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

Neuritis óptica recurrente posterior a encefalomielitis diseminada aguda en pediatría. Reporte de un caso / Recurrent optic neuritis after acute disseminated encephalomyelitis in pediatrics. A case report

Abstract: Optic Neuritis (ON) is a condition caused by the inflammation of the optic nerve, causing diminished visual acuity and ocular pain. It is tightly related to Multiple Sclerosis (MS), often being the first demyelinating event. There is a 31% risk of recurrence during the first 10 years after the diagnosis, and 48% of the patients end up being diagnosed with Multiple Sclerosis1. Imaging studies like brain MRI (Magnetic Resonance Imaging) have a critical role in the diagnosis and prognosis of ON, as well as in the recognition of MS.2 The patient is a 11-year-old girl with recurrent ON and past medical history of Acute Disseminated Encephalomyelitis (ADEM) when she was 5 years old. ON diagnosis was based on clinical findings as well as on ophtalmologic, electrophysiologic and imaging studies. The recurrent episodes of ON improved after the use of high dose steroids. Recurrences were observed after titration of the dose, but remission was achieved after adjustment of treatment. During one of the recurrent episodes, blood work was performed to evaluate possible underlying infectious, demyelinating or autoinmmune process. Anti-MOG antibodies were found positive. The patient at the moment is not presenting with any other criteria suggesting MS or Optic Neuromyelitis, but long term follow up is adviced. Key words: Optic neuritis (ON), multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), magnetic resonance imaging (MRI), cerebrospinal fluid (CSF), right eye (RE); visual acuity (VA), optic neuromyelitis (ONM)

Evaluation of Correlation Between OCT Findings and Delayed Visual Acuity Improvement After Macular Hole Surgery

PURPOSE: We evaluated the relationship between the delayed visual acuity (VA) improvement and retinal features, including in the photoreceptor layer, after a successful macular hole surgery using optical coherence tomography (OCT) images during long-term post-operative observation. The goal was to find the mechanism in delayed VA improvement. METHODS: Postoperative OCT scans were analyzed in nine eyes of eight patients who underwent idiopathic macular hole surgery between June 2003 to June 2005. Horizontal and vertical OCT scans taken of the operated eyes immediately after absorption of intraocular gas and after VA improvement were exported to Adobe Photoshop 7.0. We measured changes in parameters of the central foveal thickness (central 1 mm area), photoreceptor layer thickness, relative reflectivity of photoreceptor to retinal pigment epithelium, and the defective area of photoreceptor layer. RESULTS: The median visual acuity was determined to be 0.2 (range: 0.15~0.3) at the VA unimproved period and 0.5 (range: 0.3~1.0) at VA improved period. The mean central foveal thickness decreased from 221.3 micrometer (range: 155~265 micrometer) to 191.2 micrometer (range: 150~231 micrometer), as VA improved (p=0.007). The mean photoreceptor layer thickness increased from 15.2 micrometer (range: 4.2~27.6 micrometer) to 22.6 micrometer (range: 4.2~35.8 micrometer) as VA improved (p=0.032), and mean relative reflectivity of photoreceptor layer increased from 0.43 (range: 0.08~0.67) to 0.48 (range: 0.10~0.70), as VA improved (p=0.415). The defective area of photoreceptor layer decreased from 70% (range: 90~45%) to 27% (range: 8~5), as VA improved (p=0.001). CONCLUSIONS: A decrease of the central foveal thickness and of photoreceptor layer defective signal, and an increase of photoreceptor layer thickness were observed on OCT during delayed vision improvement after a successful macular hole surgery. Improvement of macular edema and photoreceptor reorganization are suggested as important parts of the mechanism toward vision recovery.