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Show REFERENCES 1. Bidot S, Bruce BB, Saindane AM, Newman NJ, Biousse V. Asymmetric papilledema in idiopathic intracranial hypertension. J Neuroophthalmol. 2015;35:31-36. 2. Killer HE, Laeng HR, Flammer P, Groscurth P. The arachnoid trabeculae and septae in the subarachnoid space of the human optic nerve: anatomy and clinical considerations. Br J Ophthalmol. 2003;87:777-781. 3. Fan B, Bordigari G, Flammer J, Killer HE, Meyer P, Neutzner A. Meningothelial cells participate in immunological processes in the cerebrospinal fluid. J Neuroimmunol. 2012;244:45-50. 4. Xin X, Fan B, Flammer J, Miller NR, Jaggi GP, Killer HE, Meyer P, Neutzner A. Meningothelial cells react to elevated pressure and oxidative stress. PLoS One. 2011;6:e20142. 5. Jaggi G, Harlev M, Zeigler U, Dothan S, Miller NR, Killer HE. Cerebrospinal fluid segregation optic neuropathy: an experimental animal model. Br J Ophthalmol. 2010;94:1088-1093. 6. Killer HE, Jaggi GP, Flammer J, Miller NR, Huber AR, Mironov A. Cerebrospinal fluid dynamics between the intracranial and the subarachnoid space of the optic nerve. Is it always bidirectional? Brain. 2007;129:1027-1030. 7. Killer HE, Jaggi GP, Miller NR, Huber AR, Londolt H, Mironov A, Meyer P, Remonda L. Cerebrospinal fluid dynamics between the basal cisterns and the subarachnoid space of the optic nerve in patients with papilloedema. Br J Ophthalmol. 2010;95:822-827. 8. Mader TH, Gibson CR, Pass AF, Lee AG, Killer HE, Hansen HC, Devray JP, Barratt MR, Tarver WJ, Sargsyan AE, Kramer LA, Riascos R, Bedi DG, Pettit DR. Optic disc edema in an astronaut after repeat long-duration space flight. J Neuroophthalmol. 2013;33:249-255. 9. Killer HE, Miller NR, Flammer J, Meyer P, Weinreb RN, Remonder A, Jaggi BP. Cerebrospinal fluid exchange in normal-tension glaucoma. Br J Ophthalmol. 2012;96:544-548. Asymmetric Papilledema in Idiopathic Intracranial Hypertension: Response We thank Killer et al for their comments on our article (1) and for sharing their expertise on the emerging concept of compartmentation of the perioptic subarachnoid spaces (2). We believe that compartmen-tation of the perioptic subarachnoid spaces probably plays an important role in the development of papillede-ma by interfering with the transmission of the cerebro-spinal fluid (CSF) pressure between the intracranial subarachnoid spaces and the lamina cribrosa. Our results may provide a new insight into the underlying mechanisms and the potential consequences of the compartmentation in idio-pathic intracranial hypertension (IIH), by protecting the optic disc from increased CSF pressure. This is likely not specific to IIH, and we agree with Killer et al that the optic canals might also play a role in other ocular conditions in which a disorder of the CSF pressure has been suggested, such as optic disc edema after prolonged spaceflight (3), or in glaucoma. Samuel Bidot, MD Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA Beau B. Bruce, MD, PhD Departments of Ophthalmology and Neurology, Emory University School of Medicine, Atlanta, GA Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Atlanta, GA Amit M. Saindane, MD Department of Radiology and Imaging Science, Emory University School of Medicine, Atlanta, GA Nancy J. Newman, MD Departments of Ophthalmology, Neurology, and Neurological Surgery, Emory University School of Medicine, Atlanta, GA Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine, Atlanta, GA Supported in part by an unrestricted departmental grant (Department of Ophthalmology) from Research to Prevent Blindness, Inc, New York, and by NIH/NEI core grant P30- EY06360 (Department of Ophthalmology). S. Bidot receives research support from Berthe Fouassier Foundation (Paris, France) and the Philippe Foundation (New York, New York). B. B. Bruce receives research support from the NIH/ NEI (K23-EY019341). N. J. Newman received the Research to Prevent Blindness Lew R. Wasserman Merit Award. The authors report no conflicts of interest. REFERENCES 1. Bidot S, Bruce BB, Saindane AM, Newman NJ, Biousse V. Asymmetric papilledema in idiopathic intracranial hypertension. J Neuroophthalmol. 2015;35:31-36. 2. Killer HE, Subramanian PS. Compartmentalized cerebrospinal fluid. Intl Ophthalmol Clin. 2014;54:95-102. 3. Mader TH, Gibson CR, Pass AF, Lee AG, Killer HE, Hansen HC, Devray JP, Barratt MR, Tarver WJ, Sargsyan AE, Kramer LA, Riascos R, Bedi DG, Pettit DR. Optic disc edema in an astronaut after repeat long-duration space flight. J Neuroophthalmol. 2013;33:249-255. Letters to the Editor: J Neuro-Ophthalmol 2015; 35: 329-332 331 Letters to the Editor Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. |
