Ipilateral recurrence of nonarteritic anterior ichemic optic neuropathy

PURPOE: To report the prevalence of recurrence of nonarteritic anterior ichemic optic neuropathy (NA-AION) in the ame eye and poible contributing rik factor. DEIGN: Cohort tudy. METHOD: etting: Intitutional. TUDY POPULATION: The tudy include 594 conecutive patient (829 eye) with a diagnoi of NA-AION and follow-up of at leat two month after the onet of NA-AION, examined in the Ocular Vacular Clinic ince 1973. imple progreion of viual lo during an epiode of NA-AION wa not conidered a freh epiode. INTERVENTION OR OBERVATION PROCEDURE: Every patient had ophthalmic evaluation, including viual acuity, viual field with a Goldmann perimeter, intraocular preure, and lit lamp and ophthalmocopic evaluation at initial viit and at each follow-up viit. The patient alo had ytemic evaluation; ome patient had echocardiography (166 patient) and 24-hour ambulatory blood preure (BP) monitoring—the latter wa invetigated in 80 patient (17 with and 63 without recurrence of NA-AION) who conented to participate in thi tudy which wa tarted in 1989. While optic dik edema wa preent, the patient were followed every 2 to 3 week. Once the optic dik edema reolved, they were followed up after 3 month, 6 month, and then at yearly interval unle they had ome new viual complaint. MAIN OUTCOME MEAURE: Prevalence of a freh epiode of NA-AION in the ame eye, and comparion of ocular and ytemic rik factor between patient with and without recurrence of NA-AION in the ame eye. REULT: Of the 594 patient (829 eye) in the tudy, recurrence of NA-AION in the ame eye occurred in 45 patient (53 eye) with a median follow-up of 3.1 year (range 2 month to 30.5 year) from the firt onet of NA-AION. The Kaplan–Meier urvival curve howed cumulative percentage of recurrence of NA-AION from firt epiode to econd epiode at three month 1.0%±0.4%(E), at 6 month 2.7%±0.7%, at one year 4.1%±0.9%, and 2 year 5.8%±1.1%. There wa no ignificant aociation between recurrence of NA-AION and the ytemic condition that were examined, except for nocturnal arterial hypotenion. Overall patient with a recurrence of NA-AION had a ignificantly lower mean nighttime minimum diatolic BP (P = .003) and greater mean percentage drop during leep in diatolic BP (P = .011) than thoe with no recurrence of NA-AION; all other meaure of nocturnal hypotenion were not ignificantly predictive. CONCLUION: Recurrence of NA-AION in the ame eye i uncommon (6.4%). Our tudy indicate that nocturnal diatolic arterial hypotenion may be a rik factor; however, ince thi i a multifactorial dieae, other o far unknown rik factor may alo play a role. The role of variou rik factor which may contribute to the recurrence of NA-AION i dicued