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Achmed Pircher,1,2 Albert Neutzner,3 Margherita Montali,4 Andreas Huber,5 Hendrik PN Scholl,2,6 Jatta Berberat,7 Luca Remonda,7 Hanspeter E Killer3 1Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden; 2Department of Ophthalmology, University Hospital Basel & University Basel, Basel, Switzerland; 3Department of Biomedicine, University Hospital Basel & University Basel, Basel, Switzerland; 4Department of Ophthalmology, San Bassiano Hospital, Bassano del Grappa, Italy; 5Department of Medicine, Private University of the Principality of Lie Triesen, Triesen, Liechtenstein; 6Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland; 7Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, SwitzerlandCorrespondence: Achmed PircherDepartment of Neuroscience/Ophthalmology, Uppsala University, Uppsala, SwedenTel +46 76 496 37 51Email achmed.pircher@gmail.comObjective: To report on the lipocalin-type prostaglandin D synthase (L-PGDS) concentrations in the cerebrospinal fluid (CSF) of the perioptic and lumbar subarachnoid space (SAS) in patients with radiologically proven optic nerve (ON) sheath compartmentation presenting as normal-tension glaucoma (NTG).Methods: Retrospective biochemical analysis of CSF in thirteen patients with ON sheath compartmentation presenting as NTG (four females, mean age 70± 8 years). CSF was sampled from the SAS of the ON during ON sheath fenestration for ON sheath compartmentation and from the lumbar SAS at the time of lumbar puncture. Nephelometry was used for the quantification of L-PGDS and albumin concentration. Albumin was measured in order to assess the amount of contamination with serum in the CSF samples taken from the ON SAS. Main outcome measures were L-PGDS concentrations in the CSF of the perioptic and lumbar SAS.Results: Mean L-PGDS concentration was 24± 8 mg/L in the lumbar SAS compared to 33± 27 mg/L without correction of serum contamination and 45± 39 mg/L after correction of serum contamination in the perioptic SAS. The difference between the lumbar and the perioptic SAS was statistically significant (P=0.0047 without correction of serum contamination, P=0.0002 with correction of serum contamination; Mann–Witney U-test).Conclusion: This study demonstrates a concentration gradient of L-PGDS levels within the CSF with a statistically significant higher concentration in the compartmentalized perioptic SAS compared to that in the lumbar SAS. Biochemical changes in the perioptic SAS might be involved in the pathophysiology in NTG patients with ON sheath compartmentation.Keywords: lipocalin-type prostaglandin D synthase, cerebrospinal fluid, optic nerve sheath compartment syndrome, normal-tension glaucoma, optic nerve

Importance: Optic nerve (ON) dysfunction is a common feature of different diseases. The pathophysiology is not yet fully understood. Background: This study describes five patients with ON sheath (ONS) compartment syndrome (ONSCS) and contributes to the hypothesis that impaired cerebrospinal fluid (CSF) flow can play a role in the development of ON dysfunction. Design: Retrospective case series. Participants: Five patients with ONSCS were included in the study. Methods: Elaboration of medical histories and clinical and diagnostic findings over a long time period was carried out by analysing medical records and by a detailed medical consultation. Main Outcome Measures: The main outcome measures include clinical history; visual acuity; field, intraocular and CSF pressures; and contrast‐loaded computed tomographic (CT) cisternography. Results: Compartmentation of the ONS demonstrated by contrast‐loaded CT cisternography was the consistent finding in all five patients who demonstrated findings of ON dysfunction. The aetiologies varied and included meningitis, papilloedema, sphenoid wing meningioma, disc herniation and normal‐tension glaucoma. Conclusion and Relevance: Compartmentation of the ONS with consecutively impaired CSF dynamics within the ON subarachnoid space can lead to ON dysfunction. Different aetiologies can cause the development of ONSCS. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to examine the translaminar pressure difference (TLP) in Caucasian patients with normal tension glaucoma (NTG) and its possible impact onto the pathogenesis of NTG. Methods Retrospective analysis of medical records of patients with open-angle glaucoma (OAG) in the period from 2005 to 2015 from the Ophthalmology Department, Cantonal Hospital Aarau, Switzerland. A total of 67 eyes of 38 patients (mean age 68.6 ± 11.3 years, 21 women and 17 men) fulfilled the diagnostic criteria of progressive NTG and underwent lumbar puncture (LP) during computer-assisted cisternography (CT - cisternography). The intraocular pressure (IOP) and lumbar cerebrospinal fluid pressure (CSF-p) were analysed and the TLP calculated. The TLP was compared with the mean defect (MD) of visual fields. Statistical analysis was performed with the one and two-tailed paired and unpaired t-test and the non-parametric Spearman correlation test. Results The mean lumbar opening CSF-p measured 11.6 ± 3.7 mmHg. The mean IOP in the right eye measured 14.7 ± 2.4 mmHg, in the left eye 14.7 ± 2.5 mmHg. The calculated mean TLP was 3.0 ± 4.2 mmHg in the right and 3.3 ± 4.3 mmHg in the left eye. There was no significant correlation between TLP and the MD of visual fields in both eyes. Conclusions This study did not confirm either a lower lumbar CSF-p or increased TLP compared to previous retrospective and prospective studies. As cerebrospinal fluid (CSF) flow is not homogenous throughout all CSF spaces and CSF-p and IOP fluctuate, the current view on TLP needs modifications to improve its validity. [ABSTRACT FROM AUTHOR]

Permanent visual loss is a devastating yet preventable complication of cryptococcal meningitis. Early and aggressive management of cerebrospinal fluid pressure in conjunction with antifungal therapy is required. Historically, the mechanisms of visual loss in cryptococcal meningitis have included optic neuritis and papilloedema. Hence, the basis of visual loss therapy has been steroid therapy and intracranial pressure lowering without clear guidelines. With the use of high-resolution magnetic resonance imaging of the optic nerve, an additional mechanism has emerged, namely an optic nerve sheath compartment syndrome (ONSCS) caused by severely elevated intracranial pressure and fungal loading in the peri-optic space. An improved understanding of these mechanisms and recognition of the important role played by raised intracranial pressure allows for more targeted treatment measures and better outcomes. In the present case series of 90 HIV co-infected patients with cryptococcal meningitis, we present the clinical and electrophysiological manifestations of Cryptococcus-induced visual loss and review the mechanisms involved.

Current concepts of the pathophysiology of normal tension glaucoma (NTG) include intraocular pressure, vascular dysregulation and the concept of a translaminar pressure gradient. Studies on NTG performed with cisternography demonstrated an impaired cerebrospinal fluid (CSF) dynamics in the subarachnoid space of the optic nerve sheath, most pronounced behind the lamina cribrosa. Stagnant CSF might be another risk factor for NTG., (© 2020 Elsevier B.V. All rights reserved.)