Partially reversible bilateral non-arteritic anterior ischemic optic neuropathy and branch retinal artery occlusion following semaglutide use. a case report.

PURPOSE: To report a case of bilateral non-arteritic optic neuropathy (NA-AION) associated with unilateral branch retinal artery occlusion (BRAO) following semaglutide exposure and the partial improvement of bilateral disc swelling and partial recovery of visual function after the discontinuation of Semaglutide. METHODS: A retrospective case report. RESULTS: A 37-year-old obese male, who had no known systemic diseases, presented with a sudden drop in vision in the right eye and blurred vision in the left eye after 11 months of using semaglutide. His best-corrected visual acuity (BCVA) was 6/200 in the right eye and 20/25 in the left eye. A relative afferent pupillary defect (rAPD) of 0.9 log units was observed in the right eye. Dilated fundus examination showed bilateral optic disc swelling, more significantly in the right eye, along with an inferior macular ischemia indicating BRAO in the right eye. One month after semaglutide discontinuation, he had BCVA of 20/30 in the right eye and 20/20 in the left eye. Dilated fundus examination showed small optic nerve heads in both eyes with marked improvement of disc swelling in both eyes. CONCLUSION: This case suggests that careful optic nerve assessments in addition to retinal examination can be helpful prior to initiating semaglutide, which might be potentially associated with bilateral and partially reversible NA-AION.