BACKGROUND Venous sinus stenosis (VSS) stenting has emerged as an effective treatment for patient... more BACKGROUND Venous sinus stenosis (VSS) stenting has emerged as an effective treatment for patients with Idiopathic Intracranial Hypertension (IIH). However, stenting carries risk of in-stent stenosis/thrombosis and cumulative bleeding risk from long-term dual antiplatelet (DAPT) use. Thus, we investigated the potential safety and efficacy of primary balloon angioplasty as an alternative to stenting in IIH. METHODS A prospectively maintained single-center registry of IIH patients undergoing endovascular procedures was queried. Inclusion criteria included patients with confirmed IIH and angiographically demonstrable VSS who underwent interventions from 2012- 2021. Patients were dichotomized into primary balloon angioplasty (Group A) and primary stenting (Group S), comparing clinical outcomes using bivariate analyses. RESULTS 62 patients were included with median age of 33 [IQR 26-37], 74% females. Group A (9/62) and Group S (53/62) had similar baseline characteristics. Papilledema improvement was higher in Group S at 6 weeks and 6 months (44 vs. 93, p = 0.002 and 44 vs. 92%, p = 0.004), with similar improvements across all symptoms. Group S had higher mean post-procedure venous pressure gradient change (8 vs. 3 mmHg, p = 0.02) and a lower CSF opening pressure at 6 months (23 vs. 36 cmH2O, p < 0.001). VPS rescue rate was higher in Group A (44 vs. 2%, p = 0.001). There was only one procedural complications; a subdural hematoma in Group A. CONCLUSIONS Primary VSS balloon angioplasty provides a marginal and short-lived improvement of IIH symptoms compared to stenting. These findings suggest a cautious and limited role for short-term rescue angioplasty in poor shunting and stenting candidates with refractory IIH.
Introduction Venous sinus stenosis (VSS) stenting in medically refractory Idiopathic Intracranial... more Introduction Venous sinus stenosis (VSS) stenting in medically refractory Idiopathic Intracranial Hypertension (IIH) patients has emerged as an effective treatment with low rates of failure and recurrence. However, the best treatment strategy following recurrence of symptoms in previously stented patients with initial response is unclear and frequently leads to shunt placement. We investigated the role of re‐stenting in patients with recurrence after prior successful stenting. Methods This is a retrospective review of a prospectively maintained IIH registry. Inclusion criteria included patients with confirmed IIH and angiographically demonstrable VSS who underwent interventions from 2012–2022. Patients were divided into those who underwent a single stenting procedure (Group S) and those who underwent placement of an additional stent due to recurrence of clinical symptoms and angiographic stenosis (Group R). All re‐stenting was performed in adjacent or remote regions of stenosis. Biv...
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2011
Idiopathic intracranial hypertension (IIH) is a rare condition characterized by raised intracrani... more Idiopathic intracranial hypertension (IIH) is a rare condition characterized by raised intracranial pressure (ICP) without related pathology in either the brain or the composition of cerebrospinal fluid (CSF). Herein, we provide a brief review of the clinical presentation of IIH and the anesthetic considerations in parturients diagnosed with the disorder. We conducted a MEDLINE® literature search for all types of articles published in English with restriction for year of publication, and we used the search terms &amp;amp;amp;amp;amp;amp;amp;amp;quot;idiopathic intracranial hypertension&amp;amp;amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;amp;amp;quot;pseudotumor cerebri&amp;amp;amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;amp;amp;quot;benign intracranial hypertension&amp;amp;amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;amp;amp;quot;pregnancy&amp;amp;amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;amp;amp;quot;cesarean section&amp;amp;amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;amp;amp;quot;labour analgesia&amp;amp;amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;amp;amp;quot;epidural&amp;amp;amp;amp;amp;amp;amp;amp;quot;, and &amp;amp;amp;amp;amp;amp;amp;amp;quot;anesthesia&amp;amp;amp;amp;amp;amp;amp;amp;quot;. Idiopathic intracranial hypertension affects primarily obese women of childbearing age. The main symptom is headache, and the cardinal sign is papilledema. The main goal of management is to preserve visual function. Treatment lies in the administration of diuretics and corticosteroids, control of excessive weight gain, and surgical management, such as cerebrospinal fluid diversion or optic nerve sheath fenestration for refractory cases. For the parturient with IIH, Cesarean delivery is not necessarily indicated. Neuraxial anesthesia has been used uneventfully for both labour analgesia and for Cesarean delivery. There are reports describing successful use of both spinal and epidural anesthesia, even in IIH patients with CSF diversion devices in situ. Although IIH is rare, there are special considerations for anesthetic management in the parturient. Despite the presence of raised ICP in these patients, there are no specific contraindications to neuraxial techniques, and uncal herniation has not been reported to occur in patients with IIH.
Endocrinology, Diabetes & Metabolism Case Reports, 2022
Summary Thyroid dermopathy is an uncommon manifestation of thyroid disease that impairs the quali... more Summary Thyroid dermopathy is an uncommon manifestation of thyroid disease that impairs the quality of life in certain cases. Currently, the available treatments offer limited results and a chance of recurrence. Teprotumumab, a novel medication that results in the regression of thyroid ophthalmopathy, may have similar effects on dermopathy. We describe four patients treated with teprotumumab for their thyroid ophthalmopathy who concomitantly had dermatopathy upon initiation of their infusions. Patients improved after two to three infusions and three out of the four patients have not suffered a recurrence.Teprotumumab is a monoclonal antibody (MAB) that attenuates an inflammatory response, resulting in decreased edema and tissue expansion. Given the similarities of their pathophysiology, we believe that the resolution of thyroid dermatopathy and regression of thyroid eye disease occurs via the same mechanism. We encourage further investigation utilizing teprotumumab for patients whos...
Journal of Pediatric Ophthalmology & Strabismus, 1986
A case of linear scleroderma presenting as a pseudo oculomotor palsy is reviewed. The patient&... more A case of linear scleroderma presenting as a pseudo oculomotor palsy is reviewed. The patient&amp;amp;#39;s facial skin abnormalities suggested the underlying etiology. This case illustrates a previously unreported finding in linear scleroderma, mydriasis without atrophy, reminding the clinician to look at the skin in patients with unexplained unilateral pupillary disturbances.
Optometry and vision science : official publication of the American Academy of Optometry, Dec 1, 2017
Differentiating papilledema from pseudopapilledema reflecting tilted/crowded optic discs or disc ... more Differentiating papilledema from pseudopapilledema reflecting tilted/crowded optic discs or disc drusen is critical but can be challenging. Our study suggests that spectral-domain optical coherence tomography (OCT) peripapillary retinal nerve fiber layer thickness and retrobulbar optic nerve sheath diameter (ONSD) measured by A-scan ultrasound provide useful information when differentiating the two conditions. To evaluate the use of A-scan ultrasound and spectral-domain OCT retinal nerve fiber layer thickness (RNFLT) in differentiating papilledema associated with idiopathic intracranial hypertension from pseudopapilledema. Retrospective cross-sectional analysis included 23 papilledema and 28 pseudopapilledema patients. Ultrasound-measured ONSD at primary gaze, percent change in ONSD at lateral gaze (30° test), and peripapillary RNFLT were analyzed. Receiver operating characteristic curves were constructed using one eye from each subject. Compared with pseudopapilledema, papilledema ...
Thyroid-associated ophthalmopathy, a condition commonly associated with Graves' disease, rema... more Thyroid-associated ophthalmopathy, a condition commonly associated with Graves' disease, remains inadequately treated. Current medical therapies, which primarily consist of glucocorticoids, have limited efficacy and present safety concerns. Inhibition of the insulin-like growth factor I receptor (IGF-IR) is a new therapeutic strategy to attenuate the underlying autoimmune pathogenesis of ophthalmopathy. We conducted a multicenter, double-masked, randomized, placebo-controlled trial to determine the efficacy and safety of teprotumumab, a human monoclonal antibody inhibitor of IGF-IR, in patients with active, moderate-to-severe ophthalmopathy. A total of 88 patients were randomly assigned to receive placebo or active drug administered intravenously once every 3 weeks for a total of eight infusions. The primary end point was the response in the study eye. This response was defined as a reduction of 2 points or more in the Clinical Activity Score (scores range from 0 to 7, with a sc...
OBJECTIVE: To determine whether dynamic changes in optic nerve head (ONH) structure, as measured ... more OBJECTIVE: To determine whether dynamic changes in optic nerve head (ONH) structure, as measured by high definition optical coherence tomography (HD-OCT), occur immediately after lowering intracranial pressure (ICP). BACKGROUND: Biomechanical changes in the ONH with sustained elevation in ICP are well-established. However, the time course of structural changes in ONH with elevated ICP has not been studied. It is not known whether acute ICP changes will cause dynamic measurable changes in the ONH. HD-OCT allows in-vivo enhanced depth imaging of papillary sub-structures. DESIGN/METHODS: We conducted a prospective pilot study in 5 female patients with idiopathic intracranial hypertension (IIH) undergoing a clinically indicated lumbar puncture (LP) after IRB approval. The Cirrus HD-OCT (Carl Zeiss Meditec) was positioned to acquire images in the lateral decubitus position. Optic disc cube 200x200 and HD5 Line Raster scans centered on the ONH were obtained immediately before and after draining cerebrospinal fluid (CSF) in the left lateral decubitus position. Retinal nerve fiber layer (RNFL) thickness, peri-papillary retinal pigment epithelium/bruch’s membrane (RPE/BM) angulation, transverse diameter of neural canal at level of RPE/BM, and highest vertical point of internal limiting membrane (ILM) from transverse diameter were measured. Descriptive statistics are presented. RESULTS: The mean opening and closing CSF pressures were 31.6±11.8 and 11.6±3.3 cmH2O, respectively. Average RNFL thickness decreased after LP in all subjects (mean; pre LP: 151±71µm; post LP: 129±40µm). The mean decrease in average RNFL thickness was 32±36µm. The neural canal diameter (mean; pre LP: 1985±559µm; post LP: 1590±228 µm) and RPE/BM angulation (mean change; 5.8±2.0 degrees) decreased in all subjects. A decrease in papillary height was seen in 3 of 5 subjects (mean; pre LP: 976±274 µm; post LP: 938±300 µm). CONCLUSIONS: There is an acute change in ONH biomechanical parameters with change in ICP in IIH patients. A larger prospective study is needed to determine the utility of OCT as a non-invasive method for monitoring ICP. Disclosure: Dr. Anand has nothing to disclose. Dr. Pass has nothing to disclose. Dr. Calvillo has nothing to disclose. Dr. Tang has nothing to disclose. Dr. Cajavilca has nothing to disclose. Dr. Urfy has nothing to disclose. Dr. Suarez has nothing to disclose. Dr. Rao has nothing to disclose. Dr. Bershad has nothing to disclose.
The University of Houston College of Optometry (UHCO) has developed a strong Telemedicine Optomet... more The University of Houston College of Optometry (UHCO) has developed a strong Telemedicine Optometry/Ophthalmology program. Patient care, clinical teaching and research benefit from utilizing Telemedicine technology. This initiative between Optometry and Ophthalmology is at the forefront of eyecare! Presented here: clinical teaching opportunities via tele-education including retinal, uveitic, neuro-ophthalmic disorders and glaucoma. Seminars introduce students to this technology and enhance their clinical experience through exposure to eye pathologies often related to systemic diseases. UHCO&amp;amp;#39;s affiliated clinics include multidisciplinary centers staffed by optometrists: the Frost Eye Clinic (HIV multidisciplinary care), Good Neighbor Health Clinic and Rusk School Health Promotion Project (indigent multidisciplinary care). These centers can converse on line with eyecare professionals. Large sites interested in low vision/visual rehabilitation include: The Institute for Rehabilitation and Research (TIRR), the Social Security Hospital (Lima, Peru), the Matagorda General Hospital and the Quentin Mease Hospital. These sites, do offer quality care but require visual rehabilitation programs provided by UHCO. These sites also provide exposure to pathology for the students. A residency program trains optometrists in Telemedicine. The research program focuses on optics and imaging necessary to diagnose glaucoma, diabetic retinopathy, and neuro-ophthalmic disorders through Telemedicine. UHCO supports the advancement of standards in tele-eyecare.
Horner's syndrome is classically characterized by a triad of miosis, partial ptosis and anhid... more Horner's syndrome is classically characterized by a triad of miosis, partial ptosis and anhidrosis. The etiology is due to an interruption in the sympathetic innervation to the eye. A prompt diagnosis is crucial, given that Horner's syndrome could be a manifesta-tion of a life-threatening condition. A thorough case history and clinical evaluation must be employed to arrive at the diagnosis. An important means for confirming Horner's syndrome is pharmacological testing, which is also used to localize the level where the sympathetic chain is compromised. Following the diagnosis and localization of the lesion, an algorithm should be followed to determine the testing indicated, in order to ascertain the underlying cause of the condition. There is a known association between mediastinal neuroblastoma and preganglionic Horner's syndrome. We present a case of a seven-year-old boy with a history of excision of a mediastinal neuroblastoma at age two, who soon after presented ...
A 27-year-old woman reports having had 3 episodes of transient " darkening" of vision i... more A 27-year-old woman reports having had 3 episodes of transient " darkening" of vision in her right eye. Each episode lasted 3 to 5 minutes without any associated symptoms. Her general health is excellent; her only medication is an oral contraceptive. She has no history of migraine. Her examination, including visual fields, is entirely normal. What evaluation and therapy should be undertaken? Transient monocular vision loss (TMVL) of abrupt onset typically represents a focal retinal, choroidal, or optic nerve functional deficit due to ischemia. Historical clues are important, such as asking your patient what area of the visual field was lost; the duration of the loss; and the pres-ence of any neurological symptoms, such as headache, numbness, or weakness. In your patient, the absence of scintillations and headaches and the fact that the vision loss is monocular makes a diagnosis of migraine less likely. A careful history, asking for associated systemic symptoms, is importan...
Optical coherence tomography is an imaging technique using low coherence light sources to produce... more Optical coherence tomography is an imaging technique using low coherence light sources to produce high-resolution cross-sectional images. This article reviews pertinent anatomy and various pathologies causing optic atrophy (eg, compressive, infiltrating, demyelinating) versus optic nerve swelling (from increased intracranial pressure known as papilledema or other optic nerve intrinsic pathologies). On optical coherence tomography, optic atrophy is often associated with reduced average retinal nerve fiber layer thickness, whereas optic nerve swelling is usually associated with increased average retinal nerve fiber layer thickness.
BACKGROUND Venous sinus stenosis (VSS) stenting has emerged as an effective treatment for patient... more BACKGROUND Venous sinus stenosis (VSS) stenting has emerged as an effective treatment for patients with Idiopathic Intracranial Hypertension (IIH). However, stenting carries risk of in-stent stenosis/thrombosis and cumulative bleeding risk from long-term dual antiplatelet (DAPT) use. Thus, we investigated the potential safety and efficacy of primary balloon angioplasty as an alternative to stenting in IIH. METHODS A prospectively maintained single-center registry of IIH patients undergoing endovascular procedures was queried. Inclusion criteria included patients with confirmed IIH and angiographically demonstrable VSS who underwent interventions from 2012- 2021. Patients were dichotomized into primary balloon angioplasty (Group A) and primary stenting (Group S), comparing clinical outcomes using bivariate analyses. RESULTS 62 patients were included with median age of 33 [IQR 26-37], 74% females. Group A (9/62) and Group S (53/62) had similar baseline characteristics. Papilledema improvement was higher in Group S at 6 weeks and 6 months (44 vs. 93, p = 0.002 and 44 vs. 92%, p = 0.004), with similar improvements across all symptoms. Group S had higher mean post-procedure venous pressure gradient change (8 vs. 3 mmHg, p = 0.02) and a lower CSF opening pressure at 6 months (23 vs. 36 cmH2O, p < 0.001). VPS rescue rate was higher in Group A (44 vs. 2%, p = 0.001). There was only one procedural complications; a subdural hematoma in Group A. CONCLUSIONS Primary VSS balloon angioplasty provides a marginal and short-lived improvement of IIH symptoms compared to stenting. These findings suggest a cautious and limited role for short-term rescue angioplasty in poor shunting and stenting candidates with refractory IIH.
Introduction Venous sinus stenosis (VSS) stenting in medically refractory Idiopathic Intracranial... more Introduction Venous sinus stenosis (VSS) stenting in medically refractory Idiopathic Intracranial Hypertension (IIH) patients has emerged as an effective treatment with low rates of failure and recurrence. However, the best treatment strategy following recurrence of symptoms in previously stented patients with initial response is unclear and frequently leads to shunt placement. We investigated the role of re‐stenting in patients with recurrence after prior successful stenting. Methods This is a retrospective review of a prospectively maintained IIH registry. Inclusion criteria included patients with confirmed IIH and angiographically demonstrable VSS who underwent interventions from 2012–2022. Patients were divided into those who underwent a single stenting procedure (Group S) and those who underwent placement of an additional stent due to recurrence of clinical symptoms and angiographic stenosis (Group R). All re‐stenting was performed in adjacent or remote regions of stenosis. Biv...
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2011
Idiopathic intracranial hypertension (IIH) is a rare condition characterized by raised intracrani... more Idiopathic intracranial hypertension (IIH) is a rare condition characterized by raised intracranial pressure (ICP) without related pathology in either the brain or the composition of cerebrospinal fluid (CSF). Herein, we provide a brief review of the clinical presentation of IIH and the anesthetic considerations in parturients diagnosed with the disorder. We conducted a MEDLINE® literature search for all types of articles published in English with restriction for year of publication, and we used the search terms &amp;amp;amp;amp;amp;amp;amp;amp;quot;idiopathic intracranial hypertension&amp;amp;amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;amp;amp;quot;pseudotumor cerebri&amp;amp;amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;amp;amp;quot;benign intracranial hypertension&amp;amp;amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;amp;amp;quot;pregnancy&amp;amp;amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;amp;amp;quot;cesarean section&amp;amp;amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;amp;amp;quot;labour analgesia&amp;amp;amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;amp;amp;quot;epidural&amp;amp;amp;amp;amp;amp;amp;amp;quot;, and &amp;amp;amp;amp;amp;amp;amp;amp;quot;anesthesia&amp;amp;amp;amp;amp;amp;amp;amp;quot;. Idiopathic intracranial hypertension affects primarily obese women of childbearing age. The main symptom is headache, and the cardinal sign is papilledema. The main goal of management is to preserve visual function. Treatment lies in the administration of diuretics and corticosteroids, control of excessive weight gain, and surgical management, such as cerebrospinal fluid diversion or optic nerve sheath fenestration for refractory cases. For the parturient with IIH, Cesarean delivery is not necessarily indicated. Neuraxial anesthesia has been used uneventfully for both labour analgesia and for Cesarean delivery. There are reports describing successful use of both spinal and epidural anesthesia, even in IIH patients with CSF diversion devices in situ. Although IIH is rare, there are special considerations for anesthetic management in the parturient. Despite the presence of raised ICP in these patients, there are no specific contraindications to neuraxial techniques, and uncal herniation has not been reported to occur in patients with IIH.
Endocrinology, Diabetes & Metabolism Case Reports, 2022
Summary Thyroid dermopathy is an uncommon manifestation of thyroid disease that impairs the quali... more Summary Thyroid dermopathy is an uncommon manifestation of thyroid disease that impairs the quality of life in certain cases. Currently, the available treatments offer limited results and a chance of recurrence. Teprotumumab, a novel medication that results in the regression of thyroid ophthalmopathy, may have similar effects on dermopathy. We describe four patients treated with teprotumumab for their thyroid ophthalmopathy who concomitantly had dermatopathy upon initiation of their infusions. Patients improved after two to three infusions and three out of the four patients have not suffered a recurrence.Teprotumumab is a monoclonal antibody (MAB) that attenuates an inflammatory response, resulting in decreased edema and tissue expansion. Given the similarities of their pathophysiology, we believe that the resolution of thyroid dermatopathy and regression of thyroid eye disease occurs via the same mechanism. We encourage further investigation utilizing teprotumumab for patients whos...
Journal of Pediatric Ophthalmology & Strabismus, 1986
A case of linear scleroderma presenting as a pseudo oculomotor palsy is reviewed. The patient&... more A case of linear scleroderma presenting as a pseudo oculomotor palsy is reviewed. The patient&amp;amp;#39;s facial skin abnormalities suggested the underlying etiology. This case illustrates a previously unreported finding in linear scleroderma, mydriasis without atrophy, reminding the clinician to look at the skin in patients with unexplained unilateral pupillary disturbances.
Optometry and vision science : official publication of the American Academy of Optometry, Dec 1, 2017
Differentiating papilledema from pseudopapilledema reflecting tilted/crowded optic discs or disc ... more Differentiating papilledema from pseudopapilledema reflecting tilted/crowded optic discs or disc drusen is critical but can be challenging. Our study suggests that spectral-domain optical coherence tomography (OCT) peripapillary retinal nerve fiber layer thickness and retrobulbar optic nerve sheath diameter (ONSD) measured by A-scan ultrasound provide useful information when differentiating the two conditions. To evaluate the use of A-scan ultrasound and spectral-domain OCT retinal nerve fiber layer thickness (RNFLT) in differentiating papilledema associated with idiopathic intracranial hypertension from pseudopapilledema. Retrospective cross-sectional analysis included 23 papilledema and 28 pseudopapilledema patients. Ultrasound-measured ONSD at primary gaze, percent change in ONSD at lateral gaze (30° test), and peripapillary RNFLT were analyzed. Receiver operating characteristic curves were constructed using one eye from each subject. Compared with pseudopapilledema, papilledema ...
Thyroid-associated ophthalmopathy, a condition commonly associated with Graves' disease, rema... more Thyroid-associated ophthalmopathy, a condition commonly associated with Graves' disease, remains inadequately treated. Current medical therapies, which primarily consist of glucocorticoids, have limited efficacy and present safety concerns. Inhibition of the insulin-like growth factor I receptor (IGF-IR) is a new therapeutic strategy to attenuate the underlying autoimmune pathogenesis of ophthalmopathy. We conducted a multicenter, double-masked, randomized, placebo-controlled trial to determine the efficacy and safety of teprotumumab, a human monoclonal antibody inhibitor of IGF-IR, in patients with active, moderate-to-severe ophthalmopathy. A total of 88 patients were randomly assigned to receive placebo or active drug administered intravenously once every 3 weeks for a total of eight infusions. The primary end point was the response in the study eye. This response was defined as a reduction of 2 points or more in the Clinical Activity Score (scores range from 0 to 7, with a sc...
OBJECTIVE: To determine whether dynamic changes in optic nerve head (ONH) structure, as measured ... more OBJECTIVE: To determine whether dynamic changes in optic nerve head (ONH) structure, as measured by high definition optical coherence tomography (HD-OCT), occur immediately after lowering intracranial pressure (ICP). BACKGROUND: Biomechanical changes in the ONH with sustained elevation in ICP are well-established. However, the time course of structural changes in ONH with elevated ICP has not been studied. It is not known whether acute ICP changes will cause dynamic measurable changes in the ONH. HD-OCT allows in-vivo enhanced depth imaging of papillary sub-structures. DESIGN/METHODS: We conducted a prospective pilot study in 5 female patients with idiopathic intracranial hypertension (IIH) undergoing a clinically indicated lumbar puncture (LP) after IRB approval. The Cirrus HD-OCT (Carl Zeiss Meditec) was positioned to acquire images in the lateral decubitus position. Optic disc cube 200x200 and HD5 Line Raster scans centered on the ONH were obtained immediately before and after draining cerebrospinal fluid (CSF) in the left lateral decubitus position. Retinal nerve fiber layer (RNFL) thickness, peri-papillary retinal pigment epithelium/bruch’s membrane (RPE/BM) angulation, transverse diameter of neural canal at level of RPE/BM, and highest vertical point of internal limiting membrane (ILM) from transverse diameter were measured. Descriptive statistics are presented. RESULTS: The mean opening and closing CSF pressures were 31.6±11.8 and 11.6±3.3 cmH2O, respectively. Average RNFL thickness decreased after LP in all subjects (mean; pre LP: 151±71µm; post LP: 129±40µm). The mean decrease in average RNFL thickness was 32±36µm. The neural canal diameter (mean; pre LP: 1985±559µm; post LP: 1590±228 µm) and RPE/BM angulation (mean change; 5.8±2.0 degrees) decreased in all subjects. A decrease in papillary height was seen in 3 of 5 subjects (mean; pre LP: 976±274 µm; post LP: 938±300 µm). CONCLUSIONS: There is an acute change in ONH biomechanical parameters with change in ICP in IIH patients. A larger prospective study is needed to determine the utility of OCT as a non-invasive method for monitoring ICP. Disclosure: Dr. Anand has nothing to disclose. Dr. Pass has nothing to disclose. Dr. Calvillo has nothing to disclose. Dr. Tang has nothing to disclose. Dr. Cajavilca has nothing to disclose. Dr. Urfy has nothing to disclose. Dr. Suarez has nothing to disclose. Dr. Rao has nothing to disclose. Dr. Bershad has nothing to disclose.
The University of Houston College of Optometry (UHCO) has developed a strong Telemedicine Optomet... more The University of Houston College of Optometry (UHCO) has developed a strong Telemedicine Optometry/Ophthalmology program. Patient care, clinical teaching and research benefit from utilizing Telemedicine technology. This initiative between Optometry and Ophthalmology is at the forefront of eyecare! Presented here: clinical teaching opportunities via tele-education including retinal, uveitic, neuro-ophthalmic disorders and glaucoma. Seminars introduce students to this technology and enhance their clinical experience through exposure to eye pathologies often related to systemic diseases. UHCO&amp;amp;#39;s affiliated clinics include multidisciplinary centers staffed by optometrists: the Frost Eye Clinic (HIV multidisciplinary care), Good Neighbor Health Clinic and Rusk School Health Promotion Project (indigent multidisciplinary care). These centers can converse on line with eyecare professionals. Large sites interested in low vision/visual rehabilitation include: The Institute for Rehabilitation and Research (TIRR), the Social Security Hospital (Lima, Peru), the Matagorda General Hospital and the Quentin Mease Hospital. These sites, do offer quality care but require visual rehabilitation programs provided by UHCO. These sites also provide exposure to pathology for the students. A residency program trains optometrists in Telemedicine. The research program focuses on optics and imaging necessary to diagnose glaucoma, diabetic retinopathy, and neuro-ophthalmic disorders through Telemedicine. UHCO supports the advancement of standards in tele-eyecare.
Horner's syndrome is classically characterized by a triad of miosis, partial ptosis and anhid... more Horner's syndrome is classically characterized by a triad of miosis, partial ptosis and anhidrosis. The etiology is due to an interruption in the sympathetic innervation to the eye. A prompt diagnosis is crucial, given that Horner's syndrome could be a manifesta-tion of a life-threatening condition. A thorough case history and clinical evaluation must be employed to arrive at the diagnosis. An important means for confirming Horner's syndrome is pharmacological testing, which is also used to localize the level where the sympathetic chain is compromised. Following the diagnosis and localization of the lesion, an algorithm should be followed to determine the testing indicated, in order to ascertain the underlying cause of the condition. There is a known association between mediastinal neuroblastoma and preganglionic Horner's syndrome. We present a case of a seven-year-old boy with a history of excision of a mediastinal neuroblastoma at age two, who soon after presented ...
A 27-year-old woman reports having had 3 episodes of transient " darkening" of vision i... more A 27-year-old woman reports having had 3 episodes of transient " darkening" of vision in her right eye. Each episode lasted 3 to 5 minutes without any associated symptoms. Her general health is excellent; her only medication is an oral contraceptive. She has no history of migraine. Her examination, including visual fields, is entirely normal. What evaluation and therapy should be undertaken? Transient monocular vision loss (TMVL) of abrupt onset typically represents a focal retinal, choroidal, or optic nerve functional deficit due to ischemia. Historical clues are important, such as asking your patient what area of the visual field was lost; the duration of the loss; and the pres-ence of any neurological symptoms, such as headache, numbness, or weakness. In your patient, the absence of scintillations and headaches and the fact that the vision loss is monocular makes a diagnosis of migraine less likely. A careful history, asking for associated systemic symptoms, is importan...
Optical coherence tomography is an imaging technique using low coherence light sources to produce... more Optical coherence tomography is an imaging technique using low coherence light sources to produce high-resolution cross-sectional images. This article reviews pertinent anatomy and various pathologies causing optic atrophy (eg, compressive, infiltrating, demyelinating) versus optic nerve swelling (from increased intracranial pressure known as papilledema or other optic nerve intrinsic pathologies). On optical coherence tomography, optic atrophy is often associated with reduced average retinal nerve fiber layer thickness, whereas optic nerve swelling is usually associated with increased average retinal nerve fiber layer thickness.
Uploads
Papers by Rosa Tang