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Klin Monbl Augenheilkd 2025; 242(04): 471-474
DOI: 10.1055/a-2532-1032
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Hyperreflective Dots (HRDs) in Two Patients with Nonarteritic Anterior Ischemic Optic Neuropathy (NAION)

Hyperreflektive Punkte bei 2 Patienten mit nicht arteriitischer anteriorer ischämischer Optikusneuropathie
Elisa Santos
1   Neuroophthalmology, Hôpital ophtalmique Jules-Gonin, Lausanne, Switzerland
,
Peter M. Maloca
2   IOB Basel, Ophthalmology, University Hospital Basel, Switzerland
,
Aki Kawasaki
1   Neuroophthalmology, Hôpital ophtalmique Jules-Gonin, Lausanne, Switzerland
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Introduction

Nonarteritic anterior ischemic optic neuropathy (NAION) is the most frequent cause of acute unilateral optic neuropathy in adults over the age of 50. It is believed to result from inadequate perfusion through the ciliary circulation supplying the optic nerve head. Several studies have suggested an associated inflammatory component in NAION. In a histopathological study of a single human optic nerve conducted 20 days after a clinical NAION, Salgado et al. observed both microglial activation and infiltration of extrinsic macrophages within the infarcted region [1]. One major challenge in evaluating tissue inflammation in NAION is the lack of an effective in vivo biomarker. Spectral-domain optical coherence tomography (SD-OCT) may be promising in this domain. Indeed, recent OCT studies have suggested that hyperreflective dots (HRDs), which are typically small (< 30 microns) hyperreflective round lesions observed in the outer retinal layers on SD-OCT scans and commonly seen in conditions like age-related macular degeneration (AMD), retinal vein occlusion, or diabetic macular edema, may represent inflammatory cells [2]. In a laser-induced model of ischemic optic neuropathy, Kokona et al. demonstrated that HRDs visible within the optic nerve head and the surrounding vitreous in SD-OCT scans (Spectralis, Heidelberg Engineering, Heidelberg, Germany) correspond to activated macrophages invading the retina during the early stages of injury [3].

Herein, we present two cases of unilateral NAION demonstrating a transient appearance of HRDs within the peripapillary inner retinal layers and discuss the possible significance of HRDs in the current context.



Publication History

Received: 23 October 2024

Accepted: 29 January 2025

Article published online:
16 April 2025

© 2025. Thieme. All rights reserved.

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  • References

  • 1 Salgado C, Vilson F, Miller NR. et al. Cellular inflammation in nonarteritic anterior ischemic optic neuropathy and its primate model. Arch Ophthalmol 2011; 129: 1583-1591
    CrossrefPubMedSearch in Google Scholar
  • 2 Coscas G, De Benedetto U, Coscas F. et al. Hyperreflective dots: a new spectral-domain optical coherence tomography entity for follow-up and prognosis in exudative age-related macular degeneration. Ophthalmologica 2013; 229: 32-37
    PubMedSearch in Google Scholar
  • 3 Kokona D, Häner NU, Ebneter A. et al. Imaging of macrophage dynamics with optical coherence tomography in anterior ischemic optic neuropathy. Exp Eye Res 2017; 154: 159-167
    CrossrefPubMedSearch in Google Scholar
  • 4 Donmez O, Kocaoglu G, Yaman A. et al. Macular Evaluation with Spectral Domain Type Optic Coherence Tomography in Eyes with Acute Nonarteritic Ischemic Optic Neuropathy at the Presentation Visit. Open Ophthalmol J 2017; 11: 17-23
    CrossrefPubMedSearch in Google Scholar
  • 5 Molaie AM, Pramil V, Hedges 3rd TR. et al. Vitreoretinal Findings in Nonarteritic Ischemic Optic Neuropathy. J Neuroophthalmol 2022; 42: 124-129
    CrossrefPubMedSearch in Google Scholar