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Introduction: We report a case of cerebral venous sinus thrombosis (CVST) that presented with bilateral optic disc swelling and diplopia in the absence of headaches. Case Presentation: A 54-year-old woman with no relevant medical history presented with a 2-week history of diplopia and no loss of visual acuity in each eye. Eye movements revealed bilateral abduction deficits, and fundoscopic examination revealed bilateral optic disc swelling. Non-contrast computed tomography of the head showed no abnormalities. Magnetic resonance venography revealed the absence of flow in the superior sagittal and left transverse sinuses as a consequence of thrombosis. The patient was diagnosed with intracranial hypertension associated with abducens nerve palsies secondary to CVST and was initiated on anticoagulant therapy. CVST can lead to stroke even in younger individuals. Conclusion: CVST should be considered in differential diagnosis when bilateral papilledema and abducens nerve palsies are present, even in the absence of headache or other neurological findings.

Copyright of Die Ophthalmologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: We report a case of cerebral venous sinus thrombosis (CVST) that presented with bilateral optic disc swelling and diplopia in the absence of headaches. Case Presentation: A 54-year-old woman with no relevant medical history presented with a 2-week history of diplopia and no loss of visual acuity in each eye. Eye movements revealed bilateral abduction deficits, and fundoscopic examination revealed bilateral optic disc swelling. Non-contrast computed tomography of the head showed no abnormalities. Magnetic resonance venography revealed the absence of flow in the superior sagittal and left transverse sinuses as a consequence of thrombosis. The patient was diagnosed with intracranial hypertension associated with abducens nerve palsies secondary to CVST and was initiated on anticoagulant therapy. CVST can lead to stroke even in younger individuals. Conclusion: CVST should be considered in differential diagnosis when bilateral papilledema and abducens nerve palsies are present, even in the absence of headache or other neurological findings. [ABSTRACT FROM AUTHOR]

ObjectiveThis study aimed to compare enhanced depth imaging optical coherence tomography (EDI-OCT) features of exudative retinal detachment (ERD) type and optic disc (OD) swelling type Vogt–Koyanagi–Harada (VKH) disease.MethodsHospitalized VKH patients were retrospectively reviewed and classified into the ERD type and the OD swelling type. The EDI-OCT features were then analyzed.ResultsThe study included 32 ERD type and 15 OD swelling type VKH patients at the acute uveitis stage. The interval between the onset of ocular symptoms and the start of treatment in OD swelling type VKH disease was significantly longer compared to the ERD type (p < 0.001). A fuzzy or lost pattern of the choroidal vasculature was observed in 100% of VKH patients of both types. Moreover, high frequencies (greater than or equal to 50%) of fluctuations in the internal limiting membrane, interdigitation zone disruption, ERD, retinal pigment epithelium (RPE) folds, and ellipsoid zone disruption were observed in both types. Patients with OD swelling type VKH disease exhibited higher frequencies of OD swelling and hyperreflective substances above the RPE (p < 0.001 and p = 0.003, respectively), with lower frequencies of ERD and bacillary layer detachment (p = 0.012 and p < 0.001, respectively). At the convalescence stage, changes in the EDI-OCT images of 10 ERD type and 5 OD swelling type VKH patients were analyzed. The frequencies of the OCT features decreased with similar trends in both types of VKH disease.ConclusionAlthough ERD type and OD swelling type VKH disease have their own unique characteristics, they share common EDI-OCT features. The Fuzzy or lost pattern of the choroidal vasculature that indicates choroidal inflammation may serve as a diagnostic aid for VKH disease, especially for the OD swelling type and the early-stage ERD type.

Purpose: To analyze the etiology and implications of optic disc swelling in cancer patients treated at a specialized tertiary cancer center in Jordan. Methods: This was a retrospective study of all cancer patients who had optic disc swelling between January 2019 and December 2020 at King Hussein Cancer Center (KHCC). Patients' data included age, sex, laterality, visual acuity, and the underlying cause and management for the optic disc swelling. Results: Optic disc swelling was present in 58 cancer patients (96 eyes), with 38 (65%) having bilateral involvement. Among these, 33 (57%) were female, and 43 (74%) were ≤40 years old. At diagnosis, 58 (63%) eyes had a best-corrected visual acuity (BCVA) better than 0.5, improving to 73 (76%) eyes at the last follow-up. High intracranial pressure (ICP) was the most common primary cause (30 patients/52%), followed by tumor infiltration of the optic nerve (10 patients/17%), optic nerve compression (7 patients/12%), and optic nerve inflammation (5 patients/9%). Four patients had pseudopapilledema. Among the 30 patients with high ICP, CNS tumors were predominant (21 patients/70%), with only 3 having idiopathic intracranial hypertension. Medications, including ATRA (All-Trans Retinoic Acid) and systemic steroids, contributed to increased ICP in six patients (20%). BCVA was less than 0.5 in all eyes (100%) affected by tumor infiltration, optic nerve inflammation, and ischemic optic neuropathy, while only eight eyes (14%) with optic disc swelling due to elevated ICP had a BCVA less than 0.5 (p < 0.0001). Management included steroids (53 patients/91%), acetazolamide (30 patients/52%), chemotherapy (20 patients/34%), radiation therapy (13 patients/22%), frequent lumbar punctures (12 patients/21%), and surgery (28 patients/48%). Visual acuity improved in 40 eyes (42%), with only 4 eyes (4%) experiencing deterioration. At a 12-month median follow-up period, 11 (19%) patients were dead, 10 (10%) eyes had poor vision (BCVA less than 0.1), and 21 (22%) eyes had BCVA 0.5 or better. Conclusions: Various underlying pathologies can induce optic disc swelling in cancer patients, a grave condition capable of causing vision loss. Notably, tumor infiltration of the optic nerve tends to result in more profound visual impairment compared to papilledema due to elevated ICP. Timely detection is crucial, and immediate symptomatic treatment followed by addressing the underlying cause is essential to prevent irreversible optic nerve damage and vision loss in cancer patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: In children, tuberculosis of the central nervous system most usually manifests as tubercular meningitis, hydrocephalus post-tubercular meningitis, and, in rare cases, space-occupying lesions known as tuberculoma. We address the diagnostic difficulty in an adult patient with mainly ocular symptoms who was diagnosed with tuberculoma. A 19-year-old young man came with painless bilateral blurring of vision. Bilateral optic disc swelling and bilateral sixth cranial nerve palsy were present. METHODS: Brain imaging revealed ring-enhancing lesions in the cerebellar vermis, left cerebellar hemisphere and left middle cerebral peduncle with surrounding extensive perilesional edema causing effacement of fourth ventricle leading to obstructive hydrocephalus suggestive of tuberculoma. RESULTS: He had a high erythrocyte sedimentation rate and a positive Mantoux test. His Quantiferon-TB Gold test result was positive. The examination of cerebrospinal fluid suggested a high opening pressure. Following anti-tubercular medication along with systemic steroids, his vision improved due to decreased optic disc swelling. CONCLUSION: We wish to highlight that visual loss and grave consequences of tuberculoma can be averted with early recognition and treatment.

Background: Current guidelines suggest high-dose steroids as first-line treatment for dysthyroid optic neuropathy (DON). When steroids fail, decompressive surgery is mandatory. Methods: We conducted a single-center, retrospective cohort study in a tertiary care combined Thyroid-Eye clinic in Milan, Italy. We studied 88 orbits of 56 patients that were submitted to surgical orbital decompression to treat DON from 2005 to 2020. Of these, 33 orbits (37.5%) underwent surgery as first-line treatment for DON whereas the other 55 (62.5%) were decompressed after being unresponsive to very high-dose steroids. Previous orbital surgery, concurrent neurological or ophthalmologic diseases, or incomplete follow-up were considered as exclusion criteria from this study. Surgery was considered successful if no further decompression was needed to preserve vision. Pinhole best corrected visual acuity (p-BCVA), color sensitivity, automated visual field, pupil reflexes, optic disk and fundus appearance, exophtalmometry, and ocular motility were studied before and after surgery (1 week, 1, 3, 6, and 12 months). Activity of Graves' Orbitopathy (GO) was graded using a clinical activity score (CAS). Results: Surgery was successful in 77 orbits (87.5%). The remaining 11 orbits (12.5%) needed further surgery to treat DON definitively. All parameters of visual function improved significantly at follow-up and GO inactivated (CAS <3) within 1 month. At 3 months, all 77 responding orbits had p-BCVA >0.63 whereas all of the 11 non-responding orbits had p-BCVA ≤0.63. Visual field parameters and color sensitivity were not associated with response to surgery. High-dose steroid treatment before surgery was associated with a better response rate (96% vs. 73%; p = 0.004). Balanced decompression was associated with a higher response rate compared with medial wall decompression (96% vs. 80%; p = 0.04). A significant inverse correlation was observed between final p-BCVA and the patient's age (r = −0.42; p = 0.0003). Conclusions: Surgical decompression was found to be a very effective treatment for DON. In this study, all clinical parameters improved after surgery and further intervention was rarely needed. [ABSTRACT FROM AUTHOR]

A 52-year-old male patient presented with longstanding non-specific symptoms of ocular redness and irritation. Clinical examination not only revealed bilateral anterior scleritis but also bilateral optic disc swelling. Additional history taking revealed headaches and tinnitus, both starting around the same time as the eye redness, as well as a prior episode of swelling and redness of both ears. The lumbar puncture opening pressure was 29 cm of cerebrospinal fluid (CSF). There were 11 white blood cells/µl in the CSF. Subsequent magnetic resonance imaging showed focal thickening of the dura mater over the left cerebral convexity, suggestive of focal pachymeningitis. 18F-fluorodeoxyglucose positron emission tomography demonstrated hypermetabolic abnormalities located at the auricles, the nostrils, the anterior part of the eyes, and the dura mater over the left cerebral convexity, suggestive of relapsing polychondritis (RPC). RPC is a rare systemic immune-mediated condition; diagnosis can sometimes be delayed or missed due to insidious disease onset with non-specific symptoms. Nevertheless, sight-threatening or even life-threatening complications may occur. Given the high prevalence of ocular involvement, one should be suspicious when faced with patients with recurrent ocular inflammation. Optic disc swelling is a more uncommon finding, and while different mechanisms have been reported, it has rarely been associated with raised intracranial pressure. Nevertheless, intracranial hypertension arising from inflammation of the CSF and/or surrounding meninges caused by the newly diagnosed RPC was identified as the most likely underlying mechanism for the bilateral optic disc swelling in our patient. [ABSTRACT FROM AUTHOR]

Copyright of Neurologie Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Our study evaluates the sensitivity of papilledema as a sign of high intracranial pressure in children. Patients younger than 18 years old, diagnosed with increased ICP, and who had received dilated fundus examination between 2019 and 2021 were retrospectively reviewed. Factors including the patient's age, sex, aetiology, duration of signs or symptoms, intracranial pressure (ICP), and presence of papilledema were evaluated. We included 39 patients in this study, whose mean age was 6.7 years. The 31 patients without papilledema had a mean age of 5.7 years, and 8 patients (20%) with papilledema had a mean age of 10.4 (p < 0.037). The mean duration of signs or symptoms was nine weeks in patients without papilledema and seven weeks in those with papilledema (p = 0.410). The leading causes of increased ICP with papilledema were supratentorial tumor (12.5%), infratentorial tumor (33.3%), and hydrocephalus (20%) (p = 0.479). Papilledema was statistically significantly more common in older patients. We found no statistical significance between sex, diagnosis, and symptoms. The relatively low incidence of papilledema (20%) in our study shows that papilledema's absence does not ensure the absence of increased ICP, especially in younger patients. [ABSTRACT FROM AUTHOR]

To report a case of unilateral disc swelling as the only presentation of enterovirus meningitis in a 43-year-old male who presented with reduction in visual quality. Vision was 20/20 unaided in both eyes and the only ocular finding was left optic disc edema accompanied by left relative afferent pupillary defect. Visual field examination revealed a generalized reduction in sensitivity, a paracentral scotoma and a superior and inferior arcuate defect. Apart from a marginally elevated white blood cell count, the evaluation for common diseases associated with unilateral disc swelling was negative. A comprehensive neurology and rheumatology assessment,the orbital, brain and cervical spine Magnetic Resonance Imaging (MRI), the chest and abdomen Computed Tomography (CT) and chest radiograph had no findings. However, the cerebrosipinal fluid (CSF) examination indicated the presence of enterovirus RNA. A diagnosis of enterovirus meningitis was established.Patient's general health was not affected and symptoms gradually settled, with no specific anti-enteroviral treatment. Only the CSF analysis provided interesting evidence of the site of the visual dysfunction. [ABSTRACT FROM AUTHOR]

Background and Aim: Optic disc swelling is due to arrest or obstruction of axoplasmic flow at the lamina cribrosa. It may be due to various pathological conditions like ischemia, infiltration, inflammation, compression, metabolic and toxic damage. In this study, the clinical profile of each case of unilateral disc edema was analysed in relation to age of presentation, gender, systemic association, risk factor and prognosis. Material and Methods: The present study was done in the department of ophthalmology, medical college and hospital. The patients with the unilateral disc edema were included in the study. Visual acuity was measured using Snellen’s acuity chart and converted to logmar for the purpose of statistical analysis. Intraocular pressure was recorded. Colour vision was recorded using ishihara chart. Routine blood investigations were done. Radiological imaging was done. Results: Females are affected more commonly compared to males in the study group. The commonest cause for unilateral disc edema is nonarteritic AION and the next common cause is optic neuritis. Compressive disc edema, inflammatory disc edema and neuroretinitis are the other conditions causing unilateral disc edema. In this study 60 % of the persons showed disc pallor on follow up and 40 % of person showed normal fundus. 66.67 % of patients of NAION had disc pallor on follow up. MRI BRAIN in NAION showed small vessel ischemic changes in 6.67% of persons which indicates the ischemic change were also noted in brain. Conclusion: If a patient with unilateral disc swelling presents to neuroophthalmology clinic, NA-AION and ON should be considered first in the differential diagnosis. Other causes of disc edema should not be missed. [ABSTRACT FROM AUTHOR]

Pseudo-Foster Kennedy syndrome (PFKS) is defined as unilateral disc oedema with contralateral optic nerve pallor, in the absence of intracranial pathologies. Diabetic papillopathy is a rare ocular manifestation of diabetes mellitus (DM). We report a rare case of PFKS secondary to diabetic papillopathy in a young patient with type 2 DM who had poor glucose control. There was optic disc swelling over the right eye and optic disc pallor over the left eye. His visual field assessment showed right inferior field defect and general depression in the left. Optical coherence tomography retinal nerve fibre layer showed normal thickness over the right eye and generalized thinning over the left eye. Neuroimaging and other laboratory investigations were unremarkable. With good glycemic control, the optic disc swelling over the right eye resolved. Visual field defect remained the same but retinal nerve fiber layer showed thinning in areas where the edema had resolved. [ABSTRACT FROM AUTHOR]

Our study evaluates the sensitivity of papilledema as a sign of high intracranial pressure in children. Patients younger than 18 years old, diagnosed with increased ICP, and who had received dilated fundus examination between 2019 and 2021 were retrospectively reviewed. Factors including the patient’s age, sex, aetiology, duration of signs or symptoms, intracranial pressure (ICP), and presence of papilledema were evaluated. We included 39 patients in this study, whose mean age was 6.7 years. The 31 patients without papilledema had a mean age of 5.7 years, and 8 patients (20%) with papilledema had a mean age of 10.4 (p < 0.037). The mean duration of signs or symptoms was nine weeks in patients without papilledema and seven weeks in those with papilledema (p = 0.410). The leading causes of increased ICP with papilledema were supratentorial tumor (12.5%), infratentorial tumor (33.3%), and hydrocephalus (20%) (p = 0.479). Papilledema was statistically significantly more common in older patients. We found no statistical significance between sex, diagnosis, and symptoms. The relatively low incidence of papilledema (20%) in our study shows that papilledema’s absence does not ensure the absence of increased ICP, especially in younger patients.

Syphilis produces myriad nonspecific signs and symptoms. For example, optic disk swelling might be seen in patients with syphilis as a result of cranial hypertension (papilloedema), inflammatory optic neuritis with papillitis, or optic perineuritis. We report a case involving differential diagnosis of syphilitic bilateral papillitis mimicking papilloedema.

Abstract Background This study is to evaluate the accuracy of machine learning for differentiation between optic neuropathies, pseudopapilledema (PPE) and normals. Methods Two hundred and ninety-five images of optic neuropathies, 295 images of PPE, and 779 control images were used. Pseudopapilledema was defined as follows: cases with elevated optic nerve head and blurred disc margin, with normal visual acuity (> 0.8 Snellen visual acuity), visual field, color vision, and pupillary reflex. The optic neuropathy group included cases of ischemic optic neuropathy (177), optic neuritis (48), diabetic optic neuropathy (17), papilledema (22), and retinal disorders (31). We compared four machine learning classifiers (our model, GoogleNet Inception v3, 19-layer Very Deep Convolution Network from Visual Geometry group (VGG), and 50-layer Deep Residual Learning (ResNet)). Accuracy and area under receiver operating characteristic curve (AUROC) were analyzed. Results The accuracy of machine learning classifiers ranged from 95.89 to 98.63% (our model: 95.89%, Inception V3: 96.45%, ResNet: 98.63%, and VGG: 96.80%). A high AUROC score was noted in both ResNet and VGG (0.999). Conclusions Machine learning techniques can be combined with fundus photography as an effective approach to distinguish between PPE and elevated optic disc associated with optic neuropathies.

BACKGROUND Malignant hypertension is macrovascular and microvascular endothelial injury responsible for multiple organ damage. Considering the anatomical and functional homologies between the posterior pole of the eye and the kidney, ophthalmological explorations may inform clinicians on the mechanisms underpinning concurrent kidney injury in this condition. More specifically, we investigated whether the wall-to-lumen ratio (WLR) of retinal arterioles measured by adaptive optics ophthalmoscopy could be correlated to WLR of kidney arterioles as determined by pathology. We sought to estimate the incidence of retinal arteriole occlusion a supposedly uncommon complication of malignant hypertension. METHODS All patients hospitalized in our renal Intensive Care Unit for malignant hypertension between 2016 and 2019 were referred to ophthalmological examinations. RESULTS Twenty-seven patients were included. Median retinal WLR was 0.39 [0.31–0.47] and was correlated with initial systolic (r = 0.56, P = 0.003) and mean blood pressure (r = 0.46, P = 0.02) upon admission. The retinal WLR was not correlated to renal pathological findings, as assessed by juxtaglomerular WLR (r = 0.38, P = 0.2), ratio of glomerulosclerosis (r = −0.39, P = 0.2), or tubulointerstitial fibrosis (r = −0.45, P = 0.08). Retinal WLR was not associated with neurological or cardiovascular end-organ damage. Branch retinal artery occlusion was detected in 18.5% of patients and exudative retinal detachment (ERD) in 29.6% of patients, without any significant correlation with canonical signs of retinal hypertension including optic disc swelling. CONCLUSIONS In the setting of malignant hypertension, we failed to demonstrate a significant relationship between WLR and other meaningful end-organ injuries. However, branch retinal artery occlusion and ERD may have been hitherto underestimated. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare enhanced depth imaging optical coherence tomography (EDI-OCT) features of exudative retinal detachment (ERD) type and optic disc (OD) swelling type Vogt-Koyanagi-Harada (VKH) disease., Methods: Hospitalized VKH patients were retrospectively reviewed and classified into the ERD type and the OD swelling type. The EDI-OCT features were then analyzed., Results: The study included 32 ERD type and 15 OD swelling type VKH patients at the acute uveitis stage. The interval between the onset of ocular symptoms and the start of treatment in OD swelling type VKH disease was significantly longer compared to the ERD type ( p < 0.001). A fuzzy or lost pattern of the choroidal vasculature was observed in 100% of VKH patients of both types. Moreover, high frequencies (greater than or equal to 50%) of fluctuations in the internal limiting membrane, interdigitation zone disruption, ERD, retinal pigment epithelium (RPE) folds, and ellipsoid zone disruption were observed in both types. Patients with OD swelling type VKH disease exhibited higher frequencies of OD swelling and hyperreflective substances above the RPE ( p < 0.001 and p = 0.003, respectively), with lower frequencies of ERD and bacillary layer detachment ( p = 0.012 and p < 0.001, respectively). At the convalescence stage, changes in the EDI-OCT images of 10 ERD type and 5 OD swelling type VKH patients were analyzed. The frequencies of the OCT features decreased with similar trends in both types of VKH disease., Conclusion: Although ERD type and OD swelling type VKH disease have their own unique characteristics, they share common EDI-OCT features. The Fuzzy or lost pattern of the choroidal vasculature that indicates choroidal inflammation may serve as a diagnostic aid for VKH disease, especially for the OD swelling type and the early-stage ERD type., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Liu, Wang, An and Zhang.)

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple systems. Systemic lupus erythematosus is a disease of 1000 faces and can present with ocular manifestations. Early recognition and treatment are essential to prevent morbidities which can reach up to blindness. Ocular involvement occurs in around 30% of SLE patient. Materials and methods: A case of 40-years-old female complained of an acute periorbital edema with visual involvement concurrent with arthralgia. Results: Ophthalmology evaluation showed ulcerative keratitis. Laboratory investigation showed leukopenia and anemia. Immunological screening showed high positive Anti-nuclear antibody (ANA), anti-double-stranded DNA and low complements level. Magnetic resonance imaging (MRI) of the brain with contrast showed left optic disc swelling and bilateral periorbital edema. The patient was diagnosed as SLE with ocular manifestations and started on pulse steroid therapy with immunoglobulin intravenous infusion. Her ocular manifestation improved and follow up MRI showed improvement of the Left optic disc swelling. Conclusion: Optic nerve disease is a rare ocular manifestation of SLE. It is important to recognize it early to avoid serious complication and blindness. [ABSTRACT FROM AUTHOR]

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple systems. Systemic lupus erythematosus is a disease of 1000 faces and can present with ocular manifestations. Early recognition and treatment are essential to prevent morbidities which can reach up to blindness. Ocular involvement occurs in around 30% of SLE patient. Materials and methods: A case of 40-years-old female complained of an acute periorbital edema with visual involvement concurrent with arthralgia. Results: Ophthalmology evaluation showed ulcerative keratitis. Laboratory investigation showed leukopenia and anemia. Immunological screening showed high positive Anti-nuclear antibody (ANA), anti-double-stranded DNA and low complements level. Magnetic resonance imaging (MRI) of the brain with contrast showed left optic disc swelling and bilateral periorbital edema. The patient was diagnosed as SLE with ocular manifestations and started on pulse steroid therapy with immunoglobulin intravenous infusion. Her ocular manifestation improved and follow up MRI showed improvement of the Left optic disc swelling. Conclusion: Optic nerve disease is a rare ocular manifestation of SLE. It is important to recognize it early to avoid serious complication and blindness. [ABSTRACT FROM AUTHOR]

Purpose: To present a case of optic disc swelling caused by sinusitis. Methods: Ocular symptoms were investigated using computed tomography imaging of the facial bones to detect the relationship between the sinus inflammation and the optic nerve. Results: A particular configuration of the optic nerve was detected. Optic nerve course through the inflamed sphenoidal sinus is a condition associated with a greater risk of inflammation. Conclusion: Sinusitis is a rare but treatable cause of optic neuritis. The choice of the correct radiological investigation to be done to set up a proper treatment of the sinus pathological condition is also essential for the resolution of ocular symptoms.

Mine Yildirim, Deniz Kilic, Mehmet Emin Dursun, Birgul Dursun Department of Ophthalmology, Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey Abstract: In this report, we present a case of diabetic papillopathy that resolved after a single dose of intravitreal ranibizumab injection. A 50-year-old male presented with painless visual loss in his right eye. His visual acuity was 1/10 in the right eye and 10/10 in the left eye. Anterior segment examination of both eyes was unremarkable. Posterior segment of the right eye showed nonproliferative diabetic retinopathy with a swollen optic disc. Fluorescein angiography and optical coherence tomography were performed. There was dye leakage from the right optic disc. Optical coherence tomography revealed a significant increase in retinal nerve fiber layer thickness. Magnetic resonance imaging of the brain and orbit were normal. The patient received a single intravitreal ranibizumab (0.5 mg) injection. Two weeks after the injection, there was a marked regression of the disc swelling. Three months after the injection the optic disc was pallor and visual acuity was 6/10. Keywords: diabetic papillopathy, optic disc swelling, ranibizumab, optical coherence tomograpy

Background: Optic disc swelling poses a diagnostic challenge due to its multiple underlying pathological causes. This study aimed to investigate the use of fluorescein angiography (FLA) in combination with optical coherence tomography (OCT) as a diagnostic tool for differentiating between papilledema and papillitis in cases of optic disc swelling., Material and Methods: A total of 12 patients were included in the study in whom both FLA and OCT of the optic disc were performed to evaluate the optic disc swelling in cases of papilledema (7 patients, 14 eyes) and papillitis (5 patients, 7 eyes). The fluorescence behavior of the optic disc during late phase FLA was examined in relation to papillary thickness measured by OCT., Results and Discussion: In the papilledema group OCT revealed a mean papillary thickness of 873 µm. In 6 patients FLA detected a ring-shaped papillary hyperfluorescence with papillary thicknesses ranging from 611 µm to 972 µm. Another patient with chronic and marked papilledema exhibited bilateral panpapillary leakage in FLA and papillary thicknesses of 1287 µm (right eye) and 1526 µm (left eye). In the papillitis group FLA showed panpapillary leakage in all cases. The mean papillary thickness was 865 µm (range 632-1195 µm)., Conclusion: In acute optic disc swelling and a papillary prominence less than 1000 µm in OCT, a difference in FLA was noticeable between papilledema and papillitis. While acute and mild papilledema exhibited a ring-shaped hyperfluorescence, papillitis showed a panpapillary leakage in late phase FLA in the examined cases. This difference could not be seen in the case of papilledema with chronic and severe swelling., (© 2024. The Author(s).)

Over the last decade, the National Aeronautics and Space Administration's (NASA) Space Medicine Division has documented a variety of unusual physiological and pathological neuro-ophthalmic findings in astronauts during and following long duration space flight. These ndings include optic disc swelling, globe flattening, choroidal folds, and hyperopic shifts in refraction. Cephalad fluid shift has been proposed as a possible unifying etiology, but the specific mechanism responsible for these changes remains obscure. This manuscript reviews the history, clinical findings, and potential neurophysiological etiologies for spaceflight-associated neuro-ocular syndrome. [ABSTRACT FROM AUTHOR]

Syphilis produces myriad nonspecific signs and symptoms. For example, optic disk swelling might be seen in patients with syphilis as a result of cranial hypertension (papilloedema), inflammatory optic neuritis with papillitis, or optic perineuritis. We report a case involving differential diagnosis of syphilitic bilateral papillitis mimicking papilloedema. [ABSTRACT FROM AUTHOR]

Ischaemic optic neuropathy (ION) is the commonest adult optic neuropathy encountered in Southeast Asia and will increase in incidence with an ageing population. It occurs in two forms: arteritic and non-arteritic. The latter variety being by far the commoner encountered in the region and presenting as an anterior optic neuropathy with optic disc swelling. The clinical presentation of both varieties is described with particular reference to the hyperaemic disc appearance of the non-arteritic disease as opposed to the ischaemic, pale, swollen, infarcted disc seen in arteritic anterior ION. Essential visual field defects found in both varieties are emphasized; the prognosis and treatment are discussed. Pathological specimens are also illustrated. Posterior ION is briefly mentioned being a diagnosis of exclusion. The anatomy, especially the blood supply of the optic nerve head, is discussed along with its role in the production of the different varieties of ION. [ABSTRACT FROM AUTHOR]

The authors reviewed 93 consecutive cases with optic disc swelling (ODS) to compare clinical manifestations and prognosis among the causes. Among unilateral ODS patients ≥50 years old and without pain, anterior ischaemic optic neuropathy accounted for 87.5%. Furthermore, papilloedema (PE) presented unilateral ODS with an atrophic or hypoplastic disc in the opposite eye. Despite no differences for age and initial visual acuity between PE and pseudopapilloedema, the two main causes of bilateral ODS, some PE patients showed poor visual prognosis. Understanding differences in frequencies and clinical features of ODS related to cause and age group can help to accurately determine cause and predict outcome. [ABSTRACT FROM AUTHOR]

Background To analyze the etiology of optic disc swelling (ODS) and compare the clinical features between non-arteritic anterior ischemic optic neuropathy (NA-AION) and optic neuritis (ON) at our center from January 2019 to January 2020. Methodology Clinical records of all patients who presented with ODS between January 2019 and January 2020 were reviewed. The collected data were analyzed using IBM SPSS Statistics for Windows (Version 23.0, IBM Corp., Armonk, NY, USA). Results A total of 70 eyes among 47 patients were included in this review. There were 24 patients (51%) who had unilateral ODS, while 23 patients (49.0%) had bilateral ODS. The most common etiology of unilateral ODS was ON (45.7%), NA-AION (25%), and neuroretinitis (12.5%). Among bilateral ODS, the most common cause was papilledema (30.4%), hypertensive retinopathy (21.7%), diabetic papillitis (13.1%), and optic disc drusen (13.1%). Among unilateral ODS, the mean onset age was significantly older in NA-AION cases than that in ON cases (57.5 years vs. 40.3 years, P  = 0.016). Ocular pain was a significant clinical finding observed in ON cases (54.5%) and none in NA-AION cases ( P  = 0.043). Although there was no significant difference in the initial visual acuity (VA) between NA-AION and ON, the final VA was significantly improved in ON compared to NA-AION (0.31 ± 0.34 vs. 1.14 ± 1.00, P = 0.029). Conclusions Many differential diagnoses must be considered when a patient is presented with ODS. With the increased prevalence of hypertension and diabetes in Malaysia, it is not a surprise that both hypertensive retinopathy and diabetic papillitis together accounted for one-third of the bilateral ODS patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Chee et al.)

The purpose of this study was to describe the clinical and multimodal imaging findings in acute Vogt-Koyanagi-Harada (VKH) disease without clinically evident exudative retinal detachment (ERD). We retrospectively reviewed the charts of 18 patients (36 eyes), diagnosed with acute VKH disease without clinically evident ERD. All patients underwent complete ophthalmic examination, fundus photography, optical coherence tomography (OCT), B-scan ultrasonography, fluorescein angiography (FA), and indocyanine green angiography (ICGA). Of 18 patients, twelve (66.7 %) were female and 6 (33.3 %) were male. Mean age was 39 years (range, 23-60). Ten patients had been referred with an erroneous diagnosis of primary optic nerve disorder (8; 44.4 %) or isolated anterior uveitis (2; 11.1 %). Anterior chamber or vitreous inflammatory reaction was noted in 22 eyes (61.1 %), each. Fundus findings included optic disc swelling in 30 eyes (83.3 %), retinal striae in 20 eyes (55.5 %), and yellowish deep lesions in 3 eyes (8.3 %). OCT showed a shallow, localized subclinical ERD in 18 eyes (50 %), and retinal pigment epithelial folds in 23 eyes (63.9 %). B-scan ultrasonography showed diffuse, low- to medium-reflective choroidal thickening in all eyes. FA disclosed delayed choroidal perfusion in at least one eye of all patients (100 %), mild pinpoint leakage in 21 eyes (58.3 %), optic disc hyperfluorescence in 35 eyes (97.2 %) and choroidal folds in 13 eyes (36.1 %). ICGA findings included delayed choroidal perfusion in 24 eyes (66.7 %), decrease in the number of large choroidal vessels in 36 eyes (100 %), fuzzy choroidal vessels in 35 eyes (97.2 %), and hypofluorescent dark dots in 28 eyes (77.8 %). The association of bilateral optic disc edema with retinal striae and intraocular inflammatory reaction highly suggests acute VKH disease. A multimodal imaging approach including fundus photography, OCT, B-scan ultrasonography, FA, and ICGA provides important clues for the definite diagnosis and help differentiate VKH disease from primary optic nerve disorders. [ABSTRACT FROM AUTHOR]

Purpose: To elucidate the clinical differences between serous retinal detachment (RD)-type and optic disc (OD) swelling-type Vogt-Koyanagi-Harada (VKH) disease. Methods: We performed a retrospective review of 96 patients with new-onset, active VKH disease. Patients were classified into serous RD-type or OD swelling-type VKH disease groups by means of optical coherence tomography and fluorescein angiography, and the differences between the 2 groups were analyzed. Results: Eighty-two patients were classified as having RD-type VKH disease (34 men and 48 women, aged 40.5 ± 12.6 years) and 14 patients as having OD swelling-type VKH disease (1 man and 13 women, aged 54.6 ± 11.6 years). Patients with the OD swelling type had older onset ( P < 0.001) and were more proportionately female ( P = 0.02) than those with the RD type. OD swelling-type VKH disease had a longer interval between disease onset and treatment initiation (22.4 ± 14.0 days vs 12.6 ± 14.7 days; P = 0.02) and a higher frequency of chronic disease (64.3 vs 30.5 %; P = 0.03) than did serous RD-type VKH disease. In the OD swelling type, patients with pretreatment visual acuity (VA) lower than 20/20 developed chronic disease more frequently than did those with VA of 20/20 or better ( P = 0.02). Conclusions: Patients with OD swelling-type VKH disease are more likely to be female, have older onset, and develop chronic disease than patients with RD-type VKH disease. In OD swelling-type VKH disease, worse VA before treatment is associated with the development of chronic disease. [ABSTRACT FROM AUTHOR]