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Objective Several surgical treatment modalities, including lumboperitoneal or ventriculoperitoneal shunt surgery, subtemporal decompression, endovascular venous sinus stenting, optic nerve decompression (OND), were used in the management of idiopathic intracranial hypertension (IIH). Each surgical technique has different advantages and disadvantages. Endoscopic OND is rarely used in the management of IIH. There are only four reported cases. The aim of this study is to describe the surgical results of patients treated with this less invasive surgical technique. Methods A series of 10 consecutive cases of unilateral OND was reviewed. Between December 2008 and December 2012 these patients underwent the endoscopic approach without nerve sheath opening. Presenting symptoms, neurological examination findings, magnetic resonance venography imaging results, fundoscopic and visual acuity examination findings, and automated perimetry test results were recorded. Perioperative results, including complications and length of hospital stay, were evaluated. Findings at follow-up evaluations were also recorded. Results This report is the first series of unilateral OND performed using the endoscopic approach. The mean patient age was 34.1 years (range, 9–49 years); there were nine female and one male patients. Visual impairment was the main symptom in this patient group, whereas headache was a secondary complaint. The patients were first managed with medical treatment for at least 3 months. Unilateral endoscopic OND was performed on the side with the most visual failure. Mean follow-up was 28.4 months (range, 8–55 months). The visual field defects and visual acuity improved in eight of nine patients, whereas papilloedema improved in seven of nine patients. Also headaches resolved in four of seven patients. There were no complications in this relatively small series. Conclusions The surgical treatment of IIH by using the unilateral endoscopic OND technique is a safe and effective method in the hands of experienced surgeons with advanced endoscopic skills. A collaboration with the ophthalmology team is needed for the follow-up. Further studies with larger patient numbers is needed to compare unilateral endoscopic OND technique with the current techniques used in the surgical management of IIH.

Purpose To correlate retinal nerve fiber layer thickness (RNFL) and optic nerve head (ONH) parameters measured with optical coherence tomography (OCT) with the Scoring Tool for Assessing Risk (STAR) threshold in patients with ocular hypertension (OH). Methods The study included 92 patients with OH. They were divided into low-risk (n=32), moderate-risk (n=36), and high-risk (n=24) groups according to STAR criteria. RNFL and ONH OCT protocols were used to evaluate all study participants. Major parameters for RNFL analysis were average RNFL thickness, superior quadrant, nasal quadrant, inferior quadrant, temporal quadrant, and segmental thickness per 12 o'clock hour position. ONH parameters were vertical integrated rim area (VIRA), horizontal integrated rim width (HIRW), disc diameter, disc area, cup area, rim area, cup-to-disc (CID) area ratio, horizontal CID ratio, and vertical CID ratio. Results The highest area under receiver operating characteristics curves for distinguishing the high-risk group from the other groups were vertical CID ratio (0.88), CID area (0.88), VIRA (0.87), and HIRW (0.81) for ONH parameters, and inferior (0.82) and 6 o'clock hour position (0.77) for peripapillary RNFL thickness measurements. Conclusions Inferior average, 6 o'clock hour position analyses for RNFL measurement, and VIRA, HIRW, CID area, and vertical CID ratio for ONH measurement were the best parameters for STAR staging in patients with OH.

Purpose To describe ocular manifestations in primary varicella infection and their relationship to systemic severity and the associated eyelid rash. Methods One hundred consecutive children with primary varicella were examined prospectively. The cases were classified as mild, moderate, and severe according to the severity of clinical presentation. Excluding the presence of eyelid rash, children with ocular findings were assigned to group 1 (G1), and those without ocular findings were assigned to group 2 (G2). Patients in G1 were also evaluated according to the nature of ocular manifestations and the course of uveitis. Results Twenty-one percent of patients had ocular involvement (G1) and 79% had no ocular involvement (G2). While chickenpox had a mild course in 85.7% of patients in G1 and 88.6% of patients in G2, all others had a moderate course. None of the children had a severe course. A varicella eyelid rash was present in 28.6% of patients in G1 and 13.9% in G2. Among ocular findings, 38.1% of patients had conjunctivitis, 57.1% had anterior uveitis, and 4.8% had disciform keratouveitis. There was no significant association between severity of chickenpox and severity of ocular involvement (p=0.712). There was also no relationship between eyelid rash and ocular involvement (p=0.787). Conclusions There is neither an association between the severity of chickenpox and the severity of ocular involvement nor an association between the presence of a varicella eyelid rash and the development of uveitis. As the prognosis regarding sequelae of ocular involvement in varicella infection is good, only those patients with ocular signs and symptoms need be referred by pediatricians for an ophthalmologic examination.

Objectives To determine the prognosis of internuclear ophthalmoplegia (INO) caused by infarction. Design Multicenter, retrospective observational case series. Participants Thirty three patients with ischemic-related INO. Methods Chart review of clinical details. Main outcome measure Resolution of diplopia in primary position. Results Of the group, 78.8% demonstrated resolution of diplopia in primary position with an average time to resolution of 2.25 months. The presence of associated neurologic symptoms (vertigo, ataxia, dysarthria, facial palsy, pyramidal tract signs) correlated with a worse prognosis for resolution of diplopia. When performed magnetic resonance imaging (MRI) demonstrated the causative infarct in only 52% of cases; the presence of an MRI-demonstrable lesion was not significantly associated with prognosis for resolution. Conclusions Similar to ischemic ocular motor palsies, most ischemic-based INO become asymptomatic in primary position over 2 to 3 months. The presence of associated features correlated with persistent diplopia. MRI has limited yield in demonstrating the causative infarct.