrent miscarriages and thrombocytopenia. Nonarteritic anterior ischaemic optic neuropathy (AION) is a condition characterised by acute unilateral vision loss, usually painless, as a result of acute ischemia in posterior ciliary arteries. We present two cases of non-arteritic AION as the initial manifestation of primary antiphospholipid syndrome, an exceptional circumstance, rarely reported in the literature.1
Clinical cases Case1-A 35 year old woman, smoker, with sudden vision loss in the left eye as a central horizontal band. Neurological examination revealed visual field defects and papilledema with blurry edges. Cranial CT, gadolinium-enhanced MRI, and visual evoked potentials were performed without pathological findings. In the screening for hypercoagulability, elevated anticardiolipin IgG and IgM were found (82.1 and 11.1 MPL GPL(subsequently confirmed. The patient had no other symptoms. Case 2-A 35 year old male, ex-smoker suddenly presented retroorbital pain and vision loss in the temporal band of the left eye. On examination, papilledema and visual field defects, consistent with vision loss, were observed. Magnetic resonance imaging showed no abnormality, and laboratory tests only confirmed the presence of lupus anticoagulant.
Conclusions The non-arteritic AION is an uncommon condition in young people, compelling us to investigate prothrombotic factors as lupus anticoagulant or antiphospholipid antibodies, which may explain its appearance in the context of a primary antiphospholipid syndrome. Up to 35% of young patients with non-arteritic AION present involvement in the contralateral eye within 7 months.2 For this reason and for the possible involvement of other organs, anticoagulation must be the elective treatment in these cases.
Tugcu B, Acar N, Coskun CT, Celik S, Yigit FU. Nonarteritic anterior ischemic optic neuropathy as the presenting manifestation of primary antiphospholipid syndrome. Indian J Ophthalmol 2014; 62 (5):642.
Preechawat P, Bruce BB, Newman NJ, Biousse V. Anterior ischemic optic neuropathy in patients younger than 50 years. Am J Ophthalmol 2007; 144 (6):953–60.