PMC10032434_01
Color fundus photos of right eye (a) and left eye (a) showing severe optic disc edema
in both eyes with peripapillary hemorrhages and cotton wool spots emanating from the
disc and macular exudates obtained at 1 month post-discharge.
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These findings observed at the time of hospitalization showed mild improvement on fundus imaging obtained 1 month post-discharge (Figure 1).
Axial T2-weighted MRI orbits showing features of increased ICP with flattening of
posterior globes (arrows) and bilateral perioptic nerve sheath distention.
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Magnetic resonance imaging (MRI) of the head and orbit and magnetic resonance venography (MRV) of the brain showed confirmatory findings of a partially empty sella, flattening of the posterior globes, and distention of subarachnoid fluid surrounding the optic nerve sheaths (Figure 2).
Findings 1 month after presentation. OCT of the retinal nerve fiber layer (RNFL) of
both eyes showed severe papilledema with average RNFL thickness of 435 and 483 microm,
respectively (a). Humphrey Visual Field 30-2 showed a corresponding enlargement of the
blind spots and paracentral changes in both eyes (b). Macular OCT scans of the right (i)
and left (ii) eyes demonstrate symmetrical irregular outer retinal thinning with
disruption of the photoreceptor ellipsoid zone (c).
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Despite good central vision, severe papilledema with visual field changes of enlarged blind spots and paracentral changes correlating to his macular pathology persisted (Figure 3).
Findings 13 months after presentation. OCT of the RNFL of the right and left eyes
demonstrated significant reduction in papilledema when compared with 1 month after
presentation. Average RNFL thickness was 131 and 116 microm, respectively. Ganglion cell
analysis of the right and left eyes also demonstrated normal ganglion cell layer and
inner plexiform layer thickness, averaging 88 and 87 microm in the right and left eyes,
respectively (a). Humphrey Visual Field 30-2 similarly showed a reduction in blind spots
(b).
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Repeat optic nerve height and retinal nerve fiber layer analysis of both eyes 13 months later demonstrated significantly decreased thickness compared with initial measurements (Figure 4(a)). Ganglion cell and inner plexiform layer thickness corroborated the improvement in papilledema and intact optic nerve function, demonstrating normal values in all sectors bilaterally (Figure 4(a)).