Retinal and Optic Nerve Deformations Due to Orbital Versus Intracranial Venous Hypertension

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Title Retinal and Optic Nerve Deformations Due to Orbital Versus Intracranial Venous Hypertension
Creator Mark J. Kupersmith; Patrick A. Sibony
Affiliation Departments of Neurology, Ophthalmology, and Neurosurgery (MJK), New York Eye and Ear Infirmary and Icahn School of Medicine at Mount Sinai, New York, New York; and Department of Ophthalmology (PSS), State University of New York at Stony Brook, Stony Brook, New York
Abstract Introduction: Abnormal forces around the optic nerve head (ONH) due to orbital diseases, intracranial hypertension (IH), glaucoma, and space travel, are associated with alterations of the ONH shape. Elevated cerebral and ophthalmic venous pressure can contribute to stress and strain on the ONH and peripapillary retina. We hypothesize that IH and elevated ophthalmic venous pressure without IH cause different ONH and retinal changes. Methods: We compared MRI and spectral domain optical coherence tomography (SDOCT) findings in patients with cavernous sinus arteriovenous shunts (CSAVSs), where orbital venous pressure is known to be elevated, with patients with intracranial dural venous sinus thrombosis and secondary IH. We also compared the results to those obtained in the Idiopathic IH (IIH) Treatment Trial. Results: Among 18 patients with dural venous sinus thrombosis, the MRI/magnetic resonance venography displayed partial empty sella (61%) and optic nerve sheath distension (67%). None exhibited ophthalmic vein dilation or signs of orbital congestion. SDOCT of these eyes and IIH eyes showed a similar frequency of abnormal thickening of the mean retinal nerve fiber layer, anterior displacement of the basement membrane opening, peripapillary wrinkles, retinal folds (RF), and choroidal folds (CF). Among 21 patients with CSAVSs, MRI showed ipsilateral dilated superior ophthalmic vein (76%) and orbital congestion (52%) without distension of the optic nerve sheath or globe distortion. SDOCT showed CF (19%), one with overlying RF, and no ONH deformations. Conclusions: SDOCT findings for dural venous sinus thrombosis are similar to those seen with IIH but distinct from changes due to local ophthalmic venous hypertension. These data support the concept that IH even if due to a vascular cause and local orbital venous hypertension cause different stresses and strains on the ONH.
Subject Intracranial Hypertension; Intracranial Pressure; Magnetic Resonance Imaging; Optic Nerve; Orbital Diseases; Papilledema; Retina; Retinal Diseases; Optical Coherence Tomography; Visual Acuity
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Date 2021-09
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, September 2021, Volume 41, Issue 3
Collection Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s6bgy7qj
Setname ehsl_novel_jno
ID 2033210
Reference URL https://collections.lib.utah.edu/ark:/87278/s6bgy7qj
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