Diagnostic performance of neuroimaging in suspected idiopathic intracranial hypertension.

The diagnostic utility of neuroradiologic signs associated with idiopathic intracranial hypertension (IIH) for the evaluation of patients presenting with papilloedema remains yet to be elucidated. This multicentre retrospective cohort study assessed consecutive patients presenting with suspected papilloedema to Auckland District Health Board (NZ) and Stanford University Medical Centre (US), between 2005 and 2019, undergoing magnetic resonance imaging and venography (MRI/MRV) or computed tomography and venography (CT/CTV) prior to lumbar puncture assessment for diagnostic suspicion of IIH. Data were collected regarding demographic, clinical, radiologic, and lumbar puncture parameters, and the diagnosis of IIH was determined according to the Friedman criteria for primary pseudotumor cerebri syndrome. A total of 204 participants (174 females; mean ± SD age 29.9 ± 12.2 years) were included, and 156 (76.5%) participants fulfilled the diagnostic criteria for IIH. The presence of any IIH-associated radiologic sign on MRI/MRV demonstrated a sensitivity (95% CI) of 74.8% (65.8%-82.0%) and specificity (95% CI) of 94.7% (82.7%-98.5%), while radiologic signs on CT/CTV exhibited a sensitivity (95% CI) of 61.0% (49.9%-71.2%) and specificity (95% CI) of 100.0% (83.2%-100.0%). In summary, the modest sensitivities of radiologic signs of IIH would support the routine use of lumbar puncture assessment following neuroimaging to secure the diagnosis. However, the high specificities might lend limited support for the judicious deferment of lumbar puncture assessment among typical IIH demographic patients who consent to the inherent small risk of missed pathology, which has been proposed by some clinicians.

Long term outcomes of idiopathic intracranial hypertension: Observational study and literature review.

BACKGROUND: Idiopathic intracranial hypertension (IIH) is an unexplained increase in intracranial pressure often associated with obesity. The aim of this study was to conduct a retrospective observational study of the long term clinical, visual, and treatment outcomes in IIH patients. METHODS: A retrospective observational study of patients diagnosed with IIH over a 12-year period at a single centre was completed via database review. Demographic data, symptoms at baseline and last visit, treatments undertaken, and duration of follow-up were included. Visual outcomes, including visual acuity, colour vision, 30-2 Humphrey automated perimetry data, and retinal nerve fibre layer thickness (RNFL), were collected at baseline and last visit. RESULTS: IIH was diagnosed in 132 patients (90.9 % female) with a median of 2.8 years (range: 0-9.1) follow-up. Mean BMI was 35.9 ± 7.9 kg/m2. Symptoms at presentation were headache (87.6 %), pulsatile tinnitus (27.2 %) and transient visual obscurations (27.2 %). First-line management was acetazolamide in 86.4 %, with 34.2 % of these patients ceasing treatment because of adverse events. Visual field measures and RNFL at last follow-up improved when compared to baseline (median MD: - 1.99 dB (IQR -3.6 to -0.9) to -0.85 (-2.1 to 0.0) (p < 0.001), median RNFL: 132 µm (IQR 116 - 183) to 103 (92 - 113) (p < 0.001)). Some patients (6.1 %) required surgery for more severe IIH. CONCLUSIONS: Long-term symptomatic and visual prognosis in IIH patients is excellent. However, a subset of patients with more severe disease require surgical intervention. Adverse events of treatment lead to high medication discontinuation rates.

Exploring topical anti-glaucoma medication effects on the ocular surface in the context of the current understanding of dry eye.

PURPOSE: To assess tear film parameters, ocular surface characteristics, and dry eye symptomology in patients receiving topical anti-glaucoma medications. METHODS: Thirty-three patients with a diagnosis of open angle glaucoma or ocular hypertension, receiving unilateral topical anti-glaucoma medication for at least 6 months, were recruited in a cross-sectional, investigator-masked, paired-eye comparison study. Tear film parameters, ocular surface characteristics, and dry eye symptomology of treated and fellow eyes were evaluated and compared. RESULTS: The mean ±â€¯SD age of the participants was 67 ±â€¯12 years, and the mean ±â€¯SD treatment duration was 5.3 ±â€¯4.4 years. Treated eyes had poorer non-invasive tear film breakup time (p = 0.03), tear film osmolarity (p = 0.04), bulbar conjunctival hyperaemia (p = 0.04), eyelid margin abnormality grade (p = 0.01), tear meniscus height (p = 0.03), and anaesthetised Schirmer value (p = 0.04) than fellow eyes. There were no significant differences in dry eye symptomology, meibomian gland assessments, and ocular surface staining between treated and fellow eyes (all p > 0.05). CONCLUSIONS: Adverse changes in tear film stability, tear osmolarity, conjunctival hyperaemia, and eyelid margins were observed in treated eyes. This suggests that inflammatory mechanisms may be implicated in the development of dry eye in patients receiving long term topical anti-glaucoma therapy.

Presumed autoimmune retinopathy following chickenpox; a case report.

PURPOSE: To report a case of presumed autoimmune retinopathy in a patient who had been diagnosed with chickenpox immediately prior to symptom onset. METHOD: This is a retrospective case report with fundus autofluorescence and spectral-domain optical coherence tomography. RESULTS: A 29-year-old immunocompetent man presented with a two-month history of photopsia and a bluish light predominantly in the left eye with onset immediately following a diagnosis of chickenpox. He subsequently developed blurring of vision in his left eye with spectral-domain optical coherence tomography showing disruption and loss of ellipsoid layer in a perivascular pattern in both eyes with fundus autofluorescence demonstrating an abnormal increase in autofluorescence predominately around the vascular arcades. Autoimmune retinopathy was suspected on the basis of the clinical presentation, electrophysiology, absence of fundus lesions, retinal degenerations or dystrophies, or intraocular inflammation and temporal association with varicella infection. Antiretinal antibody testing with Western blot and immunohistochemistry were reported to be negative, however, given the consistent evidence from all other aspects of workup and investigation the patient was commenced on a trial of prednisone. This resulted in marked reduction in photopsia and expansion of visual fields. CONCLUSION: The diagnosis of autoimmune retinopathy is ultimately clinical in nature. Despite the absence of positive retinal autoantibodies, a diagnosis of autoimmune retinopathy was made based upon consistent evidence from all other aspects of workup and investigation. This allowed prompt treatment with immunosuppressive agents with subsequent stabilization of this patient's visual function.

Variations in optic nerve head morphology by intraocular pressure in open-angle glaucoma.

PURPOSE: To compare optic disc topography in eyes in three intraocular pressure (IOP) groups of <15 mmHg, 15-20 mmHg, and ≥21 mmHg using spectral domain optical coherence tomography (SD-OCT) and confocal scanning laser ophthalmoscopy, adjusting for the degree of damage, as measured by retinal nerve fiber layer (RNFL) thickness and average visual field loss. METHODS: A total of 184 eyes of 112 patients with primary open-angle glaucoma were recruited into groups based on baseline untreated intraocular pressure (IOP) of <15 mmHg (normal-tension glaucoma [NTG], very low), 15-20 mmHg (NTG, medium), or ≥21 mmHg (high-tension glaucoma [HTG]). Patients underwent scanning laser ophthalmoscopy, SD-OCT, and Humphrey visual field testing. Univariate and multivariate models were created, accounting for degree of retinal ganglion cell (RGC) loss by either OCT RNFL thickness or visual field mean deviation (MD). RESULTS: Univariate and multivariate analyses demonstrated no morphological differences in HRT or OCT parameters among IOP groups that met Bonferroni-corrected statistical significance when using either MD or OCT RNFL as the damage criterion (p < 0.0063). The mean cup depth was shallower for the IOP <15 mmHg group than the IOP ≥21 mmHg group (p < 0.05) for both MD (p < 0.011) and OCT RNFL (p < 0.014). CONCLUSION: Normal-tension and high-tension glaucoma are not distinguishable by optic nerve head topography with HRT and OCT when the degree of damage by Humphrey visual field testing is taken into account.

Repeatability and Agreement of Orbscan II, Pentacam HR, and Galilei Tomography Systems in Corneas With Keratoconus.

PURPOSE: To assess the repeatability and agreement of keratometry and pachymetry measurements obtained using 3 tomographers in eyes with keratoconus. DESIGN: Reliability analysis. METHODS: setting: Institutional. STUDY POPULATION: Fifty eyes of 50 participants with keratoconus. observational procedure: Steep keratometry, flat keratometry, central corneal thickness (CCT), and thinnest corneal thickness (TCT) measurements using Galilei, Orbscan II, and Pentacam HR. MAIN OUTCOME MEASURES: Repeatability was assessed using within-subject standard deviation (SW), coefficient of variation (CV), and intraclass correlation coefficient (ICC). Bland-Altman plots and 95% limits of agreement (LoA) were used to evaluate agreement between device pairs. RESULTS: For all studied parameters, ICC was >0.97 with the least repeatable measurements obtained using Orbscan II. Mean steep keratometry values were similar while mean flat keratometry values were significantly different between all devices. The Galilei and Pentacam HR had the lowest 95% LoA for both CCT and TCT. There were no significant differences in mean CCT between Galilei and Pentacam HR. Mean Orbscan II CCT measurements were not significantly different overall but had wide 95% LoA with Pentacam HR (-47.95 to 58.09 µm) and Galilei (-43.70 to 53.91 µm). Mean Orbscan II CCT measurements were significantly lower when an acoustic factor of 0.92 was applied (-33.6 µm vs Pentacam HR, P < .001; -33.6 µm vs Galilei; P < .001). CONCLUSIONS: Keratometric and pachymetric measurements of keratoconic eyes obtained by Galilei, Orbscan II, and Pentacam were disparate. Measurements were less repeatable with Orbscan II compared with Pentacam HR and Galilei, although overall repeatability was high for all instruments.