Partial regression of peripapillary myelinated nerve fibers after non-arteritic anterior ischemic optic neuropathy

Negrete, Francisco J Muñoz; Casanova, Victor Aguado; Ramón, Pablo Vicente Muñoz; Mariscal, Marta Gomez; Palomeque, Teresa Salva; Rebolleda, Gema

doi:10.5935/0004-2749.2022-0237

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CASE REPORT • Arq. Bras. Oftalmol. 87 (2) • 2024 • https://doi.org/10.5935/0004-2749.2022-0237 copy

Partial regression of peripapillary myelinated nerve fibers after non-arteritic anterior ischemic optic neuropathy

Regressão parcial das fibras nervosas peripapilares mielinizadas após neuropatia óptica isquêmica anterior não arterítica

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

A 71-year-old woman presented a non-arteritic anterior ischemic optic neuropathy in an optic nerve with previously registered superonasal peripapillary myelinated nerve fibers. Her past medical history was significant for controlled systemic hypertension, hyperlipidemia, and diabetes mellitus. The physiologic cup was absent in both optic discs. Non-arteritic anterior ischemic optic neuropathy mainly affected the temporal and inferior sectors of the peripapillary retinal nerve fiber layer, as could be demonstrated by retinal nerve fiber layer optical coherence tomography and optic disc optical coherence tomography angiography. Unlike other published reports, just a slight regression of the myelinated nerve fibers was observed after 1 year of follow-up. This occurred because ischemia mainly affected the temporal and inferior peripapillary sectors, whereas myelinated nerve fibers were superonasal to the optic disc.

Keywords:
Optic neuropathy; ischemic; Nerve fibers; myelinated; Optic nerve diseases; Tomography; optical coherence; Retinal neovascularization; Visual acuity; Humans; Case report

Case	Year of publication	Authors	Ischemic event	Age	Sex	Risk factors	Clinical course
1	1981	Schachat(⁴4 Schachat AP, Miller NR. Atrophy of myelinated retinal nerve fibers after acute optic neuropathy. Am J Ophthalmol. 1981;92(6):854-6.)	NAION	45	M	no	MNF regressed 6 months after the event
2	1983	Minning(⁶6 Minning CA, Davidorf FH. Neovascularization associated with myelinated nerve fibers: a case report. Ann Ophthalmol. 1983; 15(12):1142-4.)	RNV	47	M	no	Recurrent VH that resolved after focal photocoagulation and PRP
3	1987	Teich(⁷7 Teich SA. Disappearance of myelinated retinal nerve fibers after a branch retinal artery occlusion. Am J Ophthalmol. 1987;103(6): 835-7.)	BRAO	54	M	T2DM, aortic stenosis, chronic renal failure	Both MNF and BRAO were inferotemporal to the optic disc MNF regressed after the event
4	1990	Kodama(⁸8 Kodama T, Hayasaka S, Setogawa T. Myelinated retinal nerve fibers: prevalence, location and effect on visual acuity. Ophthalmologica. 1990;200(2):77-83.)	RNV, BRVO	50	F	controlled HBP	Recurrent VH that required vitrectomy and BRVO during follow-upBoth MNF and BRVO were superotemporal to the optic disc
5	1996	Leys(⁹9 Leys AM, Leys MJ, Hooymans JM, Craandijk A, Malenfant M, van Germeersch D, et al. Myelinated nerve fibers and retinal vascular abnormalities. Retina. 1996;16(2):89-96.)	RNV	15	M	no	Recurrent VH that resolved after focal photocoagulation
6	1996	Leys(⁹9 Leys AM, Leys MJ, Hooymans JM, Craandijk A, Malenfant M, van Germeersch D, et al. Myelinated nerve fibers and retinal vascular abnormalities. Retina. 1996;16(2):89-96.)	RNV	27	M	no	Mild VH that resolved spontaneously
7	1996	Leys(⁹9 Leys AM, Leys MJ, Hooymans JM, Craandijk A, Malenfant M, van Germeersch D, et al. Myelinated nerve fibers and retinal vascular abnormalities. Retina. 1996;16(2):89-96.)	RNV	30	F	no	Recurrent VH that required PRP and pars plana vitrectomy
8	1996	Leys(⁹9 Leys AM, Leys MJ, Hooymans JM, Craandijk A, Malenfant M, van Germeersch D, et al. Myelinated nerve fibers and retinal vascular abnormalities. Retina. 1996;16(2):89-96.)	RNV	43	F	no	Recurrent VH that resolved after focal photocoagulation MNF regressed after laser but arcuate scotoma was noticed
9	1996	Silvestri(¹⁰10 Silvestri G, Sehmi K, Hamilton P. Retinal vascular abnormalities. A rare complication of myelinated nerve fibers? Retina. 1996;16(3):214-8.)	RNV	24	F	no	2-year history of recurrent VH that resolved after focal photocoagulation
10	1996	Silvestri(¹⁰10 Silvestri G, Sehmi K, Hamilton P. Retinal vascular abnormalities. A rare complication of myelinated nerve fibers? Retina. 1996;16(3):214-8.)	RNV	48	M	no	Recurrent VH since childhood and amblyopia Treatment was not reported
11	1996	Silvestri(¹⁰10 Silvestri G, Sehmi K, Hamilton P. Retinal vascular abnormalities. A rare complication of myelinated nerve fibers? Retina. 1996;16(3):214-8.)	RNV	32	F	no	Recurrent VH Treatment was not reported
12	2001	Munteanu(¹¹11 Munteanu M, Munteanu G, Giuri S. [Myelinated nerve fibers associated with cilioretinal artery occlusion]. J Fr Ophtalmol. 2001;24(7):744-7. French.)	CLRAO	44	F	no	MNF surrounded the optic nerve head 360^o MNF state after the event is not reported
13	2008	Berry-Brincat(¹²12 Berry-Brincat A, Shafquat S. Myelinated nerve fibres: a rare cause of recurrent vitreous haemorrhage. Eye (Lond). 2008;22(1):165-7.)	DNV	26	F	no	6-year history of recurrent VH that persisted despite the PRP
14	2008	Sellami(¹³13 Sellami D, Bouacida W, Maalej A, Ben Amor S, Châabouni M, Kamoun B, Feki J. [Retinal neovascularization with myelinated nerve fibers]. J Fr Ophtalmol. 2008; 31(1):e2. French.)	RNV	31	F	no	VH that resolved after focal photocoagulation and cryotherapy
15	2013	Battaglia(¹⁴14 Battaglia Parodi M, De Benedetto U, Vergallo S, Knutsson KA, Bandello F, Lanzetta P, et al. Intravitreal bevacizumab for retinal neovascularizations associated with myelinated nerve fibers. J Ocul Pharmacol Ther. 2013;29(4):442-3.)	RNV	23	F	no	VH treated with three intravitreal injections of bevacizumab over a 24-month follow-up Cessation of fluorescein leakage was observed, but retinal neovascularizationdid not regress The patient had undergone focal photocoagulation 9 years earlier after recurrent VH
16	2013	Fard(³3 Fard MA, Fakhree S. Sectoral loss of myelin and axons in anterior ischemic optic neuropathy. Optom Vis Sci. 2013;90(5):e138-41.)	NAION	62	F	controlled HBP, sleep apnea	Sectoral regression of MNF 6 months after the event
17	2017	Karam(¹⁵15 Karam E, Restrepo A, Assael S. Disappearance of myelinated retinal nerve fibers after central retinal artery occlusion reveals Nettleship collaterals. Ophthalmology. 2017;124(9):1295.)	CRAO	85	F	unknown	MNF regressed 3 months after the event

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[1] Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.