Comparison of glaucomatous from non-glaucomatous optic neuropathy using Bruch’s membrane opening minimum rim width optical coherence tomography measurements

Purpose: To compare glaucomatous from non?glaucomatous optic atrophy using optical coherence tomography (OCT) based on the measurement values of Bruch’s membrane opening minimum rim width (BMO?MRW), which is a difficult task otherwise due to their varied course of disease progression, treatment protocols, and systemic association to visual impairment. Methods: This study was conducted in 40 eyes, comprising 20 eyes with non?glaucomatous optic neuropathy (NGON) and 20 eyes with glaucomatous optic neuropathy (GON). All patients underwent a complete ophthalmic examination followed by an OCT optic disc scan to calculate the measurement of BMO?MRW. Results: The 5?fold cross?validated area under the curve for GON versus NGON from logistic regression models was 0.95 (95% confidence interval [CI]: 0.86–1.00) using BMO?MRW values from all sectors. The results revealed that the measurements were significantly lesser in GON than in NGON patients. Conclusion: Hence, OCT?based BMO?MRW values could be used as an additional test to compare glaucomatous with non?glaucomatous optic neuropathy patients, especially in cases of high clinical suspicion.

Imaging application of thyroid associated ophthalmopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#Thyroid associated ophthalmopathy(TAO)is an autoimmune orbital inflammatory disease. Imaging methods play an important role in evaluating the change of orbital structures and differential diagnosis of orbital disease. In addition, imaging studies can also contribute to analyze the activity and severity of TAO and estimate compressive optic neuropathy(CON).

Descompresión orbitaria endoscópica transnasal en orbitopatía tiroidea severa / Transnasal endoscopic orbital decompression in severe thyroid orbitopathy

RESUMEN La orbitopatía tiroidea es una enfermedad autoinmune, en la que una reacción inflamatoria genera aumento de la presión orbitaria con protrusión de su contenido. A menudo es autolimitada y sus síntomas más frecuentes son retracción palpebral, exoftalmo y diplopía. Existen casos severos con compromiso de la agudeza visual por compresión del nervio óptico. El diagnóstico es clínico, pero debe complementarse con una tomografía computarizada. Su tratamiento depende de la gravedad y actividad de la enfermedad, siendo los procedimientos quirúrgicos, como la descompresión orbitaria, de elección en exoftalmo y neuropatía óptica compresiva. El pilar de tratamiento en la orbitopatía tiroidea severa es la cirugía descompresiva. Se han descrito múltiples técnicas, pero con limitaciones. La descompresión endoscópica transnasal, es considerada actualmente el procedimiento de elección, ya que permite una buena visualización de la pared medial, con resultados comparables y menores complicaciones, respecto a métodos tradicionales. Describimos un caso de oftalmopatía tiroidea severa, con exoftalmo, diplopía y disminución de la agudeza visual, en la que se realizó una descompresión endoscópica con muy buenos resultados.

ABSTRACT Thyroid orbitopathy is an autoimmune disease in which an inflammatory reaction generates increased orbital pressure with protrusion of its contents. It is often self-limiting and its most frequent symptoms are eyelid retraction, exophthalmos and diplopia. There are severe cases with compromised visual acuity due to compression of the optic nerve. The diagnosis is clinical, but must be complemented with a computed tomography scan. Its treatment depends on the severity and activity of the disease and the surgicals procedures such as orbital decompression is the best choice in exophthalmos and compressive optic neuropathy. The treatment in severe thyroid orbitopathy is decompressive surgery. Multiple techniques have been described, but with limitations. The transnasal endoscopic decompression is currently considered the gold standard, since it allows a good visualization of the medial wall with comparable results and less complications, compared to traditional methods. We present a case of severe thyroid ophthalmopathy, with exophthalmos, diplopia and decreased visual acuity, in which a transnasal endoscopic decompression was performed with very good outcomes.

A Case of Meningioma Masquerading as Ischemic Optic Neuropathy

PURPOSE: We report a case of meningioma diagnosed as ischemic optic neuropathy. CASE SUMMARY: A 45-year-old women presented with decreased visual acuity in her left eye without eye movement pain. Her best corrected visual acuity (BCVA) in that eye was 0.3. She showed a relative afferent pupillary defect, abnormal color vision test, and inferior visual field defect in her left eye. The optic disc showed slight blurring superiorly and pallor temporally. Fluorescein angiography showed choroidal filling defect, and ischemic optic neuropathy was suspected. The carotid artery sonography showed normal results. The BCVA of the left eye was 0.5 after 7 months. The visual field test and color vision test were improved after 7 months. The optic disc was pale. The magnetic resonance imaging was performed because of persistent headache, and that showed a suprasellar mass that was removed by surgical resection and diagnosed as meningioma on biopsy. CONCLUSIONS: The possibility of compressive optic neuropathy should be considered in presumed ischemic optic neuropathy if the patient complains of persistent headache.

Multifocal visual evoked potential in optic neuritis, ischemic optic neuropathy and compressive optic neuropathy.

Purpose: To investigate the effect of optic neuritis (ON), ischemic optic neuropathy (ION) and compressive optic neuropathy (CON) on multifocal visual evoked potential (mfVEP) amplitudes and latencies, and to compare the parameters among three optic nerve disorders. Materials and Methods: mfVEP was recorded for 71 eyes of controls and 48 eyes of optic nerve disorders with subgroups of optic neuritis (ON, n = 21 eyes), ischemic optic neuropathy (ION, n = 14 eyes), and compressive optic neuropathy (CON, n = 13 eyes). The size of defect in mfVEP amplitude probability plots and relative latency plots were analyzed. The pattern of the defect in amplitude probability plot was classified according to the visual field profile of optic neuritis treatment trail (ONTT). Results: Median of mfVEP amplitude (log SNR) averaged across 60 sectors were reduced in ON (0.17 (0.13‑0.33)), ION (0.14 (0.12‑0.21)) and CON (0.21 (0.14‑0.30)) when compared to controls. The median mfVEP relative latencies compared to controls were significantly prolonged in ON and CON group of 10.53 (2.62‑15.50) ms and 5.73 (2.67‑14.14) ms respectively compared to ION group (2.06 (‑4.09‑13.02)). The common mfVEP amplitude defects observed in probability plots were diffuse pattern in ON, inferior altitudinal defect in ION and temporal hemianopia in CON eyes. Conclusions: Optic nerve disorders cause reduction in mfVEP amplitudes. The extent of delayed latency noted in ischemic optic neuropathy was significantly lesser compared to subjects with optic neuritis and compressive optic neuropathy. mfVEP amplitudes can be used to objectively assess the topography of the visual field defect.

Uncommon Ocular Manifestations of Neurofibromatosis: Case Report and Review

PURPOSE: To report and review several cases of uncommon ocular manifestations in neurofibromatosis patients. CASE SUMMARY: A 19-year-old woman diagnosed with type 2 neurofibromatosis visited our hospital with amblyopia of the right eye and mild visual disturbance of the left eye. Best corrected visual acuity was 20/250 in the right eye, 20/25 in the left eye and relative afferent pupillary defect in the right eye was observed. Fundus examination of both eyes showed papilledema. Magnetic resonance imaging showed schwannoma from the optic nerve to the optic chiasm. A 28-year-old woman diagnosed with type 2 neurofibromatosis visited our hospital with amblyopia of the right eye. Best corrected visual acuity was finger count in the right eye, 20/20 in the left eye and relative afferent pupillary defect in the right eye was observed. Fundus examination of the right eye showed a slightly elevated lesion at the macula, as well as dragged optic disc and retinal vessels to the macula. An 8-year-old girl diagnosed with type 1 neurofibromatosis visited our hospital with enophthalmos and strabismus of the left eye. On exophthalmometry, enophthalmos in the left eye was found; measurements were 15.0 mm in the right eye and 13.0 mm in the left eye. Three-dimensional computed tomography revealed sphenoidal hypoplasia and a left lateral orbital wall defect. CONCLUSIONS: The authors of the present study report on neurofibromatosis patients who had an uncommon ocular manifestation. Neurofibromatosis can represent various ocular manifestations but reports of compressive optic neuropathy, dragged disc syndrome and sphenoidal hypoplasia are rare.

A Giant Unruptured Aneurysm of Distal Internal Carotid Artery Presenting with Compressive Optic Neuropathy

PURPOSE: To report a case of compressive optic neuropathy due to a giant unruptured aneurysm of a distal internal carotid artery. CASE SUMMARY: A 68-year-old female presented with a one-week history of visual disturbance in her left eye. The patient had no underlying disease except hypertension. Best corrected visual acuity was 20/20 in the right eye and 8/20 in the left eye. The color perception test showed abnormal findings in the left eye. Slit lamp examination showed no abnormal finding except incipient cataract in both eyes. Additionally, fundus examination showed no abnormal finding. Brain MRI and MRA revealed a 2.4 x 2.2 x 3.0-cm-sized unruptured giant aneurysm on the left internal carotid artery. CONCLUSIONS: A giant aneurysm should be considered as a cause for acute or subacute optic neuropathy in a patient with hypertension.

A Case of Suprasellar Arachnoid Cyst with Compressive Optic Neuropathy

PURPOSE: To report a case of suprasellar arachnoid cyst with compressive optic neuropathy. CASE SUMMARY: A 50-year-old man presented with decreased visual acuity in the right eye of 6 months duration. Best corrected visual acuity was 0.2 in the right eye, 1.0 in the left eye, and the intraocular pressure was 13 mm Hg in the right eye, and 18 mm Hg in the left eye. Fundus examination showed pale optic disc in the right eye and retinal nerve fiber layer defects in both eyes. Visual field examination revealed a central visual field of 10degrees in the right eye and an inferior visual field defect in the left eye. The brain magnetic resonance image (MRI) showed a suprasellar arachnoid cyst that compressing the optic nerve and chiasm. CONCLUSIONS: The author experienced arachnoid cyst accompanied by optic disc atrophy and visual field defect in a patient diagnosed and treated for glaucoma. In cases of non-specific clinical features that differ from typical glaucomatous presentations, the utilization of brain MRI appears to be helpful in diagnosis and treatment.

Paquimeningitis craneal hipertrófica y estenosis traqueal idiopáticas: coincidencia o asociación? / Idiopathic hypertrophic cranial paquimeningitis and tracheal stenosis: coincidence or association?

La paquimeningitis hipertrófica idiopática crónica y la estenosis traqueal subglótica idiopática son raras condiciones de origen desconocido. En ambas existen un proceso inflamatorio fibrótico que afecta respectivamente, la duramadre y la traquea. La paquimeningitis hipertrófica idiopática crónica en forma típica, causa parálisis progresiva de nervios craneales, cefaleas, hipertensión intracraneal o disfunción cerebelosa. En la estenosis traqueal subglótica idiopática, usualmente limitada a la región subglótica y los dos primeros anillos traqueales, los sintomas son variables incluyendo disnea progresiva, sibilancias y estribor notables sobre el cuello. La paquimeningitis hipertrófica idiopática crónica ocurre en pacientes de todas las edades y el examen de elección para detectarla es la resonancia magnética cerebral, en tanto que la estenosis traqueal subglótica idiopática suele afectar mujeres jóvenes o maduras y es mejor evidenciada mediante tomografía computarizada. El diagnóstico es uno de exclusión. Deben descartarse enfermedades infecciosas como tuberculosis y lúes, y otras como sarcoidosis, carcinomatosis meníngea o vasculitis. Suelen responder inicialmente a los corticosteroides pero puede haber recurrencia al suspenderlos. La evolución a largo plazo es incierta. Este trabajo informa acerca de una paciente en quien ambas condiciones se dieron cita, discutiéndose sus manifestaciones clínicas, radiológicas y patológicas. Aunque considerada esencial para el diagnóstico, en nuestro caso no se realizó una biopsia meníngea. Planteamos la posibilidad de una asociación entre ambas condiciones, por su inicio simultáneo con recaídas, por su condición de inflamación crónica y recurrente y su respuesta a los corticosteroides.

Chronic idiopathic hypertrophic paquimeningitis and chronic subglottic tracheal stenosis are rare conditions of unknown origin. In both there is a fibrotic inflammatory process affecting, respectively the dura mater and the trachea. The chronic idiopathic hypertrophic paquimeningitis in its typical presentation causes progressive paralysis of cranial nerves, headaches, intracranial hypertensión or cerebellar dysfunction. In the chronic subglottic tracheal stenosis, usually limited to the subglottic region and the two first traqueal rings, its symptoms are variable including progressive shortness of breath, wheezing and stridor notable on the neck. The chronic idiopathic hypertrophic paquimeningitis occurs in patients of all ages and the test of choice for diagnosis it is the brain magnetic resonance image, while the chronic subglottic tracheal stenosis usually affect young or mature women and is best evidenced by computerizide tomography scan. The diagnósis is one of exclusion. Infectious diseases such as tuberculosis and lues, and others as sarcoidosis, meningeal carcinomatosis or vasculitides should be discarded. Often initially respond to corticosteroids but may have recurrences when stopped. The evolution in the long term is uncertain. This paper reports on a patient with both conditions, discussing their clinical, radiological and pathological manifestation. Although considered essential for the diagnosis, in our case was not performed a meningeal biopsy. We postulate the possibility of association between these two conditions, based in their simultaneous onset, the occurence of relapses in both diseases, its condition of recurrent and chronic inflammation, and its response to corticosteroids.

A Case of Compressive Optic Neuropathy due to Breast Cancer Metastasis

PURPOSE: To report a case of compressive optic neuropathy due to breast cancer metastasis to the periorbital lesion 26 years after the treatment of primary cancer. CASE SUMMARY: A 64-year-old female presented with headache, facial pain and visual disturbance in her left eye for four months. The patient had received chemotherapy and radiotherapy after left breast modified radical mastectomy for invasive ductal carcinoma 26 years previously, and right breast wide resection with axillary dissection nine years earlier. Best corrected visual acuity was 20/20 in the right eye and 8/20 in the left eye. The color perception test showed abnormal findings in the left eye. MRI and PET-CT revealed an enhancing mass in the left periorbital area that was compressing the optic nerve. Partial resection of the tumor and left orbital wall was performed. Adjuvant chemotherapy and radiotherapy was performed after the operation. After two months later, the best corrected visual acuity was 20/20 in the left eye, and the color perception test showed normal findings, which have been maintained for one year. CONCLUSIONS: Prompt management can result in visual recovery in patients with compressive optic neuropathy caused by breast cancer metastasis.

A Case of Compressive Optic Neuropathy Caused by Sphenoid Sinus Mucocele

One of causes of compressive optic neuropathy is the sphenoid mucoceles which occur when the dranage of sinus is blocked. Mucocele of sphenoid sinus is rare, compressive to optic nerve and often misdiagnosed as pituitary tumor. We experienced a case of sphenoid sinus mucocele causing progressive visual disturbance, visual field defect, exophthalmos and headache. Plain skull and brain CT scan demonstrated sphenoid sinus mucocele. The visual acuity and visual field dramatically improved after surgery. Therefore early accurate detection and early surgical treatment are emphasized.