Visual Field Improvement in Non-Arteritic Posterior Ischemic Optic Neuropathy in a Patient Treated with Intravenous Steroids

A 50-year-old man presented with a nasal visual field defect in the left eye. His medical history was unremarkable. On ophthalmic examination, his best-corrected visual acuity (BCVA) was 1.2 in both eyes. Fundoscopy revealed no abnormalities in either eye. Goldmann visual field test showed a nasal visual field defect in the left eye. The patient was diagnosed with NPION of the left eye and was followed up without treatment. However, four days after the initial visit, his BCVA decreased to counting finger in the left eye. Goldmann visual field test showed a complete nasal visual field defect with central absolute scotoma. Following admission, the patient was treated for 3 days with intravenous methylprednisolone pulse therapy. Three months later, his BCVA was improved to 0.8 in the left eye, but central relative scotoma was remained. Six months later, his BCVA was maintained at 0.8, and central relative scotoma was disappeared. However, the optic disc looked diffusely pale in the left eye. This case highlights that steroid therapy is an option for severe cases with posterior ischemic optic neuropathy.