Anterior Lamina Cribrosa Surface Position in Idiopathic Intracranial Hypertension and Glaucoma

2016 ◽  
Vol 27 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Jenni M. Villarruel ◽  
Xiao Q. Li ◽  
Daniella Bach-Holm ◽  
Steffen Hamann
Keyword(s):  
Optic Nerve ◽  
Intracranial Hypertension ◽  
Optic Nerve Head ◽  
Idiopathic Intracranial Hypertension ◽  
Open Angle Glaucoma ◽  
Fluid Pressure ◽  
Lamina Cribrosa ◽  
Enhanced Depth Imaging ◽  
Mean Deviation ◽  
Control Subjects

Purpose To compare the anterior lamina cribrosa (LC) surface position in patients with idiopathic intracranial hypertension (IIH), primary open-angle glaucoma (high-tension glaucoma [HTG] and normal-tension glaucoma [NTG]), and healthy controls using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). Methods This was a retrospective, cross-sectional observational study of 11 eyes with IIH, 20 eyes with HTG, 20 eyes with NTG, and 37 control eyes. Serial horizontal B-scans of the optic nerve head were obtained using EDI-OCT. The LC depth, defined as the distance from the Bruch membrane opening plane to the anterior LC surface, was manually measured on selected B-scans covering the central three-quarters of the optic nerve head in each eye. Results Mean LC depth in patients with IIH (325.2 ± 92.1 µm) was significantly (p<0.01) decreased compared to control subjects (387.8 ± 53.9 µm). In HTG, the mean LC depth (493.0 ± 115.2 µm) was significantly increased compared to NTG (376.6 ± 27.1 µm, p<0.05) and control subjects (332.7 ± 53.1 µm, p<0.001). The trans-LC pressure difference (TLPD) (intraocular pressure − cerebrospinal fluid pressure) was positively correlated with the LC depth (r = 0.96, p<0.001) and inversely correlated with visual field perimetric mean deviation in patients with IIH (r = -0.88, p<0.001). Conclusions The LC is positioned anteriorly in patients with IIH and posteriorly in glaucomatous eyes compared to normal controls. The positional changes of the LC could be a result of the TLPD between the intraocular and intracranial pressure compartments.

3D Optic Nerve Head Segmentation in Idiopathic Intracranial Hypertension

2012 ◽  
pp. 262-267 ◽  
Author(s):  
Ella Maria Kadas ◽  
Falko Kaufhold ◽  
Christian Schulz ◽  
Friedemann Paul ◽  
Konrad Polthier ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Intracranial Hypertension ◽  
Optic Nerve Head ◽  
Idiopathic Intracranial Hypertension ◽  
Head Segmentation

Spontaneous Skull Base Cerebrospinal Fluid Leaks and Their Relationship to Idiopathic Intracranial Hypertension

2020 ◽  
Vol 35 (1) ◽  
pp. 36-43 ◽  
Author(s):  
Samuel Bidot ◽  
Joshua M. Levy ◽  
Amit M. Saindane ◽  
Kannan M. Narayana ◽  
Michael Dattilo ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Intracranial Hypertension ◽  
Skull Base ◽  
Optic Nerve Head ◽  
Idiopathic Intracranial Hypertension ◽  
Signs And Symptoms ◽  
Csf Leak ◽  
Imaging Evaluation ◽  
Cerebrospinal Fluid Leaks

Background The association between spontaneous skull base cerebrospinal fluid (CSF) leaks and idiopathic intracranial hypertension (IIH) has been suggested, but its significance remains unclear. Objective To estimate the prevalence of IIH in spontaneous skull base CSF leak patients. Methods Systematic collection of demographics, neuro-ophthalmic and magnetic resonance imaging evaluation of spontaneous skull base CSF leak patients seen pre- and post-leak repair in one neuro-ophthalmology service. Patients with preexisting IIH were diagnosed with definite IIH if adequate documentation was provided; otherwise, they were categorized with presumed IIH. Classic radiographic signs of intracranial hypertension and bilateral transverse venous sinus stenosis were recorded. Results Thirty six patients were included (age [interquartile range]: 50 [45;54] years; 94% women; body mass index: 36.8 [30.5;39.9] kg/m2), among whom six (16.7%, [95% confidence interval, CI]: [6.4;32.8]) had a preexisting diagnosis of definite or presumed IIH. Of the remaining 30 patients, four (13.3%, 95%CI: [3.8;30.7]) had optic nerve head changes suggesting previously undiagnosed IIH, while one was newly diagnosed with definite IIH at initial consultation. One out of 29 patients with normal findings of the optic nerve head at presentation developed new onset papilledema following surgery (3.4%, 95%CI: [0.1;17.8]) and was ultimately diagnosed with definite IIH. Overall, the prevalence of definite IIH was 19.4% (95%CI: [8.2;36.0]). Conclusion Striking demographic overlap exists between IIH patients and those with spontaneous CSF leak. Definite IIH was present in approximately 20% of our patients. However, its true prevalence is likely higher than identified by using classic criteria. We therefore hypothesize that an active CSF leak serves as an auto-diversion for CSF, thereby “treating” the intracranial hypertension and eliminating characteristic signs and symptoms at initial presentation.

scholarly journals Pediatric Idiopathic Intracranial Hypertension: A not so Rare and Benign Condition

2014 ◽  
Vol 7 (1) ◽  
pp. 5-9
Author(s):  
Manish Modi ◽  
Karan Gupta
Keyword(s):  
Optic Nerve ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Fluid Pressure ◽  
Case Series ◽  
Invasive Procedure ◽  
Positive Outcome ◽  
Benign Condition ◽  
Work Up

ABSTRACT Objective Pediatric idiopathic intracranial hypertension is an underdiagnosed entity with catastrophic presentations. High index of suspicion with early diagnosis and prompt treatment is the key to successful management. Trans-nasal trans-sphenoid Endoscopic Optic Nerve Fenestration is an effective surgical modality for the reversal of vision loss in pediatric idiopathic intracranial hypertension (IIH). Materials and methods This is a single center observational prospective case series. Five diagnosed pediatric patients of IIH satisfying the modified Dandy criteria and reported to the out-patient services of otolaryngology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India in the year 2012 were included in this study. All children underwent thorough clinical examination, complete Neuro-ophthalmological work-up including Visual acuity (V/A), Visual field charting (V/F), Fundus venogram and Radiological work-up with MRI for special optic nerve sections in sagittal reconstruction. Cerebro-Spinal Fluid pressure (CSF) measured preoperatively for all children. Standard endoscopic optic nerve Sheath Fenestration was performed on all children. visual improvement was assessed by comparing preoperative ophthalmological findings. Results Improvement in vision was taken as a positive outcome. Vision improved in all except one child, who had pre-existing optic nerve atrophy. Conclusion Endoscopic optic nerve fenestration is an effective minimally invasive procedure to revert visual loss in pediatric idiopathic intracranial hypertension. How to cite this article Gupta AK, Gupta K, Modi M, Gupta A. Pediatric Idiopathic Intracranial Hypertension: A not so Rare and Benign Condition. Clin Rhinol An Int J 2014;7(1):5-9.

Relationship between Corneal Biomechanical Properties and Optic Nerve Head Changes after Deep Sclerectomy

2017 ◽  
Vol 27 (5) ◽  
pp. 535-541 ◽  
Author(s):  
Laura Díez-Álvarez ◽  
Francisco J. Muñoz-Negrete ◽  
Pilar Casas-Llera ◽  
Noelia Oblanca ◽  
Victoria de Juan ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Nerve Head ◽  
Open Angle Glaucoma ◽  
Biomechanical Properties ◽  
Resistance Factor ◽  
Corneal Hysteresis ◽  
Enhanced Depth Imaging ◽  
Deep Sclerectomy ◽  
Corneal Resistance Factor ◽  
Corneal Biomechanical Properties

Purpose To evaluate corneal biomechanical properties and optic nerve head (ONH) changes following deep sclerectomy (DS) and the relation to each other. Methods Forty-nine eyes with primary open-angle glaucoma that underwent DS were studied. Corneal biomechanical properties were assessed using the Ocular Response Analyzer and the ONH was evaluated by Spectralis optical coherence tomography with enhanced depth imaging technology before surgery and 3 months postoperatively. Changes in corneal hysteresis (CH), corneal resistance factor (CRF), optic nerve cupping, prelaminar tissue thickness, and lamina cribrosa depth and thickness were registered. A correlation matrix and multiple linear regression models were used to determine predictors of ONH changes. Results At 3 months after surgery, mean corneal compensated intraocular pressure (IOPcc) significantly decreased by 27.9% (p<00.001) and mean Goldmann-correlated IOP (IOPg) decreased by 30.52% (p<00.001). Mean CH increased and CRF decreased by 18.4% and 10.1%, respectively (p<00.001). There was a significant reversal of ONH cupping mainly due to a prelaminar tissue thickening (p<00.001). Significant associations were found between ONH cupping reversal and prelaminar tissue thickening with preoperative IOPcc (p = 0.046), IOPg (p = 0.02), and CRF (p = 0.002) and with changes in IOP, CH, and CRF (p<00.001, p = 0.004, p = 0.018, respectively) after surgery. Conclusions Corneal hysteresis increased and CRF decreased significantly 3 months after DS. Corneal resistance factor was the single largest preoperative factor influencing cupping reversal changes. Despite the influence of preoperative variables, postoperative IOP reduction was the only independent factor influencing changes observed in the ONH after surgery.

scholarly journals Image-Based Modeling of Optic Nerve Head Mechanics Following Lumbar Puncture

2017 ◽  
Author(s):  
Junfei Tong ◽  
Deepta Ghate ◽  
Sachin Kedar ◽  
Linxia Gu
Keyword(s):  
Optic Nerve ◽  
Lumbar Puncture ◽  
Optic Nerve Head ◽  
Computational Models ◽  
Cell Damage ◽  
Open Angle Glaucoma ◽  
Element Model ◽  
Lamina Cribrosa ◽  
Image Based Modeling

Biomechanics of optic nerve head (ONH) has attracted increasing attention in recent years due to its association with ganglion cell damage and tissue remodeling resulted vision impairments [1, 2]. The ONH is exposed to both intraocular pressure (IOP) and intracranial pressure (ICP), separated by the lamina cribrosa (LC) which is regarded as the primary site of axonal injury in glaucoma[3]. The elevated IOP was widely acknowledged as a major risk factor for glaucoma. However, a large number of glaucoma patients never have an increase in IOP [4]. In studies that have looked at lumbar puncture (LP) data, patients with open-angle glaucoma were found to have lower ICPs than non-glaucomatous controls[5]. It suggests that higher translaminar pressure difference across the LC rather than IOP alone may have an important role in the pathogenesis of ONH damage. There were few computational models had been established to investigate the ICP’s role on ONH, such as Ethier et al. found elevated ICP could induce decreased strain within LC using finite element model[6]. However, less experimental data are available for delineating the role of ICP on the behaviors of LC. In this work, we present one dataset from LP patients and reconstruct its two-dimensional computational model of the ONH based on the patient’s images to delineate the role of ICP on ONH mechanics. The changes of LC depth, BMO width and papillary height were compared between the simulation and clinical dataset. The maximum principal strain of LC was calculated to reinforce its link with mechanosensitive cells in ONH.

Imaging Features of Idiopathic Intracranial Hypertension in Children

2016 ◽  
Vol 32 (1) ◽  
pp. 120-126 ◽  
Author(s):  
Alexander J. P. W. Hartmann ◽  
Bruno P. Soares ◽  
Beau B. Bruce ◽  
Amit M. Saindane ◽  
Nancy J. Newman ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Intracranial Hypertension ◽  
Optic Nerve Head ◽  
Idiopathic Intracranial Hypertension ◽  
Empty Sella ◽  
Imaging Features ◽  
Mri Findings ◽  
Sinus Stenosis ◽  
Magnetic Resonance Imaging Mri

Magnetic resonance imaging (MRI) signs of elevated intracranial pressure and idiopathic intracranial hypertension have been well characterized in adults but not in children. The MRIs of 50 children with idiopathic intracranial hypertension and 46 adults with idiopathic intracranial hypertension were reviewed for optic nerve head protrusion, optic nerve head enhancement, posterior scleral flattening, increased perioptic cerebrospinal fluid, optic nerve tortuosity, empty or partially empty sella, tonsillar herniation, enlargement of Meckel’s cave meningoceles, and transverse venous sinus stenosis(TSS). Compared to adolescents (11-17 years, n = 40) and adults (>17 years, n = 46), prepubescent children (<11 years, n = 10) had lower frequencies of scleral flattening (50% vs 89% and 85%, P = .02), increased perioptic cerebrospinal fluid (60% vs 84% and 89%, P = .08), optic nerve tortuosity (20% vs 46% and 59%, P = .07), empty or partially empty sella (56% vs 78% and 93%, P = .007), and TSS (67% vs 93% and 96%, P = .04). Children with idiopathic intracranial hypertension have similar MRI findings as adults, but they are less frequent in prepubescent children.

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