Efficacy of dural venous sinus stenting in treating idiopathic intracranial hypertension with acute vision loss

Introduction Dural venous sinus stenting (VSS) is an effective, durable treatment for patients with idiopathic intracranial hypertension (IIH) due to underlying venous sinus stenosis. However, the use of venous sinus stenting to treat IIH with acute vision loss has rarely been described. Methods A retrospective chart analysis identified patients who received VSS for fulminant IIH, defined as acute (< 8 weeks) visual field loss to within the central 5° and/or a decrease in visual acuity to less than or equal to 20/50 in either eye in the presence of papilledema. Results Ten patients were identified with average patient age of 31.0 years, and all except one were female. Mean body mass index was 41.2 kg/m2. All patients presented with vision loss and some with headache and tinnitus. The average trans-stenotic gradient pre-stenting was 28.7 mmHg (range 9–62 mmHg). All patients had diminished or resolved venous gradients immediately following the procedure. At mean follow-up of 60.5 weeks, 100% had improvements in papilledema, 80.0% had subjective vision improvement, 55.6% had headache improvement and 87.5% had tinnitus improvement. 90.0% had stable or improved visual acuity in both eyes with a mean post-stenting Snellen acuity of 20/30 and an average gain of 3 lines Snellen acuity post-stenting (95% confidence intervals 0.1185–0.4286, p = 0.0018). Two patients (20.0%) required further surgical treatment (cerebrospinal shunting and/or stenting) after their first stenting procedure. Conclusions This series suggests that VSS is feasible in patients presenting with IIH and acute vision loss with a fairly low complication rate and satisfactory clinical outcomes.

Establishing Prediction Intervals for the SpeedWheel Acuity Test in Adults and Children

Background The SpeedWheel (SW) test is an objective test of visual acuity (VA) using suppression of the optokinetic nystagmus (OKN). Here, we established prediction intervals of the SW measures compared to Snellen acuity in adults and children. Subjects and Methods In this prospective, single center study, subjects aged at least 4 years underwent testing of VA with SW, Landolt-C, and Tumbling-E symbols (Freiburg acuity test: FrACT-C, FrACT-E). Prediction intervals were established for SW compared to FrACT-C or -E and for FrACT-E compared to FrACT-C. Mixed linear effect models were applied for statistical analysis. Results From 241 subjects, 471 eyes were included: median age 36 years, range 4 – 88 years, 43.6% male, 56.4% female. Eyes included were either healthy or had various underlying ophthalmic conditions. Prediction intervals for SW to estimate FrACT-C or -E acuity showed a similar range compared to the prediction interval of FrACT-C for the estimation of FrACT-E acuity. For each acuity step, there was no influence of age. Up to an SW acuity of 0.7 logMAR, 80% of the subjects had a FrACT-C acuity that was at most 1.6 logMAR lines below, and for an SW acuity of 1.0 logMAR, FrACT-C acuity was not worse than 4 logMAR lines. Prediction intervals for eyes with refractive error, cataract, visual field loss and retinal disease did not differ significantly from healthy eyes in contrast to eyes with amblyopia or multiple ophthalmic disorders. SW correlated well to FrACT tests and results of a previous study fell within our prediction estimates. Conclusion Our prediction intervals for SW acuity may be used to estimate Snellen acuity (FrACT-C and -E) in the clinic in adults and children unable to cooperate in other acuity testing.

Establishing an Objective Measurement of Visual Acuity with a Computerised Optokinetic Nystagmus Suppression Test

Objective Investigating the correlation between subjective and objective VA (visual acuity) elicited with a newly developed computerised optokinetic nystagmus (OKN) suppression test (“SpeedWheel”) in adults. Methods SpeedWheel presented alternating black/white stripes moving horizontally across a LED screen. Seven VA steps were induced with Bangerter filters placed onto spectacle frames. Magnified eye movements were projected from infrared cameras inside the frames and displayed onto a smartphone. Dots whose size increased in logarithmic steps were superimposed to suppress OKN. Suppression of OKN resulted in the SpeedWheel acuity which was then correlated to Snellen acuity as measured with the Freiburg Acuity test. Results 28 eyes from 14 individuals were tested. FrACT-E correlated well to SpeedWheel (r: 0.89; p < 0.001). Snellen acuity was never lower than 0.14 LogMAR of SpeedWheel values. Bangerter filters showed greater mean difference to both methods indicating that this filter is not as predictable as suggested by the filter value. Conclusion SpeedWheel offers a fast (< 80 sec) and reliable alternative option to measure objective VA.

Effect of Topical Nepafenac on Central Foveal Thickness following Panretinal Photocoagulation in Diabetic Patients

Purpose. To evaluate effectiveness of topical nepafenac in reducing macular edema following panretinal photocoagulation (PRP). Design. Prospective randomized double-blinded controlled study. Methods. Sixty eyes of 60 patients having proliferative or severe nonproliferative diabetic retinopathy had PRP. Patients were then divided into two groups: nepafenac group (30 eyes) receiving 1% topical nepafenac eye drops for 6 months and control group (30 eyes) receiving carboxymethylcellulose eye drops for 6 months. Best-corrected visual acuity (BCVA) and macular optical coherence tomography were followed up at 1, 2, 4, and 6 months after PRP. Results. BCVA was significantly better in nepafenac group than in control group at all follow-ups (P<0.01). At 6 months post-PRP, logMAR BCVA was 0.11 ± 0.04 (equivalent to 20/26 Snellen acuity) in the nepafenac group and 0.18 ± 0.08 (equivalent to 20/30 Snellen acuity) in the control group (P<0.01). Central foveal thickness (CFT) increased in both groups from the first month after PRP. Increase in CFT was higher in control group than in nepafenac group throughout follow-up, but the difference became statistically significant only after 4 months. No significant ocular adverse events were reported with topical nepafenac. Conclusion. Topical nepafenac can minimize macular edema and stabilize visual acuity following PRP for diabetic patients.