Clinical and imaging features of infiltrative optic neuropathy secondary to extraocular malignant tumors / 中华眼底病杂志

Objective:To observe the clinical and imaging features of infiltrative optic neuropathy (ION) secondary to extraocular malignant tumors.Methods:A retrospective case study. From January 2017 to October 2022, 26 eyes of 20 patients with ION secondary to extraocular malignancies and 32 eyes of 16 patients with early papilloedema (EP) secondary to intracranial metastatic carcinoma were included in the study. All eyes underwent best corrected visual acuity (BCVA), fundus color photography, orbital and/or craniocerebral magnetic resonance imaging (MRI). A total of 54 eyes were examined by visual field examination, among which ION and EP were 22 and 32 eyes, respectively. Clinical and imaging features of the affected eye were retrospectively analyzed.Results:Among 26 eyes of 20 ION patients, there were 13 males and 7 females, with the mean age of (52.8±16.9) years. There were 10 patients of hematologic malignancy, 7 patients of periorbital malignancy, 2 patients of lung cancer, 1 patient of gastric cancer, 1 patient of breast cancer and 1 patient of prostate cancer. Two patients of nasal lymphoma were recorded as hematologic malignancies and periorbital malignancies. Sixteen patients had a history of systemic or periorbital malignancy, among which 4 patients reported that they had been "clinically cured". Optic neuritis was diagnosed in 15 patients. Among the 16 patients with EP, 5 were males and 11 were females, with the mean age of (47.9±12.3) years. The primary malignant tumors were lung cancer, breast cancer, leukemia, gastric cancer, ovarian cancer, colon cancer and rectal cancer in 7, 2, 2, 2, 1, 1, 1, respectively. In 26 eyes of ION, 20 eyes complained of blurred vision or peripheral vision occlusion and progressive aggravation; no obvious visual symptoms in 6 eyes. BCVA was light sensing to 1.0 with a median of 0.3, including light sensing and light sensing in 4 eyes. Optic disc edema was observed in 19 eyes; no obvious abnormality in 7 eyes. Visual field examination showed that in 22 eyes, normal or mild enlargement of blind spot in 3 eyes, arcuate scotoma in 4 eyes, annular scotoma in 6 eyes, tubular visual field or concentric contraction of visual field in 6 eyes, and diffuse depression in 3 eyes. MRI showed optic nerve enlargement with sheath enhancement in all ION eyes. Among 32 eyes of EP, 28 eyes showed recurrent transient amaurosis, and the other 4 eyes showed horizontal diplopia. BCVA ranged from 0.8 to 1.5, with a median of 1.0. All EP patients showed different degrees of optic disc hyperemia and edema by fundus examination. The visual field examination showed normal or mild enlargement of the physiological blind spot. MRI showed thickening of the optic nerve and widening of the intrathecal space, but no obvious enhancement of the optic nerve and its intrathecal membrane, and obviously enhanced space-occupying lesions in the brain parenchyma, accompanied by compression and edema of the surrounding brain tissue and midline displacement.Conclusions:ION secondary to extrocular malignant tumors mainly manifested as mild visual symptoms and obvious optic disc edema. MRI showed thickened optic nerve and strengthened sheath, and no obvious abnormality in optic nerve parenchyma.

STUDY OF PAPILLOEDEMA & ITS CAUSATIVE FACTORS IN A TERTIARY CARE HOSPITAL

To study the etiology of papilloedema in north indian population. Our hospital based retrospective study enrolled 50 patients of papilloedema, who fullfilled our inclusion criteria. Demographic details, chief complains and detailed history was taken from all the patients. All the patients underwent blood pressure measurement by a mercury sphygmomanometer, Visual Acuity testing, Slitlamp Biomicroscopy, IOP measurement, Fundus examination. Fundus photographs were obtained using a fundus camera. Other investigations included B-scan, MRI, MRV, CT and required blood investigations were done wherever necessary. Although papilloedema occured in a vast variety of age group but maximum patients (32%) were from the age group of >18-31 years and males (64%) were more affected than females according to our study. 66% of the patients had good vision with papilloedema. In our study all the patients had bilateral papilloedema and 54% of patients were diagnosed with early papilloedema. Idiopathic Intracranial Hypertension was the main etiology for papilloedema. In this study we concluded IIH (a diagnosis of exclusion) as the most common underlying etiology for papilloedema

A Rare Case of Idiopathic Intracranial Hypertension in Prepubertal Age

@#A 2-year-old girl who was under genetic follow up for developmental delay and dysmorphism was accidentally found to have bilateral optic disc swelling during screening examination. She showed response to optokinetic drum examination and the anterior segment examination was unremarkable. Optic disc swellings were seen in both eyes. Lumbar puncture shows high opening pressure of 50 cm H2O with unremarkable CSF analysis. MRI of brain was done and showed features in keeping with mild cerebral atrophy, with no evidence of hydrocephalus or space occupying lesion. She was diagnosed with idiopathic intracranial hypertension and oral acetazolamide 125mg bd was commenced. However, papilloedema persist despite medical therapy. Ventriculoperitonel shunt was inserted to reduce the csf pressure. This case report highlights the importance of considering idiopathic intracranial hypertension as a cause of optic disc swelling in pre-pubertal children because delay in diagnosis and treatment may permanently affect visual function especially in children.

A Case Study on Idiopathic Intracranial Hypertension Management and Outcome.

Background: Pseudo Tumor Cerebri (PTC), also knownby the name Idiopathic Intracranial Hypertension (IIH),is a disorder with increased intracranial pressure (ICP) andassociated headache, nausea, vomiting, transient visualobscuration, double-vision, and visual field defects.Material and methods: Thirty-four cases of idiopathicintracranial hypertension reported to our institute, all reportedpeople are female, and all are over twenty years of age, witha diagnosis of IIH according to the Modified dandy criteriawere included and treated medically with oral acetazolamideat a dose of 500 mg/day.Results: All patients are started on oral acetazolamide 250 mgtwice daily; all patients got resolved of fundus changes andnerve palsy with the therapy within three months of follow up.Conclusions: In this study, administration of low doses ofacetazolamide 250mg twice daily for a duration of 3 monthsfor all the patients, and there were no signs of recurrenceafter cessation of acetazolamide and in the further followup. Acetazolamide plays an important role in cases of IIH forits best outcome. Early diagnosis and early treatment withacetazolamide gave good outcomes in all cases of IdiopathicIntracranial Hypertension.

Progress in the application of optic nerve sheath fenestration in the treatment of intracranial hypertensive optic neuropathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#Optic nerve sheath fenestration(ONSF), also known as optic nerve sheath decompression, was first proposed by Wecker. The procedure involves cutting incisions or windows in the retrabulbar optic nerve sheath to release the cerebral spinal fluid from the subarachnoid space of the optic nerve, reducing the pressure surrounding the optic nerve. With the development of surgical instruments and procedures, the safety of ONSF has been significantly improved with infrequent complications. Through the past three decades, more and more ophthalmologists realized that ONSF is an effective surgical treatment to stabilize or improve visual loss in idiopathic intracranial hypertension(IIH). Additionally, much progress in the use of ONSF has been made on secondary intracranial hypertension due to cerebral venous sinus occlusion, <i>Cryptococcal</i> meningitis, and intracranial mass or tumors. In this paper we review the application of ONSF in IIH, and secondary intracranial hypertension. From the review, it indicates ONSF is a good surgical alternative for ophthalmologists. It also indicates that ONSF can be used to prevent or halt progressive visual loss associated with intracranial hypertension, particularly when other treatment modalities fail to protect vision.

Cryptococcus meningitis in an immunocompetent teenage boy presented early with diplopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To report a case of cryptococcus meningitis in an immunocompetent teenager that presented early with diplopia and bilateral poor vision.METHODS:A case report RESULTS:A 17-year-old boy presented with blurring of vision in both eyes and diplopia for 3 weeks. It was associated with severe throbbing headaches, nausea and vomiting. He was also having low grade fever. On physical examination he was afebrile with no sign of meningism. His vision was 6/15 in both eyes with constricted visual field. Anterior segment was normal in both eyes. Extraocular muscles movement showed bilateral sixth nerve palsies. Fundoscopy revealed bilateral hyperaemic and slightly elevated optic disc. CT scan of the brain was normal with no evidence of intracranial mass or abnormal ventricles. Lumbar puncture revealed high opening pressure >300mmH2O. Cerebrospinal fluid(CSF) microscopically and culture showed presence of cryptococcus neoformans . This case was combinedly managed with neuro-medical team. Patient was started on intravenous Amphotericin B and fluconazole. His neurological symptoms recovered after a week. His vision was improved to 6/6 in both eyes with recovery of peripheral visual field. The diplopia improved with recovery of sixth nerve palsies in both eyes. Unfortunately, patient developed nosocomial lower respiratory tract infection and was treated for the problem.CONCLUSION: This case highlights the indolent nature of cryptococcus meningitis and the fact that the overt signs of meningism may not be present even in immunocompetent person. Diplopia may be one of the early presentations of meningitis patient.

Clinical study of idiopathic intracranial hypertension / 医学研究生学报

Idiopathic intracranial hypertension,which often occurs among adult overweight women,is a kind of chronic intracranial hypertension without any certain causes.The patient usually present with headache and papilloedema,and normal of brain structure and the cerebrospinal fluid composition.As visual loss is the only serious outcome,both dietary management and medical treatment are helpful in the early time,but surgery should be required as soon as visual loss occurs.The recent clinical study on idiopathic intracranial hypertension was reviewed.

Idiopathic Intracranial Hypertension (Prospective Study of 25 Patients )

From January 1996 to January 2000, twenty-five patients were diagnosed to have idiopathic intracranial hypertension at our institution. Twenty-three were females and two were males with age range of 13-43 years. Main presenting features were headache (100%), vomiting (44%), blurred vision (36%), diplopia (28%), neck pain (12%), and transient visual obscuration (12%). Duration of symptoms before diagnosis ranged from one week to 8 months. Nine patients had cranial nerve involvement. Seventeen patients were obese, 3 were using oral contraceptives and one patient had . taken tetracycline for 4 months for acne and other was taking Vit. A 50,000 units twice daily for 9 months. All patients had papilloedema. CT and MRI brain were done in all to exclude intracranial pathology. Patients were followed up every two to three months. At five years follow up, 19 were symptom-free with normal vision and 6 had residual visual deficit. Idiopathic intracranial hypertension once diagnosed necessitates regular follow-up to avoid permanent visual loss.