J Korean Ophthalmol Soc.  2022 Oct;63(10):888-893. 10.3341/jkos.2022.63.10.888.

A Case of Nonarteritic Anterior Ischemic Optic Neuropathy after Intravitreal Aflibercept Injection

• Joo S
• Lee JY
• Baek SU

• KMID: 2534444
• DOI: http://doi.org/10.3341/jkos.2022.63.10.888

Abstract

Purpose
To report a case of nonarteritic anterior ischemic optic neuropathy (NAION) development after intravitreal injection of aflibercept.
Case summary
A 71-year-old female presented with decreased visual acuity and was diagnosed with wet macular degeneration in the right eye. She received two intravitreal aflibercept injections. After 1 month, the best-corrected visual acuity (BCVA) had improved. However, the inferior rim of the optic disc was blurred and an inferior retinal nerve fiber layer (RNFL) swelling was observed. The patient received one more intravitreal aflibercept injection (a loading dose). After 2 weeks, the patient presented with sudden vision loss and the BCVA was finger-counting at 50 cm. Fundus examination revealed that the total optic disc rim was blurred and optical coherence tomography demonstrated diffuse RNFL swelling. The patient was diagnosed with NAION. After 2 months, the optic disc appeared pale but without blurring of the rim, and diffuse thinning of the RNFL was observed. Her BCVA had not improved up to 6 months of follow-up.
Conclusions
Although NAION after intravitreal injection is uncommon, physicians should not only examine the macula but also comprehensively assess the intraocular pressure, the RNFL profile, and the optic disc head, especially in patients with NAION risk factors.

Keyword

Aflibercept; Intravitreal injection; Macular degeneration; Anterior ischemic optic neuropathy