[Bilateral limbus parallel slightly prominent opacities in the corneal periphery]

Visualization of corneal vascularization in peripheral hypertrophic subepithelial corneal opacification with OCT angiography

PURPOSE

The major goal of this study was to test the hypothesis that in patients with peripheral hypertrophic subepithelial corneal opacification (PHSCO), visualization of corneal vessels is better with optical coherence tomography angiography (OCTA) than with conventional slit lamp microphotography.

METHODS

Patients with PHSCO were included in this prospective study. The corneal findings were photographed using a slit lamp camera (Haag Streit BM 900^® ) and visualized with anterior-segment OCT (Optovue XR Avanti, Fremont, California, USA). Additionally, OCTA with the Angiovue Imaging™ System was performed in the area of PHSCO.

RESULTS

Thirty-four eyes of 19 patients (26% male and 74% female) with PHSCO were included in this study. In 21 eyes, vascularization in the area of PHSCO was visualized with the Angiovue-OCT, whereas only 10 eyes presented vessels in slit lamp photographs.

CONCLUSION

Optical coherence tomography angiography allows better visualization of corneal neovascularization than slit lamp photography in patients with PHSCO. Corneal opacifications were found predominantly nasally, which was reflected by a local enlargement of corneal thickness.

[Ophthalmological symptoms of idiopathic intracranial hypertension: Importance for diagnosis and clinical course]

BACKGROUND

Ophthalmological symptoms, particularly papilledema and transient visual obscuration as well as pulsatile head and ear noises are hallmarks of idiopathic intracranial hypertension also known as pseudotumor cerebri.

DIAGNOSTICS AND COURSE

Pronounced asymmetrical and unilateral papilledema are common occurrences in patients with idiopathic intracranial hypertension. Distension of the optic nerve sheath indicates increased intracranial pressure, which need to be confirmed by lumbar puncture. The presence of papilledema indicates increased intracranial pressure but its absence does not exceed it. Previous and long-standing papilledema obviously induces changes of the optic disc which prevent the further development of major disc swelling. The development of visual atrophy can mimic a regression of papilledema. In cases of marked papilledema visual loss may be caused by nonarteritic, ischemic optic neuropathy or macular edema. Visual obscuration is present in the vast majority of cases of pronounced chronic papilledema and is an indication of long-standing increased intracranial pressure. Most patients with pseudotumor cerebri and papilledema show only mild visual field defects, such as an enlarged blind spot and/or relatively mild arcuate defects, which regress after reduction of the intracranial pressure. Some patients, however, experience a relatively rapid progression of substantial visual field defects and optic atrophy requiring immediate and effective medicinal treatment.

CONCLUSION

Ophthalmological symptoms are frequently key criteria for idiopathic intracranial hypertension. More attention should be paid to these signs and the diagnostic approach should be multidisciplinary.