Retinal Sublayer Analysis in Autoimmune Retinopathy and Identification of New Optical Coherence Tomography Phenotypes.

Purpose: Autoimmune retinopathy (AIR) is a poorly characterized disease with a wide phenotypic spectrum, complicating investigations of its underlying pathophysiology. We sought to analyze optical coherence tomography (OCT) retinal thickness changes in AIR patients.

Methods: A retrospective chart review from 2007 to 2017 was performed evaluating AIR patients at a single academic, tertiary referral center.

A direct transcutaneous approach to infraorbital nerve biopsy.

Purpose: To describe a novel transcutaneous infraorbital nerve biopsy technique which can be performed to aid in the diagnosis of perineural invasion (PNI) of facial cutaneous squamous cell carcinoma (SCC).

Methods: A single-center retrospective chart review was performed. Patients diagnosed with SCC with PNI via an infraorbital nerve biopsy between February 2019 and February 2020 were included.

Update in the Management of Idiopathic Intracranial Hypertension.

Idiopathic intracranial hypertension is a syndrome of increased intracranial pressure of unknown cause that most often occurs in women of childbearing age. Most patients are overweight or obese with a history of recent weight gain. Following a brief review of the symptoms and signs, we discuss the approach to assessment and monitoring of this condition.

A Deep-Learning Approach for Automated OCT En-Face Retinal Vessel Segmentation in Cases of Optic Disc Swelling Using Multiple En-Face Images as Input.

Purpose: In cases of optic disc swelling, segmentation of projected retinal blood vessels from optical coherence tomography (OCT) volumes is challenging due to swelling-based shadowing artifacts. Based on our hypothesis that simultaneously considering vessel information from multiple projected retinal layers can substantially increase vessel visibility, in this work, we propose a deep-learning-based approach to segment vessels involving the simultaneous use of three OCT en-face images as input.

Methods: A human expert vessel tracing combining information from OCT en-face images of the retinal pigment epithelium (RPE), inner retina, and total retina as well as a registered fundus image served as the reference standard.

Gabapentin and memantine increases randomness of oscillatory waveform in ocular palatal tremor.

Syndrome of oculopalatal tremor (OPT) causes pendular nystagmus of the eyes and its disabling consequence on the visual system. Classic pharmacotherapeutic studies revealed reduction in the eye velocity of the oscillatory waveforms. Subjective improvement in vision, however, remains out of proportionately low.

Incipient Syphilitic Papillitis.

Patients with syphilis can present with optic disc oedema (ODE) without visual compromise, which has been primarily attributed to papilloedema from raised intracranial pressure or optic perineuritis from optic nerve sheath inflammation. We report four cases of ODE in the setting of syphilis with preserved visual function, normal intracranial pressure, and no enhancement of the optic nerve or sheath on magnetic resonance imaging. We propose the term "incipient syphilitic papillitis" for cases presenting with ODE, preserved vision and absence of optic nerve sheath enhancement, which is likely a more common presentation than syphilitic optic perineuritis.

Idiopathic Intracranial Hypertension.

Purpose Of Review: Idiopathic intracranial hypertension is a syndrome of increased intracranial pressure of unclear etiology that most often occurs in obese women of childbearing age but can also occur in men, children, and older adults. This article reviews the diagnostic criteria, clinical features, neuroimaging findings, differential diagnosis, and management options for this condition.

Recent Findings: Recent population studies have found that the annual incidence of idiopathic intracranial hypertension is increasing in association with obesity rates, whereas recent scientific studies indicate a possible role for androgen sex hormones and adipose tissue in the pathogenesis of the disease.

Threshold Static Automated Perimetry of the Full Visual Field in Idiopathic Intracranial Hypertension.

Purpose: To characterize visual loss across the full visual field in idiopathic intracranial hypertension (IIH) patients with mild central visual loss.

Methods: We tested the full visual field (50° nasal, 80° temporal, 30° superior, 45° inferior) of 1 eye of 39 IIH patients by using static perimetry (size V) with the Open Perimetry Interface. Participants met the Dandy criteria for IIH and had at least Frisén grade 1 papilledema with better than -5 dB mean deviation (MD) centrally.

Autoimmune retinopathy and optic neuropathy associated with enolase-positive renal oncocytoma.

Purpose: To report a case of autoimmune retinopathy and optic neuropathy associated with an enolase-positive renal oncocytoma.

Observations: A 41-year-old man presented with subacute, painless, bilateral vision loss. On initial examination, visual acuity measured 20/125 OD and 20/1250 OS, and telangiectatic vessels were noted on the optic nerves and in the maculae.

Visual Fixation Instability in Multiple Sclerosis Measured Using SLO-OCT.

Purpose: Precise measurements of visual fixation and its instability were recorded during optical coherence tomography (OCT) as a marker of neural network dysfunction in multiple sclerosis (MS), which could be used to monitor disease progression or response to treatment.

Methods: A total of 16 MS patients and 26 normal subjects underwent 30 seconds of scanning laser ophthalmoscope (SLO)-based eye tracking during OCT scanning of retinal layer thickness. Study groups consisted of normal eyes, MS eyes without prior optic neuritis (MS wo ON), and MS eyes with prior optic neuritis (MS + ON).

Identification of Herpes Zoster-Associated Temporal Arteritis Among Cases of Giant Cell Arteritis.

Purpose: To examine whether herpes zoster antigen (also called varicella-zoster virus antigen) was detectable in temporal artery biopsies taken from individuals with giant cell arteritis (GCA).

Design: Retrospective comparative case series.

Methods: Sections of formalin-fixed paraffin-embedded temporal arteries were examined first by hematoxylin-eosin (H&E) staining to establish the diagnosis of GCA.

Optic disc haemorrhages at baseline as a risk factor for poor outcome in the Idiopathic Intracranial Hypertension Treatment Trial.

Background: The risk of optic disc haemorrhages on visual outcome in idiopathic intracranial hypertension (IIH) is unknown. We report the type and frequency of optic disc haemorrhages and other funduscopic abnormalities at baseline in the study eye of the 133 subjects enrolled in the Idiopathic Intracranial Hypertension Treatment Trial completing 6 months of follow-up.

Methods: We reviewed optic disc photographs to tabulate the frequency and type of optic disc haemorrhages, other funduscopic abnormalities and papilloedema grades of the study eye at baseline and analyse if their presence is associated with a poor visual outcome.

The Longitudinal Idiopathic Intracranial Hypertension Trial: Outcomes From Months 6-12.

Purpose: To determine whether the beneficial effects of acetazolamide (ACZ) in improving vision at 6 months continues to month 12 in participants of the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT).

Design: Nonrandomized clinical study.

Methods: In the IIHTT, subjects were randomly assigned to placebo-plus-diet or maximally tolerated dosage of acetazolamide-plus-diet.

The Yield of Diagnostic Imaging in Patients with Isolated Horner Syndrome.

We sought to determine, with a retrospective chart review, the imaging yield for patients with clinically isolated Horner syndrome. MRI/MRA of the head and neck extending from the supraorbital ridge to T4 with fat suppression and with postcontrast images was obtained. Of 88 patients with isolated Horner syndrome who were imaged, 20% had a causative etiology on imaging.

The Pattern of Visual Fixation Eccentricity and Instability in Optic Neuropathy and Its Spatial Relationship to Retinal Ganglion Cell Layer Thickness.

Purpose: The purpose of this study was to assess whether clinically useful measures of fixation instability and eccentricity can be derived from retinal tracking data obtained during optical coherence tomography (OCT) in patients with optic neuropathy (ON) and to develop a method for relating fixation to the retinal ganglion cell complex (GCC) thickness.

Methods: Twenty-nine patients with ON underwent macular volume OCT with 30 seconds of confocal scanning laser ophthalmoscope (cSLO)-based eye tracking during fixation. Kernel density estimation quantified fixation instability and fixation eccentricity from the distribution of fixation points on the retina.

TREATMENT OF RETINOPATHY AND MACULAR EDEMA SECONDARY TO A CAROTID-CAVERNOUS FISTULA.

Purpose: To present a case report on a patient with retinal complications from a carotid-cavernous fistula.

Methods: Observational case report.

Results: A 26-year-old patient sustained head trauma following a motorcycle accident.

Treatment of Nystagmus.

Acquired and congenital forms of nystagmus are commonly encountered in the course of clinical practice. Although some patients are asymptomatic, many others describe disabling oscillopsia that impairs visual function, social function, and quality of life. Such patients may present to the neurologist to request treatment.

Causes and Prognosis of Visual Acuity Loss at the Time of Initial Presentation in Idiopathic Intracranial Hypertension.

Purpose: To determine the etiology and prognosis of visual acuity loss in idiopathic intracranial hypertension (IIH) at presentation and to provide objective measures to predict visual outcome.

Methods: A retrospective review of 660 patients with IIH (2009-2013) identified 31 patients (4.7%) with 48 eyes having best-corrected visual acuity (BCVA) of 20/25 or worse on initial presentation.

Diagnostic approach to abnormal spontaneous eye movements.

Purpose Of Review: Abnormal spontaneous eye movements, including nystagmus and saccadic intrusions, are often encountered in neurologic practice and can cause disabling visual symptoms, such as oscillopsia and blurred vision. This article reviews the spectrum of abnormal spontaneous eye movements and describes their characteristics, etiology, and management.

Recent Findings: The number of prospective, controlled, and masked clinical trials evaluating candidate treatments for abnormal spontaneous eye movements has increased significantly over the past decade.

Limited Wegener's Granulomatosis Presenting with an Isolated Abduction Deficit.

Wegener's granulomatosis often affects the orbit, typically presenting with painful proptosis. The authors describe a 14 year-old girl, with limited Wegener's granulomatosis, who initially presented with an isolated painless abduction deficit that spontaneously resolved over several weeks. She subsequently developed painful proptosis and diplopia, followed by facial and oral nodules.

Third nerve palsy as the initial manifestation of giant cell arteritis.

Objective: Giant cell arteritis (GCA) is rarely reported as a cause of third nerve palsy. We describe the presentation and course of patients with third nerve palsy as the sole initial ocular manifestation of GCA.

Methods: Retrospective chart review of patients with third nerve palsy as the presenting sign of GCA.

Bilateral jugular paragangliomas: a rare cause of raised intracranial pressure.

A 28-year-old woman presented with a 2-year history of pulsatile tinnitus, with recent onset of headaches and bilateral transient visual obscurations. Examination revealed bilateral optic disc edema. MRI showed enhancing lesions surrounding the internal jugular veins and magnetic resonance venography showed bilateral internal jugular vein occlusions with extensive collaterals (figure 1).