RESUMO
Idiopathic intracranial hypertension (IIH) is a neuro-ophthalmological condition characterised by a raised intracranial pressure and papilloedema that causes disabling headaches. The main risk factors of female sex and living with obesity have been known for some time, however the knowledge of the underlying pathophysiology is evolving. Papilloedema can impact the visual function, and the majority of people are offered acetazolamide. Those with sight threatening disease need urgent management, though there is little high quality evidence to recommend any particular surgical intervention. Headache treatment is an unmet clinical need and simple medication overuse advice has the potential to reduce the chronification of migraine-like headaches. IIH is emerging as a systemic metabolic disease distinct from people living with obesity alone. While weight loss is the main stay of disease modifying therapy this is challenging to access and many healthcare professionals that manage the condition have no formal training or accessible pathways for weight management. The aim of this "how to do it" article is to present the latest advances in knowledge of IIH that we pragmatically included in routine clinical care for people living with the condition.
Assuntos
Papiledema , Pseudotumor Cerebral , Humanos , Pseudotumor Cerebral/fisiopatologia , Pseudotumor Cerebral/terapia , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/complicações , Papiledema/diagnóstico , Papiledema/fisiopatologia , Papiledema/terapia , Papiledema/etiologia , Acetazolamida/uso terapêutico , Fatores de Risco , Obesidade/complicações , Obesidade/fisiopatologia , Inibidores da Anidrase Carbônica/uso terapêutico , Gerenciamento ClínicoRESUMO
Papilledema refers to the swelling of the optic disk due to increased intracranial pressure. In clinical practice, papilledema is often confused with optic disc edema. Idiopathic intracranial hypertension (IIH) is a major cause of papilledema and there are still misconceptions about the etiology of IIH, the classification and examination of papilledema, and the treatment of IIH. This article elaborates on the misunderstandings that may exist in the diagnosis and treatment of papilledema, in order to lay a foundation for the standardized diagnosis and treatment of papilledema in China.
Assuntos
Hipertensão Intracraniana , Disco Óptico , Papiledema , Pseudotumor Cerebral , Humanos , Papiledema/diagnóstico , Papiledema/etiologia , Papiledema/terapia , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/terapia , Hipertensão Intracraniana/complicações , Hipertensão Intracraniana/diagnóstico , ChinaRESUMO
PURPOSE: This study aimed to identify predictors of rapid improvement of papilledema after stenting and develop a simple preintervention scale. METHODS: A prospective cohort of idiopathic intracranial hypertension (IIH) with venous sinus stenosis (VSS) treated with stenting in a tertiary hospital from January 2014 to December 2019 was reviewed. We categorized papilledema improvement into favorable (grades 0-1) and unfavorable (grades 2-5). We employed logistic regression analysis to find the predictive factors and develop the predictive scale. We then estimated the performance of the scale using the ROC curve and Hosmer-Lemeshow test. RESULTS: There were 110 patients who underwent venous sinus stenting, with a mean age of 37.1 years and a predominance of females (77.3%). A total of 85 patients had a favorable outcome following stenting, while 25 patients had an unfavorable outcome. The results of the multivariate analysis indicate that lower preoperative pressure gradients (odds ratio, OR: 4.01; 95% confidence interval, CI: 1.27-12.68), stenosis rates (OR: 4.16; 95% CI: 1.11-15.56), and preoperative papilledema grades (OR: 2.92; 95% CI: 1.44-5.91) were independently associated with rapid improvement of papilledema following stenting treatment. The 3item scale exhibited good discrimination with an area under the curve (AOC) of 0.81 (95% CI 0.72-0.89, pâ¯< 0.001), as well as acceptable calibration determined by the Hosmer-Lemeshow test (Pâ¯= 0.42). The optimal cut-off value of the scale (range 0-6 points) was ≥â¯4 points, with a sensitivity of 72%, specificity of 73%, and accuracy of 78%. CONCLUSION: The presence of lower preoperative pressure gradients, stenosis severity, and preoperative status of papilledema were identified as positive predictors of rapid improvement of the papilledema following stenting in IIH patients. The 3item scale provides a promising preintervention predictive model for predicting rapid response following stenting treatment in IIH patients with VSS.
Assuntos
Papiledema , Pseudotumor Cerebral , Feminino , Humanos , Adulto , Masculino , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/cirurgia , Papiledema/terapia , Constrição Patológica , Estudos Prospectivos , Resultado do Tratamento , Estudos Retrospectivos , Stents , Cavidades CranianasRESUMO
OBJECTIVE: This study aimed to identify the key factors that might affect the clinical outcome of patients with idiopathic intracranial hypertension (IIH) and Venous sinus stenting (VSS). METHODS: We performed an analysis of a prospectively collected database of patients with IIH and VSS who underwent stenting. The trans-stenotic pressure gradient was measured before and after intervention. In additional, patients' baseline characteristics, procedure details and clinical outcomes at 6-month follow-up (including changes in headache, visual impairment, papilledema, etc.) were recorded. The effects of post-intervention pressure gradient on symptom-free at 6 months were explored using logistic regression analysis, generalized additive model and receiver operator characteristic (ROC) curve. RESULTS: Of 101 patients included in this study, the median pressure gradient across stenosis decreased from 19 mmHg before intervention to 2 mmHg after intervention. At 6 months, symptom-free was observed in 58 cases (57.4%). Multivariable logistic analysis and generalized additive model showed that post-intervention pressure gradient (increased by 1 mmHg) was independently and linearly correlated with symptom-free (OR = 0.79, 95% CI = 0.67-0.94). Moreover, the post-intervention pressure gradient revealed moderate discrimination with an area under ROC curve of 0.68 (95% CI = 0.57-0.78). Similar associations were observed for the disappearance of headache and papilledema, but not for the visual recovery. CONCLUSION: The post-intervention pressure gradient may be a valid and reliable predictor of 6-month clinical outcome in patients with IIH and VSS treated by stenting. Nevertheless, external validation with blinded outcome is still needed to confirm its performance before clinical application.
Assuntos
Hipertensão Intracraniana , Papiledema , Pseudotumor Cerebral , Humanos , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/cirurgia , Papiledema/terapia , Papiledema/complicações , Constrição Patológica/terapia , Constrição Patológica/complicações , Resultado do Tratamento , Estudos Retrospectivos , Cefaleia/etiologia , Cefaleia/terapia , Stents , Cavidades Cranianas/diagnóstico por imagem , Cavidades Cranianas/cirurgiaRESUMO
BACKGROUND: This prospective cohort study compared the outcomes of stenting and medical treatment for patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis (VSS). METHODS: In this single-center cohort study, patients with IIH and VSS were evaluated between January 2014 and December 2019 with follow-up periods of 1, 3, and 6 months. The patients received either stenting or medical treatment. The two groups underwent 1:1 matching using propensity score analysis, and the clinical outcomes were compared. RESULTS: Following 1:1 matching, 36 patients who underwent stenting and 36 who underwent medical treatment were matched. The median improvements in the papilledema Frisén grade were greater in the stenting group at 1 month (-2 vs 0), 3 months (-3 vs -1), and 6 months (-3 vs -1) than in the medical treatment group. Patients who received stenting treatment had a significantly higher prevalence of complete resolution of their respective symptoms (headache, tinnitus, or visual disturbances) at 3 months (58.3% vs 13.9%, OR 8.68, 95% CI 2.74 to 27.52) and 6 months (80.6% vs 22.2%, OR 14.50, 95% CI 4.64 to 45.32) than those receiving medical treatment. CONCLUSIONS: This matched-control study shows that stenting has a greater efficacy rate and rapid resolution of papilledema and its respective symptoms compared with medical treatment.
Assuntos
Hipertensão Intracraniana , Papiledema , Pseudotumor Cerebral , Humanos , Pseudotumor Cerebral/cirurgia , Pseudotumor Cerebral/etiologia , Papiledema/terapia , Estudos de Coortes , Estudos Prospectivos , Resultado do Tratamento , Stents/efeitos adversos , Constrição Patológica/etiologia , Cavidades Cranianas , Hipertensão Intracraniana/terapia , Estudos RetrospectivosRESUMO
BACKGROUND: This study evaluates the effectiveness of a multidisciplinary protocol for management of patients with papilledema and vision loss secondary to increased intracranial pressure. METHODS: Retrospective record review of all adult patients who presented with vision-threatening papilledema (VTPE) and were treated under this protocol. Patients are admitted for lumbar drain placement and diuretics and followed daily to determine if they may be managed medically or require surgery (optic nerve sheath fenestration [ONSF] and/or cerebrospinal fluid [CSF] shunting). RESULTS: Nineteen patients were included. Twelve had body mass index in the obese range and 6 were morbidly obese. Fourteen had idiopathic intracranial hypertension. Five had secondary pseudotumor cerebri syndrome related to medication use, dural venous sinus thrombosis, hypothyroidism, end-stage renal disease, pulmonary disease, and diastolic heart failure. Three patients did not require surgery and were discharged on oral diuretics; 3 patients underwent unilateral ONSF, 9 underwent bilateral ONSF, and 4 underwent bilateral ONSF followed by ventriculoperitoneal shunt placement. The average follow-up was 10.1 months. The visual acuity improved bilaterally in 12 patients and unilaterally in 4 patients. The remaining 3 patients had worsened vision in both eyes. Fifteen patients had bilateral improvement in their visual fields. Five eyes in 3 patients showed further constriction of the visual field at follow-up. CONCLUSIONS: We demonstrate how a multidisciplinary complex care protocol for treating VTPE can expedite and streamline treatment and restore vision. We found that most patients had improved symptoms and signs, including visual acuity, visual fields, and papilledema. We encourage institutions that manage VTPE to adopt similar institutional protocols.
Assuntos
Obesidade Mórbida , Papiledema , Pseudotumor Cerebral , Adulto , Humanos , Papiledema/diagnóstico , Papiledema/etiologia , Papiledema/terapia , Nervo Óptico/patologia , Estudos Retrospectivos , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/cirurgia , DiuréticosRESUMO
Idiopathic intracranial hypertension (IIH) is a triad of headaches, visual changes, and papilledema in the absence of a secondary cause for elevated intracranial pressure. There is an association with obesity, and the incidence is rising in parallel with the obesity epidemic. Sometimes these patients present to an otolaryngologist with complaints like tinnitus, dizziness, hearing loss, and otorrhea or rhinorrhea from cerebrospinal fluid leak. IIH diagnosis in conjunction with neurology and ophthalmology, including neuroimaging and lumbar puncture with opening pressure, is key to managing of this condition. Otolaryngologists should recognize IIH as a possible diagnosis and initiate appropriate referrals and treatment.
Assuntos
Hipertensão Intracraniana , Papiledema , Pseudotumor Cerebral , Humanos , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/terapia , Obesidade/complicações , Otorrinolaringologistas , Papiledema/diagnóstico , Papiledema/etiologia , Papiledema/terapia , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/terapiaRESUMO
Papilledema is optic nerve head edema secondary to raised intracranial pressure (ICP). It is distinct from other causes of optic disk edema in that visual function is usually normal in the acute phase. Papilledema is caused by transmission of elevated ICP to the subarachnoid space surrounding the optic nerve that hinders axoplasmic transport within ganglion cell axons. There is ongoing controversy as to whether axoplasmic flow stasis is produced by physical compression of axons or microvascular ischemia. The most common cause of papilledema, especially in patients under the age of 50, is idiopathic intracranial hypertension (IIH); however, conditions that decrease cerebrospinal fluid (CSF) outflow by either causing CSF derangements or mechanically blocking CSF outflow channels, and rarely conditions that increase CSF production, can be the culprit. When papilledema is suspected clinically, blood pressure should be measured, and pseudopapilledema should be ruled out. Magnetic resonance imaging of the brain and orbits with venography sequences is the preferred neuroimaging modality that should be performed next to look for indirect imaging signs of increased ICP and to rule out nonidiopathic causes. Lumbar puncture with measurement of opening pressure and evaluation of CSF composition should then be performed. In patients not in a typical demographic group for IIH, further investigations should be conducted to assess for underlying causes of increased ICP. Magnetic resonance imaging of the neck and spine, magnetic resonance angiography of the brain, computed tomography of the chest, complete blood count, and creatinine testing should be able to identify most secondary causes of intracranial hypertension. Treatment for patients with papilledema should be targeted toward the underlying etiology. Most patients with IIH respond to weight loss and oral acetazolamide. For patients with decreased central acuity and constricted visual fields at presentation, as well as patients who do not respond to treatment with acetazolamide, surgical treatments should be considered, with ventriculoperitoneal shunting being the typical procedure of choice.
Assuntos
Hipertensão Intracraniana , Doenças do Nervo Óptico , Papiledema , Pseudotumor Cerebral , Acetazolamida , Humanos , Hipertensão Intracraniana/complicações , Hipertensão Intracraniana/diagnóstico , Papiledema/diagnóstico , Papiledema/etiologia , Papiledema/terapia , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/diagnósticoRESUMO
BACKGROUND: Eye trauma is an unfortunate and often preventable cause of vision loss. Confetti cannons are common causes of injury. Awareness of ocular hazards of confetti cannons remains low because of limited reports describing ophthalmic injuries following their use. OBJECTIVES: To describe outcomes of ocular trauma caused by confetti cannons and to increase recognition of their ocular risks. METHODS: A retrospective analysis was conducted of eye injuries caused by confetti cannons presenting to a single medical center between 2016 and 2020. Data collected included age, gender, eye injured, ocular damage, visual outcome, and details of surgeries performed. RESULTS: Overall, six consecutive patients (2 males, mean age 19.5 ± 9.74 years) were identified and studied. In all patients only one eye was injured (3 right eyes) during a private celebration, most commonly (n=5) to a bystander while in the vicinity of a cannon operated by someone else. Most common eye injuries included corneal erosion (n=4), traumatic hyphema (n=4), and retinal edema (n=3). Mean initial logMAR visual acuity in the injured eye was 0.73 ± 0.18, improving to 0.25 ± 0.16 at the final visit (P = 0.125). Two patients underwent eye surgery due to their trauma: one to repair globe penetration and another to undergo intravitreal injection of tissue plasminogen activator and C3F8 for submacular hemorrhage, followed 8 months later by intravitreal bevacizumab injection for choroidal neovascularization. CONCLUSIONS: Confetti cannons pose hazards that can cause severe ocular trauma resulting in permanent vision loss. Increasing awareness of device hazards is necessary to prevent eye injuries.
Assuntos
Bevacizumab/administração & dosagem , Lesões da Córnea , Traumatismos Oculares , Hifema , Papiledema , Ativador de Plasminogênio Tecidual/uso terapêutico , Adulto , Inibidores da Angiogênese/administração & dosagem , Criança , Neovascularização de Coroide/prevenção & controle , Lesões da Córnea/diagnóstico , Lesões da Córnea/etiologia , Lesões da Córnea/terapia , Traumatismos Oculares/etiologia , Traumatismos Oculares/patologia , Traumatismos Oculares/fisiopatologia , Traumatismos Oculares/terapia , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Hifema/diagnóstico , Hifema/etiologia , Hifema/terapia , Injeções Intravítreas/métodos , Masculino , Papiledema/diagnóstico , Papiledema/etiologia , Papiledema/terapia , Estudos Retrospectivos , Índices de Gravidade do Trauma , Testes Visuais/métodos , Acuidade VisualRESUMO
Diabetic papillitis (used interchangeably with diabetic papillopathy) is a relatively rare ocular manifestation of systemic diabetic disease. Found in both type 1 and type 2 diabetic patients, it manifests as swelling of the optic nerve head in one or both eyes and is considered a diagnosis of exclusion. Signs and symptoms of optic nerve disease are not necessarily present, and there may be spontaneous recovery. The pathogenesis is poorly understood. The following discussion will cover the presentation, diagnosis, treatment, and prognosis of diabetic papillopathy.
Assuntos
Complicações do Diabetes/complicações , Papiledema/diagnóstico , Papiledema/etiologia , Humanos , Papiledema/terapia , Fotografação , Prognóstico , Distúrbios Pupilares/etiologia , Distúrbios Pupilares/fisiopatologia , Tomografia de Coerência Óptica , Acuidade Visual , Testes de Campo VisualAssuntos
COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Papiledema/epidemiologia , Pseudotumor Cerebral/epidemiologia , Adulto , COVID-19/epidemiologia , COVID-19/transmissão , Feminino , Humanos , Masculino , Papiledema/diagnóstico , Papiledema/terapia , Estudos Prospectivos , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/terapia , Reino Unido , Adulto JovemRESUMO
SIGNIFICANCE: Amiodarone is an excellent antiarrhythmic medication; however, it has numerous systemic and ocular adverse effects. PURPOSE: We aimed to improve our understanding of amiodarone and its ocular adverse effects by performing a systematic review and meta-analysis of published case reports. METHODS: This systematic review was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We used the MEDLINE database, primarily through PubMed, and used keywords (amiodarone, eye, eye diseases, visual/ocular adverse effects/manifestations) to identify case reports of ocular adverse effects after amiodarone use. The initial search resulted in 92 total case reports. However, after excluding nonrelevant case reports, 25 cases were selected for the final analysis. RESULTS: Among the patients in the 25 case reports, 18 were male (72%), and the median age was 66 ± 9.9 years. In 15 cases (60%), the patients reported halos around light and/or decrease in vision after amiodarone use. The most common ophthalmic examination findings were cornea verticillata/vortex keratopathy in 19 cases (76%), followed by different patterns of papilledema and retinal hemorrhages in 5 cases (20%). Discontinuation of amiodarone was the most common intervention, followed by application of topical heparin. Outcomes among case reports were variable. CONCLUSIONS: Cornea verticillata/vortex keratopathy was the most common ocular adverse effect in cases where amiodarone was administered. Early recognition of amiodarone-induced ocular adverse effects is imperative to prevent worsening keratopathy or uncommon adverse effects. Collaboration between physicians prescribing amiodarone-to recognize the ocular symptoms-and referral to eye care physicians are important.
Assuntos
Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Doenças da Córnea/induzido quimicamente , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Papiledema/induzido quimicamente , Hemorragia Retiniana/induzido quimicamente , Transtornos da Visão/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Doenças da Córnea/diagnóstico , Doenças da Córnea/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Papiledema/diagnóstico , Papiledema/terapia , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/terapia , Transtornos da Visão/diagnóstico , Transtornos da Visão/terapiaRESUMO
Ischemic optic neuropathies include any vascular disease of the optic nerve. Anterior ischemic optic neuropathies are classically distinguished from posterior ischemic optic neuropathies by the presence of optic disc edema in the former, and the absence thereof in the latter. Non-arteritic acute anterior ischemic optic neuropathy is the most common ischemic optic nerve disease. Its exact cause remains unknown. A disc at risk (small and crowded optic nerve) is a typical backdrop for the development of non-arteritic ischemic optic neuropathy. There is no curative or preventive treatment. Posterior ischemic optic neuropathy is exceedingly rare, compared to anterior ischemic optic neuropathy. It is more frequent in patients with cardiovascular risk factors or in the perioperative period. There is no treatment. In any case of ischemic optic neuropathy, an arteritic cause must be ruled out urgently through clinical and paraclinical examinations. The most frequent cause is giant-cell arteritis. In this case, emergency treatment with intravenous methylprednisolone is required in order to limit vision loss in the affected eye and to prevent vision loss in the other eye.
Assuntos
Neuropatia Óptica Isquêmica , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/epidemiologia , Arterite de Células Gigantes/terapia , Humanos , Neuropatia Óptica Isquêmica/diagnóstico , Neuropatia Óptica Isquêmica/epidemiologia , Neuropatia Óptica Isquêmica/etiologia , Neuropatia Óptica Isquêmica/terapia , Papiledema/complicações , Papiledema/diagnóstico , Papiledema/epidemiologia , Papiledema/terapia , Prognóstico , Fatores de Risco , Transtornos da Visão/diagnóstico , Transtornos da Visão/epidemiologia , Transtornos da Visão/etiologia , Transtornos da Visão/terapiaRESUMO
The presentation of idiopathic intracranial hypertension (IIH) in pediatric populations has several important distinctions from that in adults, especially among prepubertal patients, in which there is no apparent association with gender or obesity. Pediatric patients are more likely to be asymptomatic or present with atypical symptoms than their adult counterparts, posing a diagnostic challenge in some cases. It is important to be aware of the ways in which diagnostic criteria for IIH are modified from that of adults. Ideal treatment practices and the natural history of pediatric IIH remain unclear. Acetazolamide is the mainstay of medical treatment, but some patients with significant visual loss may require surgical intervention. Multicenter studies to accrue a large number of cases and future prospective studies will help to better define pediatric IIH and to formulate consensus guidelines for treatment and management of these patients.
Assuntos
Papiledema , Pseudotumor Cerebral , Transtornos da Visão , Criança , Humanos , Papiledema/diagnóstico , Papiledema/etiologia , Papiledema/terapia , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/terapia , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Transtornos da Visão/terapiaRESUMO
ABSTRACT Vitreopapillary traction is an uncommon condition characterized by strong adhesion and the traction of the posterior hyaloid onto the optic disc and peripapillary retina, leading to optic disc elevation and visual loss. An 85-year-old man presented with a 6-month history of slow, progressive visual loss in the left eye along with optic disc edema. Swept-source optical coherence tomography B-scans revealed circumpapillary anterior-posterior persistent traction of dense vitreous strands onto the optic disc. Visual field examination demonstrated mild, generalized, diffuse sensitivity loss and blind-spot enlargement. A 25-gauge posterior vitrectomy was performed with posterior hyaloid separation from the optic disc, resulting in significant anatomical and visual improvement. In conclusion, swept-source optical coherence tomography aids in understanding the mechanism underlying visual loss in vitreopapillary traction. Moreover, posterior vitrectomy can effectively promote anatomical and visual improvements in these cases.
RESUMO A tração vitreopapilar é uma condição incomum caracterizada por forte adesão e tração da hialoide posterior no disco óptico e retina peripapilar, levando à elevação do disco óptico e à perda visual. Um homem de 85 anos apresentou uma história de 6 meses de perda visual lenta e progressiva no olho esquerdo, juntamente com edema do disco óptico. A tomografia de coerência óptica por fonte de varredura revelou tração persistente ântero-posterior peripapilar com traves vítreas densas sobre o disco óptico. Exame de campo visual demonstrou perda de sensibilidade difusa, generalizada, leve e aumento do ponto cego. Uma vitrectomia posterior de calibre 25 foi realizada com separação hialóide posterior do disco óptico, resultando em melhora anatômica e visual significativa. Em conclusão, a tomografia de coerência óptica por fonte de varredura auxilia na compreensão do mecanismo subjacente à perda visual na síndrome de tração vitreopapilar. Além disso, a vitrectomia posterior pode efetivamente promover melhorias visuais e anatômicas nesses casos.
Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Corpo Vítreo/patologia , Corpo Vítreo/diagnóstico por imagem , Papiledema/patologia , Papiledema/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Índice de Gravidade de Doença , Acuidade Visual , Aderências Teciduais , Papiledema/terapia , Cegueira/etiologia , Resultado do Tratamento , Membrana Epirretiniana/patologia , Membrana Epirretiniana/diagnóstico por imagemRESUMO
Vitreopapillary traction is an uncommon condition characterized by strong adhesion and the traction of the posterior hyaloid onto the optic disc and peripapillary retina, leading to optic disc elevation and visual loss. An 85-year-old man presented with a 6-month history of slow, progressive visual loss in the left eye along with optic disc edema. Swept-source optical coherence tomography B-scans revealed circumpapillary anterior-posterior persistent traction of dense vitreous strands onto the optic disc. Visual field examination demonstrated mild, generalized, diffuse sensitivity loss and blind-spot enlargement. A 25-gauge posterior vitrectomy was performed with posterior hyaloid separation from the optic disc, resulting in significant anatomical and visual improvement. In conclusion, swept-source optical coherence tomography aids in understanding the mechanism underlying visual loss in vitreopapillary traction. Moreover, posterior vitrectomy can effectively promote anatomical and visual improvements in these cases.
Assuntos
Papiledema/diagnóstico por imagem , Papiledema/patologia , Tomografia de Coerência Óptica/métodos , Corpo Vítreo/diagnóstico por imagem , Corpo Vítreo/patologia , Idoso de 80 Anos ou mais , Cegueira/etiologia , Membrana Epirretiniana/diagnóstico por imagem , Membrana Epirretiniana/patologia , Humanos , Masculino , Papiledema/terapia , Índice de Gravidade de Doença , Aderências Teciduais , Resultado do Tratamento , Acuidade VisualRESUMO
We report a case of bilateral papillitis and anterior uveitis in a pediatric patient with preceding viral prodrome. Because this is a rare disease in the pediatric population, work-up in this case was extensive given the wide differential of papilledema in the pediatric setting. The clinical significance of this case is to bring to light the timely recognition, follow-up, and treatment of this disease to minimize the burden to the patient and family.
Assuntos
Papiledema , Uveíte Anterior , Doença Aguda , Criança , Diagnóstico Diferencial , Humanos , Papiledema/diagnóstico , Papiledema/terapia , Fatores de Tempo , Uveíte Anterior/diagnóstico , Uveíte Anterior/terapiaRESUMO
BACKGROUND: Stenting of the intracranial venous sinuses is used as a treatment in certain cases of idiopathic intracranial hypertension (IIH). Interest in, and experience of, this technique is growing, particularly in recent years. We sought to provide an updated systematic review and meta-analysis of the use of venous stenting in these patients, examining clinical outcomes. METHODS: A literature search of venous stenting in IIH patients was performed. Using random-effects meta-analysis, we evaluated the following outcomes: clinical resolution of papilledema; headaches and pulsatile tinnitus; recurrence of symptoms after stenting; and complications. RESULTS: Twenty articles from 18 different centers were included. In a total of 474 patients. 418 were female (88%). The mean age of the patients was 35, while the mean body mass index (BMI) was 35 kg/m2. Median follow-up was 18 months. The overall rate of improvement in papilloedema was 93.7% (95% CI 90.5% to 96.9%), while the overall rate of improvement or resolution of headache was 79.6% (95% CI 73.3% to 85.9%). Pulsatile tinnitus resolved in 90.3% (95% CI 83.8% to 96.70%), while the overall rate of recurrence of IIH symptoms after stenting was 9.8% (95% CI 6.7% to 13%). The rate of major complications was 1.9% (95% CI 0.07% to 3.1%). CONCLUSIONS: Venous sinus stenting in patients with IIH who are refractory to medical therapy appears to have an excellent safety profile and is associated with significant improvements in headaches, pulsatile tinnitus, and papilledema.