Optical Coherence Tomography to Monitor Rebound Intracranial Hypertension with Increased Papilledema after Lumbar Puncture

Objective: We report that lumbar puncture (LP) with removal of cerebrospinal fluid (CSF) induced rebound intracranial hypertension with increased papilledema as monitored by optical coherence tomography (OCT). Background: Severe papilledema causes visual field loss and central vision damage if untreated. Fundoscopy is a key to diagnose papilledema, but is not sensitive enough to monitor therapeutic effects. Methods: OCT was applied to follow a 24-year-old woman with headache, visual dysfunction, severe bilateral papilledema, and elevated CSF opening pressure. She was first treated with serial LP, which led to symptom deterioration, increased CSF pressure, and increased the retinal nerve fiber layer (RNFL) thickness. She was then successfully treated with acetazolamide and furosemide. Results: OCT showed reduction of RNFL thickness directly after LP with CSF removal, accompanied with reduced CSF pressure. Increased RNFL thickness accompanied with worsened headache, visual dysfunction, and increased CSF pressure was observed on the next day after LP. Less than 24 h after start of medication, the symptoms had reversed and RNFL thickness was reduced. The patient was symptom-free 2 weeks after starting on medical treatment. Papilledema had vanished on fundoscopy 6 weeks after the therapy, and RNFL thickness was normalized at 3 months of follow-up. Conclusion: This case provides evidence that OCT is an objective and sensitive tool to monitor papilledema and its response to therapy, and thereby important to help in correct clinical decision-making.

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New predictive value of optical coherence tomography analysis in the diagnosis of idiopathic intracranial hypertension

Journal of Contemporary Medical Sciences ◽

10.22317/jcms.v3i10.151 ◽

2017 ◽

Vol 3 (10) ◽

Keyword(s):

Optical Coherence Tomography ◽

Intracranial Hypertension ◽

Lumbar Puncture ◽

False Positive ◽

Idiopathic Intracranial Hypertension ◽

Brain Mri ◽

Visual Fields ◽

Signs And Symptoms ◽

Optical Coherence ◽

Demographic Patterns

Objective Idiopathic Intracranial Hypertension (IIH) was first reported in 1897 as “Pseudo tumor Cerebri” when lumbar puncture was initiated in medicine. However, it is still a challenging diagnosis for many neurologists and ophthalmologists. Likewise, the sequela of IIH can be debilitating overall health and quality of life in most patients. This report presents the evolving diagnostic modalities that are different from mainstream IIH reports on gender, obesity and headaches ratios. We believe, using standard optical coherence tomography (OCT) can allow for a much earlier and more accurate diagnosis of IIH, with marked reduction in visual loss morbidity.Methods Retrospective, observational method was used to review 171 patients’ charts with suspected IIH over the past 12 years. The OCT of optic nerve and Macula was conducted by considering a list of signs and symptoms. Brain MRI, lumbar puncture, and our standard laboratory workups for optic neuropathies and visual fields were done. Visual Evoked Potentials were performed by neurologists. For purpose of this paper all IIH diagnosis fit Dandy diagnosis criteria of pseudo tumor cerebri as having a normal MRI.Results We evaluated 164 cases that had LPs done due to our proposed OCT Patterns to rule out IIH with no bio-microscopic evidence of overt papilledema. The majority of LP positive patients had some degree of visual field damage. Twenty out of 164 cases had false positive OCTs (with negative LPs) 88% accuracy in OCT diagnosis of IIH. No false positive OCT in Pattern-I.Conclusion Four different OCT diagnostic Patterns presented for IIH cases. The demographics of the patients considered having IIH by OCT Patterns I-IV and proven by positive LP; do not fit the classic demographic patterns. Classically, IIH has been reported to be observed in obese females with headaches and visible papilledema. Our findings put this classic set of presenting signs into question.

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Association between Optical Coherence Tomography Measurements and Clinical Parameters in Idiopathic Intracranial Hypertension

Journal of Ophthalmology ◽

10.1155/2021/1401609 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Priscilla Fernandes Nogueira ◽

Gustavo Coelho Caiado ◽

Carolina P. B. Gracitelli ◽

Fernando Meister Martins ◽

Felipe Chaves Duarte Barros ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Intracranial Hypertension ◽

Optic Disc ◽

Idiopathic Intracranial Hypertension ◽

Clinical Parameters ◽

Automated Perimetry ◽

Optical Coherence ◽

Rnfl Thickness ◽

Sd Oct

Purpose. To correlate optical coherence tomography (OCT) measurements with clinical parameters in idiopathic intracranial hypertension (IIH). Methods. A cross-sectional study was conducted with 22 patients with IIH and 11 controls. All participants underwent comprehensive ophthalmological examination followed by spectral-domain OCT (SD-OCT) and standard automated perimetry using the 30–2 program of the Humphrey visual field analyzer. Correlations between ganglion cell complex (GCC) thickness and retinal nerve fiber layer (RNFL) thickness, as measured by SD-OCT, and clinical parameters were assessed using generalized estimating equations. Result. The mean age of the participants was 35.0 ± 10.83 years. The groups were similar regarding age, but were significantly different regarding sex and visual acuity ( p = 0.001 and p = 0.038 , respectively). The GCC was significantly thinner in the IIH group, with a mean of 90.535 ± 9.766 μm compared to 98.119 ± 6.988 μm for the controls ( p = 0.023 ). There was a significant association between GCC thickness and optic disc pallor ( p = 0.016 ) and between edema and visual acuity ( p = 0.037 ). No significant difference was found in RNFL thickness between patients and controls. Conclusion. The GCC was thinner in the patients with IIH compared to the controls, and there was an association between GCC and optic disc pallor. This might suggest a role for OCT parameters when the structural changes that occur in IIH are investigated, possibly guiding clinical decision making.

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Optical Coherence Tomography in idiopathic intracranial hypertension - first experiences

Neuropediatrics ◽

10.1055/s-0032-1307065 ◽

2012 ◽

Vol 43 (02) ◽

Author(s):

A Stroet ◽

K Weigt-Usinger ◽

R Gold ◽

T Lücke

Keyword(s):

Optical Coherence Tomography ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Optical Coherence

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Faculty Opinions recommendation of Using optical coherence tomography as a surrogate of measurements of intracranial pressure in idiopathic intracranial hypertension.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.738879987.793579989 ◽

2020 ◽

Author(s):

Prem Subramanian

Keyword(s):

Optical Coherence Tomography ◽

Intracranial Pressure ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Optical Coherence

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Feasibility and Clinical Utility of Ultra-Widefield–Navigated Swept-Source Optical Coherence Tomography Imaging

Journal of VitreoRetinal Diseases ◽

10.1177/2474126421997335 ◽

2021 ◽

pp. 247412642199733

Author(s):

Kyle D. Kovacs ◽

M. Abdallah Mahrous ◽

Luis Gonzalez ◽

Benjamin E. Botsford ◽

Tamara L. Lenis ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Clinical Utility ◽

Clinical Decision Making ◽

Imaging System ◽

Imaging Modality ◽

Case Series ◽

Subretinal Fluid ◽

Optical Coherence ◽

Swept Source ◽

Oct Imaging

Purpose: This work aims to evaluate the clinical utility and feasibility of a novel scanning laser ophthalmoscope-based navigated ultra-widefield swept-source optical coherence tomography (UWF SS-OCT) imaging system. Methods: A retrospective, single-center, consecutive case series evaluated patients between September 2019 and October 2020 with UWF SS-OCT (modified Optos P200TxE, Optos PLC) as part of routine retinal care. The logistics of image acquisition, interpretability of images captured, nature of the peripheral abnormality, and clinical utility in management decisions were recorded. Results: Eighty-two eyes from 72 patients were included. Patients were aged 59.4 ± 17.1 years (range, 8-87 years). During imaging, 4.4 series of images were obtained in 4.1 minutes, with 86.4% of the image series deemed to be diagnostic of the peripheral pathology on blinded image review. The most common pathologic findings were chorioretinal scars (18 eyes). In 31 (38%) eyes, these images were meaningful in supporting clinical decision-making with definitive findings. Diagnoses imaged included retinal detachment combined with retinoschisis, retinal hole with overlying vitreous traction and subretinal fluid, vitreous inflammation overlying a peripheral scar, Coats disease, and peripheral retinal traction in sickle cell retinopathy. Conclusions: Navigated UWF SS-OCT imaging was clinically practical and provided high-quality characterization of peripheral retinal lesions for all eyes. Images directly contributed to management plans, including laser, injection or surgical treatment, for a clinically meaningful set of patients (38%). Future studies are needed to further assess the value of this imaging modality and its role in diagnosing, monitoring, and treating peripheral lesions.

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Functional Monitoring after Trabeculectomy or XEN Microstent Implantation Using Spectral Domain Optical Coherence Tomography and Visual Field Indices—A Retrospective Comparative Cohort Study

Biology ◽

10.3390/biology10040273 ◽

2021 ◽

Vol 10 (4) ◽

pp. 273

Author(s):

Marc Schargus ◽

Catharina Busch ◽

Matus Rehak ◽

Jie Meng ◽

Manuela Schmidt ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Cohort Study ◽

Visual Field ◽

Spectral Domain ◽

Optical Coherence ◽

Treatment Groups ◽

Rnfl Thickness ◽

Comparative Cohort Study ◽

The Mean ◽

All Treatment

The aim of this study was to compare the efficacy of trabeculectomy (TE), single XEN microstent implantation (solo XEN) or combined XEN implantation and cataract surgery (combined XEN) in primary open-angle glaucoma cases, naïve to prior surgical treatment, using a monocentric retrospective comparative cohort study. Intraocular pressure (IOP) and the number of IOP-lowering drugs (Meds) were monitored during the first 24 months after surgery. Further disease progression was monitored using peripapillary retinal nerve fiber layer (RNFL) thickness examinations using spectral domain optical coherence tomography (OCT) as well as visual acuity (VA) and visual field (VF) tests. In the TE group (52 eyes), the mean IOP decreased from 24.9 ± 5.9 to 13.9 ± 4.2 mmHg (p < 0.001) and Meds decreased from 3.2 ± 1.2 to 0.5 ± 1.1 (p < 0.001). In the solo XEN (38 eyes) and the combined XEN groups, the mean IOP decreased from 24.1 ± 4.7 to 15.7 ± 3.0 mmHg (p < 0.001) and 25.4 ± 5.6 to 14.7 ± 3.2 mmHg (p < 0.001), while Meds decreased from 3.3 ± 0.8 to 0.8 ± 1.2 (p < 0.001) and 2.7 ± 1.2 to 0.4 ± 1.0 (p < 0.001), respectively. The VF and VA indices showed no sign of further deterioration, the RNFL thickness further decreased in all treatment groups after surgery. TE and XEN led to comparable reductions in IOP and Meds. Although the VA and VF indices remained unaltered, the RNFL thickness continuously decreased in all treatment groups during the 24-month follow-up.

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