Aftab Akhunzada Muhammad, Iqbal Mustafa, Rauf Awais, Ali Asif
Department of Ophthalmology, Khyber Teaching Hospital, Peshawar, Pakistan.
J Ayub Med Coll Abbottabad. 2016 Oct-Dec;28(4):776-780.
Non Arteritic Anterior Ischemic Optic Neuropathy (NAION) is the most common acute optic neuropathy in patients over 50 years of age. This study was conducted to determine the beneficial effects of anticoagulation with Heparin and Warfarin in patients with NAION presenting within 4 weeks of onset of symptoms.
A prospective, interventional, pilot study was conducted in Eye- A unit of Khyber Teaching Hospital from July 2010 onwards on patients with NAION presenting within 4 weeks of onset of symptoms. Patients underwent complete ophthalmological examination including Snellen's visual acuity (latter converted to Log MAR), pupil examination, fundus examination and automated Humphrey visual field analysis. Hematologic tests, Thrombophilia screening, Echocardiography and carotid Doppler ultrasound were carried on patients. All patients were anticoagulated with Heparin and Warfarin after obtaining informed written consent. Patients were examined at 1 Month, 3 months and 6 months' time period. Primary parameter measured was improvement in visual acuity.
Total number of patients in our study was 24. Regarding visual outcome total number of patients having significant improvement of visual acuity in our study was 16 (66.6%), while 4 (16.7%) patients had marginal improvement of visual acuity. Three (12.5%) patients maintained stable visual acuity of 6/6 throughout the study period in presence of thrombophilic disorders. One patient (4.1%) suffered a decline in visual acuity compared to VA at baseline presentation.
Anticoagulation using heparin and warfarin does benefit patients with NAION presenting within 4 weeks of onset of symptoms. In our study a higher proportion of patients experienced significant improvement of visual acuity following anticoagulation as compared to the highest reported spontaneous improvement in such patients.
非动脉炎性前部缺血性视神经病变（NAION）是50岁以上患者中最常见的急性视神经病变。本研究旨在确定肝素和华法林抗凝治疗对症状出现后4周内就诊的NAION患者的有益效果。
2010年7月起，在开伯尔教学医院眼科A单元对症状出现后4周内就诊的NAION患者进行了一项前瞻性、干预性的试点研究。患者接受了全面的眼科检查，包括斯内伦视力检查（后者转换为最小分辨角对数视力）、瞳孔检查、眼底检查和自动 Humphrey 视野分析。对患者进行了血液学检查、血栓形成倾向筛查、超声心动图和颈动脉多普勒超声检查。在获得知情书面同意后，所有患者均接受肝素和华法林抗凝治疗。在1个月、3个月和6个月时对患者进行检查。测量的主要参数是视力的改善情况。
我们研究中的患者总数为24例。关于视力结果，我们研究中视力有显著改善的患者总数为16例（66.6%），而4例（16.7%）患者的视力有轻微改善。3例（12.5%）患有血栓形成倾向疾病的患者在整个研究期间视力保持稳定在6/6。与基线表现时的视力相比，1例患者（4.1%）视力下降。
使用肝素和华法林抗凝确实对症状出现后4周内就诊的NAION患者有益。在我们的研究中，与报道的此类患者最高自发改善率相比，更高比例的患者在抗凝后视力有显著改善。
