Papilloarterial Ischemia

Six cases of vascularly induced disc edema are described. Patients were all fairly young, with only slight and mostly transient visual decrease in spite of impaired pupillary reflexes (three cases) and altitudinal field defects. Bilateral, though asymmetric, involvement was detected in three cases. The fundus showed a usually pale disc; the emerging arteries always presented segmental constrictions and signs of inflammation (sheathing) or sclerosis (increased reflexes). The peripapillary retina showed splinter hemorrhages and cotton-wool spots. Fluorescein angiography typically showed slow retinal circulation times with arterial laminar flow often persisting well into the venous stages. The disc and peripapillary choroid showed patchy ischemia. Fluorescein leaked at the disc in all cases, often in an irregular fashion and with a tendency for dye to run along the initial arterial segments. History and medical workups were noncontributory. Three patients with evidence of inflammatory arterial disease (vitreous cells, periarterial cuffing, and fluorescein staining of the vessel walls) improved with systemic steroids. In the remaining three the papilloarterial ischemia was diagnosed as caused by premature arteriosclerosis. This vascular condition differs from ischemic optic neuropathy, in which retinal arteries are not obviously involved, and from papillophlebitis, in which the retinal vascular involvement, when present, is limited to the veins.