Anterior ischemic optic neuropathy associated with metabolic syndrome Neuropatia óptica isquêmica anterior associada a síndrome metabólica
Natalija Kosanovic-Jakovic1 Branislava Ivanovic2 Svetislav Milenkovic3 Dusica Risovic4 Vesna Dimitrijevic-Sreckovic5 Aleksandra Radosavljevic6 Dijana Risimic7 Mirko Resan8
ABSTRACT
Purpose: Metabolic syndrome denotes a common cluster of naturally connected risk factors including obesity, elevated blood pressure, insulin resistance, dyslipidemia, proinflammatory state and prothrombotic state. Anterior ischemic optic neuropathy is an acute ischaemic disorder of the optic nerve head and may lead to severe visual loss. Methods: We considered three patients with moderate degree of diabetic retinopathy and anterior ischemic optic neuropathy. They were submitted to endocrinological examination and the diagnosis of metabolic syndrome was established. Results: Cardiological examination revealed that blood pressure control was not optimal. The signs of left ventricular hypertrophy and diastolic dysfunction were confirmed by echocardiography. They are possible markers of preclinical cardiovascular disease. Conclusion: We observed that a variety of well-known risk factors in metabolic syndrome may be involved in serious eye and cardiological complications. The early diagnosis and treatment of these patients can not only improve visual function but also prevent cardiovascular complications. Keywords: Metabolic syndrome X; Optic neuropathy, ischemic; Cardiovascular diseases
INTRODUCTION
Study carried out at the University Clinical Center of Serbia - Belgrade - Serbia. 1 2 3 4
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6 7 8
Institute of Ophthalmology - Belgrade - Serbia. Institute of Cardiology - Belgrade - Serbia. Institute of Ophthalmology - Belgrade - Serbia. Clinical Hospital Center Zvezdara - Clinic of Ophthalmology “Prof. Dr Ivan Stankovic” - Belgrade - Serbia. Institute of Endocrinology, Diabetes and Metabolic Disorders - Belgrade - Serbia. Institute of Ophthalmology - Belgrade - Serbia. Institute of Ophthalmology - Belgrade - Serbia. Institute of Ophthalmology - Belgrade - Serbia. Corresponding person: Natalija Kosanovic-Jakovic. Institute of Ophthalmology, Medical Retina - University Clinical Centre of Serbia - 2 Pasterova St., 11000 Belgrade - Republic of Serbia E-mail:
[email protected] [email protected] Recebido para publicação em 24.02.2007 Última versão recebida em 27.06.2007 Aprovação em 30.07.2007
Anterior ischemic optic neuropathy (AION) represents an acute ischemic disorder of the optic nerve and may lead to severe visual loss. Clinically it is classified into two groups: arteritic (A-AION) caused by giant cell arteritis and non-arteritic (NA-AION)(1). The pathogenesis of NAAION is not completely understood. NA-AION is a multifactorial disease. In addition to predisposing anatomic factors, systemic factors play an important role in the pathogenesis of NA-AION(1-2). Systemic risk factors (arterial hypertension, diabetes mellitus, obesity, dyslipidemia etc.) are proved to have an influence on microcirculation and blood flow autoregulation of the optic nerve head(1,3). We consider the connection between metabolic syndrome and NA-AION. The definition of metabolic syndrome (MS) has been given by the WHO, the American Association of Clinical Endocrinologists (AACE) and the Adult Treatment Panel III report of the National Cholesterol Education Program (ATP III)(4-5). They identify six components of the MS related to cardiovascular disease (CVD): abdominal obesity, atherogenic dyslipidemia, arterial hypertension (HTA), insulin resistance and/or glucose intolerance, proinflammatory state and prothrombotic state. Further diagnostic criteria have been postulated by the International Diabetes Federation (IDF)(6).
Arq Bras Oftalmol. 2008;71(1):62-6
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Anterior ischemic optic neuropathy associated with metabolic syndrome
Current concepts of treatment of MS and vascular complications are medically supervised lifestyle changes, treatment of obesity with diet, increased physical activity and medical treatment for diabetes and hypertension(4-5). METHODS
We considered three patients with MS and NA-AION. Diagnosis of MS was established by an endocrinologist according to the latest diagnostic criteria (ATP III and IDF). A person has MS if three of the following five conditions are observed: • body mass index (BMI) >30 kg/m² and waist circumference ≥102cm in men and ≥88cm in women. • Elevated fasting glucose level ≥110mg/dl (≥6.1 mmol/l), elevated hemoglobin A1c (HbA1c) >6.8% or if the person has been receiving drug treatment for elevated glucose level. • High-density lipoprotein cholesterol (HDL) level
