Two Cases in Which Arteritic Anterior Ischemic Optic Neuropathy Due to Giant Cell Arteritis Occurred Sequentially in Both Eyes

Abstract

Purpose: To report two cases of arteritic anterior ischemic optic neuropathy (AAION) caused by giant cell arteritis (GCA) that occurred sequentially in both eyes.Case summary: An 86-year-old man presented with decreased visual acuity in the left eye that had commenced 3 days earlier. The left eye visual acuity was hand motion, and there was chalky-white optic disc swelling. AAION was diagnosed based on the myalgia, temporal headache, and temporal artery wall thickening. After steroid treatment, the visual acuity had not improved, while the visual acuity in the right eye was stable. A 94-year-old man presented with decreased visual acuity in the left eye that began 3 days earlier. The visual acuity in the left eye was light perception, and a subretinal hemorrhage was diagnosed. Two weeks later, he returned with decreased visual acuity in the right eye, and had chalky-white optic disc swelling in the right eye and decreased optic disc swelling in the left eye. AAION was considered based on the temporal headache and jaw claudication, and GCA was diagnosed after a temporal artery biopsy. Although systemic steroid was given, the visual acuity did not improve.Conclusions: The visual acuity of the eye that first developed AAION did not improve, but the prognosis of the later-onset eyes differed. Although GCA is rarely reported in Korea, delayed treatment can cause permanent visual loss. Therefore, in older adults with rapid visual loss and optic disc swelling, the possibility of GCA and a temporal artery biopsy should be considered.