Anterior ischemic optic neuropathy and cilioretinal artery occlusion secondary to polyarteritis nodosa: A case report

Abstract

Introduction: Polyarteritis nodosa is a systemic vasculitis characterized by necrotizing inflammatory lesions affecting the middle and small arteries.

Case presentation: A 23-year-old male presented to our ophthalmology clinic with a 1-day history of sudden vision loss in his left eye. Posterior segment examination the left eye showed optic disc borders were faint, hyperemic and fluffy with cilioretinal artery occlusion signs present. Optical coherence tomography revealed the presence of localized intracellular edema from optic disc to superior-hemi of fovea, including fovea. On optical coherence tomography angiography, there was a decrease in vessel density in the superficial and deep capillary plexus in the area matching the cilioretinal artery trace, and choroidal vessel density decreased. Wide field fundus fluorescein angiography showed a large choroidal filling defect (ischemia area) and the cilioretinal artery were not filled in the temporal quadrant. These findings made us think that short ciliary arteries were affected and were the causal of the choroidal ischemia and infarction of optic nerve.

Discussion: PAN-associated choroidal ischemia, cilioretinal artery occlusion and ischemic optic neuropathy are rare. If ischemic retinal condition is seen in young patients, PAN should be considered in the differential diagnosis as it may cause life-threatening complications in its advanced stages.

Keywords: Anterior ischemic optic neuropathy; Choroidal ischemia; Cilioretinal artery occlusion; Polyarteritis nodosa; Wide Field fundus fluorescein angiograph.