Annals of African Medicine Vol. 14, No. 2; 2015
Original Article
Access this article online Quick Response Code:
Website: www.annalsafrmed.org DOI: 10.4103/1596-3519.149917 PMID: *****
Nonglaucomatous optic atrophy in Benin City Page | 109
Vivian B. Osaguona, Valentina W. Okeigbemen Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
Correspondence to: Dr. Vivian B. Osaguona, Department of Ophthalmology, University of Benin Teaching Hospital, P.M.B. 1111, Benin City, Edo State, Nigeria. E‑mail: [email protected]
Abstract Context: Optic atrophy is a clinical sign and not a disease. The etiology of optic atrophy is diverse, some of which may be life threatening. Patients and Methods: A retrospective review of the medical records of all adult patients aged 16 years and above with nonglaucomatous optic atrophy at the eye clinic of the University of Benin Teaching Hospital over a 4-year period was conducted. Results: One hundred and four patients had nonglaucomatous optic atrophy. There were 58 males and 46 females with a male:female of 1.3:1. Their ages ranged from 16 to 83 years with a mean age of 49.2 ± 17.74 years. Majority (75%) of the patients were in the age range of 31–70 years. One hundred and fifty-seven eyes were affected with bilateral involvement in 53 patients. The etiology was unknown in 47 (45.2%) patients. Choriodoretinal disease 24 (23.1%), trauma 14 (13.5%), toxic-nutritional 8 (7.7%) and compressive lesions 5 (4.8%) were the most common among the known etiologies. Conclusion: Optic atrophy is the end result of injury to the anterior visual pathway from a myriad of disease processes. A broad knowledge of the etiology of optic atrophy is needed to make a diagnosis. Keywords: Adults, etiology, disc pallor, Nigeria
Résumé Contexte: L'atrophie optique est un signe clinique et non une maladie. L'étiologie de l'atrophie optique est diversifiée, dont certaines peuvent être mortelles. Patients et Méthodes: Une étude rétrospective des dossiers médicaux de tous les patients adultes âgés de 16 ans et plus avec non glaucomateuse atrophie optique à la clinique de l'œil d'un hôpital de soins tertiaires sur une période de 4 ans a été menée. Résultats: Cent quatre patients avaient non glaucomateuse atrophie optique. Il y avait 58 hommes et 46 femmes avec un mâle: femelle de 1,3:1. Leur âge variait de 16 à 83 ans, avec un âge moyen de 49,2 ± 17,74 années. La majorité (75%) des patients étaient dans la tranche d'âge de 31-70 ans. Cent cinquante-sept yeux ont été touchés avec la participation bilatérale chez 53 patients. L'étiologie était inconnue dans 47 (45,2%) patients. Maladie Choriodoretinal 24 (23,1%), les traumatismes 14 (13,5%), toxiques nutritionnel 8 (7,7%) et des lésions de compression 5 (4,8%) étaient les plus fréquents parmi les étiologies connues. Conclusion: L'atrophie optique est le résultat d'une blessure à la voie visuelle antérieure d'une myriade de processus pathologiques de fin. Une connaissance approfondie de l'étiologie de l'atrophie optique est nécessaire pour établir un diagnostic. Mots-clés: Adultes, l'étiologie, disque pâleur, Nigeria
Annals of African Medicine
Vol. 14, April-June, 2015
Osaguona and Okeigbemen: Nonglaucomatous optic atrophy
Introduction
Page | 110
Optic atrophy is a clinical sign. It results from disease processes that cause irreversible damage to the ganglion cells, and axons in the anterior visual pathway. The diagnosis is based on the findings of disc pallor, with associated changes in the integrity of the retinal nerve fiber layer and retinal vessels, and visual dysfunction (vision and/or visual field loss) attributable to the optic nerve.[1] The etiology is broad and may be a presentation of life‑threatening processes.[2] The aim of this study is to determine the causes of optic atrophy among adults seen at the eye clinic of the University of Benin Teaching Hospital.
Patients and Methods Approval for this study was obtained from the Ethics and Research Committee of the University of Benin Teaching Hospital. A retrospective review of the medical records of all cases of unilateral or bilateral optic atrophy at first presentation to the eye clinic at the University of Benin Teaching Hospital from May 2009 to June 2013 was performed. Inclusion criteria for the study were: (1) All adult patients aged 16 years and above, (2) ophthalmoscopic findings of optic atrophy, (3) visual dysfunction (visual acuity, color vision and/or visual field loss) attributable to the optic nerve (e.g. relative afferent pupillary defect) and (4) normal intraocular pressure. Exclusion criteria were: (1) Children below the age of 16 years and (2) patients with glaucoma whether primary or secondary glaucoma. Data on age, gender, laterality of optic atrophy, visual function, and etiology of optic atrophy were obtained. The causes of optic atrophy were classified into choroidoretinal disease, inflammatory, ischemic, toxic‑nutritional, compressive, traumatic, hereditary processes, and unknown. The results were analyzed using Microsoft Office Excel (Microsoft Corporation, 2010, Louisville KY) software.
Table 1: Age distribution of patients Age group 16-30 31-50 51-70 71-90 Total
n (%) 13 (12.5) 40 (38.5) 38 (36.5) 13 (12.5) 104 (100)
Table 2: Etiology of optic atrophy Etiologic process n (%) Diagnosis Unknown 47 (45.2) Chorioretinal 24 (23.1) Retinitis pigmentosa disease Macula degeneration Ocular tuberculosis Chronic uveitis from couching Chronic uveitis of unknown etiology Presumed toxoplasmosis Trauma 14 (13.5) Toxic‑nutritional 6 (7.6) Presumed tropical amblyopia syndrome Chronic alcohol intoxication Tobacco Anti‑tuberculosis medications Compression 5 (4.8) Pituitary adenoma Sinonasal tumour Thyroid eye disease Inflammation 3 (2.9) Optic neuritis Ischaemia 3 (2.9) Anterior ischemic optic neuropathy Central retinal artery occlusion Central retinal vein occlusion
n 11 8 1 1 2 1 3 3 1 1 2 2 1 3 1 1 1
Total number of patients=104
Table 3: Best corrected visual acuity in affected eyes Visual acuity 6/18 or better
Original Article
Access this article online Quick Response Code:
Website: www.annalsafrmed.org DOI: 10.4103/1596-3519.149917 PMID: *****
Nonglaucomatous optic atrophy in Benin City Page | 109
Vivian B. Osaguona, Valentina W. Okeigbemen Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
Correspondence to: Dr. Vivian B. Osaguona, Department of Ophthalmology, University of Benin Teaching Hospital, P.M.B. 1111, Benin City, Edo State, Nigeria. E‑mail: [email protected]
Abstract Context: Optic atrophy is a clinical sign and not a disease. The etiology of optic atrophy is diverse, some of which may be life threatening. Patients and Methods: A retrospective review of the medical records of all adult patients aged 16 years and above with nonglaucomatous optic atrophy at the eye clinic of the University of Benin Teaching Hospital over a 4-year period was conducted. Results: One hundred and four patients had nonglaucomatous optic atrophy. There were 58 males and 46 females with a male:female of 1.3:1. Their ages ranged from 16 to 83 years with a mean age of 49.2 ± 17.74 years. Majority (75%) of the patients were in the age range of 31–70 years. One hundred and fifty-seven eyes were affected with bilateral involvement in 53 patients. The etiology was unknown in 47 (45.2%) patients. Choriodoretinal disease 24 (23.1%), trauma 14 (13.5%), toxic-nutritional 8 (7.7%) and compressive lesions 5 (4.8%) were the most common among the known etiologies. Conclusion: Optic atrophy is the end result of injury to the anterior visual pathway from a myriad of disease processes. A broad knowledge of the etiology of optic atrophy is needed to make a diagnosis. Keywords: Adults, etiology, disc pallor, Nigeria
Résumé Contexte: L'atrophie optique est un signe clinique et non une maladie. L'étiologie de l'atrophie optique est diversifiée, dont certaines peuvent être mortelles. Patients et Méthodes: Une étude rétrospective des dossiers médicaux de tous les patients adultes âgés de 16 ans et plus avec non glaucomateuse atrophie optique à la clinique de l'œil d'un hôpital de soins tertiaires sur une période de 4 ans a été menée. Résultats: Cent quatre patients avaient non glaucomateuse atrophie optique. Il y avait 58 hommes et 46 femmes avec un mâle: femelle de 1,3:1. Leur âge variait de 16 à 83 ans, avec un âge moyen de 49,2 ± 17,74 années. La majorité (75%) des patients étaient dans la tranche d'âge de 31-70 ans. Cent cinquante-sept yeux ont été touchés avec la participation bilatérale chez 53 patients. L'étiologie était inconnue dans 47 (45,2%) patients. Maladie Choriodoretinal 24 (23,1%), les traumatismes 14 (13,5%), toxiques nutritionnel 8 (7,7%) et des lésions de compression 5 (4,8%) étaient les plus fréquents parmi les étiologies connues. Conclusion: L'atrophie optique est le résultat d'une blessure à la voie visuelle antérieure d'une myriade de processus pathologiques de fin. Une connaissance approfondie de l'étiologie de l'atrophie optique est nécessaire pour établir un diagnostic. Mots-clés: Adultes, l'étiologie, disque pâleur, Nigeria
Annals of African Medicine
Vol. 14, April-June, 2015
Osaguona and Okeigbemen: Nonglaucomatous optic atrophy
Introduction
Page | 110
Optic atrophy is a clinical sign. It results from disease processes that cause irreversible damage to the ganglion cells, and axons in the anterior visual pathway. The diagnosis is based on the findings of disc pallor, with associated changes in the integrity of the retinal nerve fiber layer and retinal vessels, and visual dysfunction (vision and/or visual field loss) attributable to the optic nerve.[1] The etiology is broad and may be a presentation of life‑threatening processes.[2] The aim of this study is to determine the causes of optic atrophy among adults seen at the eye clinic of the University of Benin Teaching Hospital.
Patients and Methods Approval for this study was obtained from the Ethics and Research Committee of the University of Benin Teaching Hospital. A retrospective review of the medical records of all cases of unilateral or bilateral optic atrophy at first presentation to the eye clinic at the University of Benin Teaching Hospital from May 2009 to June 2013 was performed. Inclusion criteria for the study were: (1) All adult patients aged 16 years and above, (2) ophthalmoscopic findings of optic atrophy, (3) visual dysfunction (visual acuity, color vision and/or visual field loss) attributable to the optic nerve (e.g. relative afferent pupillary defect) and (4) normal intraocular pressure. Exclusion criteria were: (1) Children below the age of 16 years and (2) patients with glaucoma whether primary or secondary glaucoma. Data on age, gender, laterality of optic atrophy, visual function, and etiology of optic atrophy were obtained. The causes of optic atrophy were classified into choroidoretinal disease, inflammatory, ischemic, toxic‑nutritional, compressive, traumatic, hereditary processes, and unknown. The results were analyzed using Microsoft Office Excel (Microsoft Corporation, 2010, Louisville KY) software.
Table 1: Age distribution of patients Age group 16-30 31-50 51-70 71-90 Total
n (%) 13 (12.5) 40 (38.5) 38 (36.5) 13 (12.5) 104 (100)
Table 2: Etiology of optic atrophy Etiologic process n (%) Diagnosis Unknown 47 (45.2) Chorioretinal 24 (23.1) Retinitis pigmentosa disease Macula degeneration Ocular tuberculosis Chronic uveitis from couching Chronic uveitis of unknown etiology Presumed toxoplasmosis Trauma 14 (13.5) Toxic‑nutritional 6 (7.6) Presumed tropical amblyopia syndrome Chronic alcohol intoxication Tobacco Anti‑tuberculosis medications Compression 5 (4.8) Pituitary adenoma Sinonasal tumour Thyroid eye disease Inflammation 3 (2.9) Optic neuritis Ischaemia 3 (2.9) Anterior ischemic optic neuropathy Central retinal artery occlusion Central retinal vein occlusion
n 11 8 1 1 2 1 3 3 1 1 2 2 1 3 1 1 1
Total number of patients=104
Table 3: Best corrected visual acuity in affected eyes Visual acuity 6/18 or better
