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September 1992

Spontaneous Improvement of Progressive Anterior Ischemic Optic Neuropathy: Report of Two Cases

Arch Ophthalmol. 1992;110(9):1197-1199. doi:10.1001/archopht.1992.01080210015004

To the Editor.  —Infrequently, visual loss occurring in patients with anterior ischemic optic neuropathy (AION) is not apoplectic, but gradual or stepwise during a period of days to weeks.1 In such cases of progressive AION, surgical decompression of the optic nerve sheath has been advocated to reverse the visual loss.2 The surgery is controversial, in part, because the natural history of progressive disease is yet to be fully defined, even though Rizzo and Lessell3 reported a 16% spontaneous improvement rate for AION overall. Herein, we describe two patients with severe visual loss due to progressive AION who demonstrated spontaneous recovery of central visual acuity.

Report of Cases.—Case 1.  —A 74-year-old man presented with a 1-week history of painless loss of vision in the lower half of the visual field in the right eye. Visual acuity with correction was 20/25 OU. A 2+ right afferent pupillary