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Prem S Subramanian - One of the best experts on this subject based on the ideXlab platform.
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optic nerve head and macular optical coherence tomography measurements in Papilledema compared with pseudoPapilledema
Journal of Neuro-ophthalmology, 2019Co-Authors: Masoud Aghsaei Fard, Sara Okhravi, Sasan Moghimi, Prem S SubramanianAbstract:BACKGROUND To compare macular and optic nerve head optical coherence tomography (OCT) measurements in mild to moderate Papilledema and pseudoPapilledema. METHODS One hundred nineteen eyes of 61 patients with mild to moderate Papilledema, 84 eyes of 48 patients with pseudoPapilledema, and 60 eyes of 60 healthy normal individuals were enrolled in this cross-sectional study. Using Spectralis SD-OCT, macular scans with macular ganglion cell-inner plexiform layer (GCIPL) and macular retinal nerve fiber layer (RNFL) segmentation were performed and divided into 2 regions (inner and outer, with a diameter of 3 and 6 mm, respectively); in addition, Bruch membrane opening (BMO) area and peripapillary RNFL thickness were obtained. RESULTS BMO area was similar in Papilledema (1.83 ± 0.34 mm), pseudoPapilledema (1.85 ± 0.37 mm), and controls (1.85 ± 0.32 mm). Average inner region macular GCIPL thickness in the Papilledema, pseudoPapilledema, and control groups was 87.2 ± 14.4 μm, 90.8 ± 6.1 μm, and 91.2 ± 9.8 μm, respectively (P > 0.05). Outer temporal region macular GCIPL was significantly thinner in the Papilledema group compared with control group (P = 0.01). By contrast, outer inferior and outer nasal macular RNFL sectors were significantly thicker in the Papilledema group compared with control groups (P = 0.01 and P < 0.01, respectively). Those measures were not different between pseudoPapilledema and control eyes. CONCLUSIONS In Papilledema eyes, outer temporal region macular GCIPL thickness decreased and outer inferior and outer nasal macular RNFL sectors thickness increased compared with the control group. These changes were not observed in the pseudoPapilledema group.
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Optical Coherence Tomography Angiography in Papilledema Compared With PseudoPapilledema
Investigative Opthalmology & Visual Science, 2019Co-Authors: Masoud Aghsaei Fard, Alireza Sahraiyan, Jalil Jalili, Marjane Hejazi, Yanin Suwan, Robert Ritch, Prem S SubramanianAbstract:Purpose The purpose of this study is to evaluate differences in optical coherence tomography angiography (OCT-A) findings between patients with Papilledema and pseudoPapilledema. Methods In this prospective, comparative study, 41 eyes of 21 subjects with Papilledema, 27 eyes of 15 subjects with pseudoPapilledema, and 44 eyes of 44 healthy normal subjects were included and were imaged using OCT-A. In addition to peripapillary total vasculature maps obtained with commercial vessel density mapping, major vessel removal using customized image analysis software was also used to measure whole image capillary density and peripapillary capillary density (PCD). Peripapiilary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) were recorded. Results Average RNFL thicknesses were greater in Papilledema eyes than in pseudoPapilledema and control subjects. GCC thickness was not different among three groups. Peripapillary vasculature values were significantly lower in Papilledema (58.5 ± 6.1%) and pseudoPapilledema (58.9 ± 4.7%) eyes compared with healthy eyes (63.2 ± 3.1%) using commercial machine software, without a difference between Papilledema and pseudoPapilledema eyes. However, using our customized software, peripapillary "capillary" density of Papilledema eyes was 29.8 ± 9.4%, which was not significantly different from healthy subjects (31.8 ± 7.4%; P = 0.94). PseudoPapilledema eyes with peripapillary density of 25.5 ± 8.3% had significantly lower capillary values compared with control eyes (P = 0.01). There was a significantly lower whole image and nasal sector peripapillary capillary density of inner retina in pseudoPapilledema eyes than Papilledema eyes (P = 0.03 and P = 0.02, respectively). Conclusions Whole image and nasal peripapillary sector capillary densities using OCT-A had diagnostic accuracy for differentiating true and pseudo-disc swelling.
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quantification of peripapillary total retinal volume in pseudoPapilledema and mild Papilledema using spectral domain optical coherence tomography
American Journal of Ophthalmology, 2014Co-Authors: Masoud Aghsaei Fard, Sara Fakhree, Parisa Abdi, Narges Hassanpoor, Prem S SubramanianAbstract:Purpose To distinguish differences in retinal nerve fiber layer (RNFL) thickness and peripapillary total retinal volume between eyes with Papilledema, pseudoPapilledema, and normal findings. Design Cohort study. Methods Forty-two eyes with mild Papilledema, 37 eyes with congenitally elevated optic disc (pseudoPapilledema), and 34 normal eyes met the inclusion criteria at 1 academic institution (in Iran) and underwent neuro-ophthalmic examination. Spectral-domain optical coherence tomography scans surrounding the optic disc were performed in each eye of patients and subjects. Main outcome measures were mean RNFL thickness and peripapillary total retinal volume measurements (inner and outer ring volumes) that were compared between groups, using the generalized estimating equation approach. Area under receiver operating characteristic curves were also calculated. Results A statistically significant difference was found in mean RNFL thickness between both groups of patients with Papilledema and pseudoPapilledema and normal subjects. Average inner peripapillary total retinal volume in the Papilledema, pseudoPapilledema, and control groups were 1.95 ± 0.24 mm 3 , 1.81 ± 0.23 mm 3 , and 1.06 ± 0.10 mm 3 , respectively. Average outer peripapillary total retinal volume in the Papilledema and pseudoPapilledema groups were 2.68 ± 0.49 mm 3 and 2.03 ± 0.24 mm 3 , respectively ( P 3 ) eyes ( P = .17). Area under the curve to discriminate pseudoPapilledema vs Papilledema eyes for average RNFL thickness and inner and outer peripapillary total retinal volumes was 0.82, 0.68, and 0.88, respectively. Conclusion Outer peripapillary total retinal ring volumes might be useful in differentiating Papilledema from pseudoPapilledema.
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minocycline associated pseudotumor cerebri with severe Papilledema
Journal of Ophthalmology, 2009Co-Authors: Simon R Bababeygy, Michael X Repka, Prem S SubramanianAbstract:Background. Pseudotumor cerebri is an acknowledged but unusual complication of oral minocycline use. Vision loss and Papilledema have been described as mild and transient, and some authors suggest that treatment is not needed. Methods. Case series of 2 patients with severe Papilledema and visual field loss. Results. Severe pseudotumor cerebri developed in 2 nonobese patients taking minocycline. Their disease required further treatment even upon drug discontinuation because of visual field loss and Papilledema. Conclusions. Minocycline-associated pseudotumor cerebri is not always a self-limited condition and may require aggressive medical or surgical management.
Masoud Aghsaei Fard - One of the best experts on this subject based on the ideXlab platform.
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optic canal size in idiopathic intracranial hypertension and asymmetric Papilledema
Clinical Neurology and Neurosurgery, 2019Co-Authors: Yasin Farrokhi, Shervin Sharif Kashani, Masoud Aghsaei Fard, Farzad Pakdel, Samira YadegariAbstract:Abstract Objective Asymmetric Papilledema (AP) is a rare condition in idiopathic intracranial hypertension (IIH). As the pathophysiology of Papilledema developement in IIH remains unclear, the study of AP could clarify some etiologic aspects. We aimed to evaluate bony optic canal size in IIH patients with AP. Patients and methods All IIH patients based on modified Dandy criteria in our referral tertiary eye hospital underwent neuro-opthalmologic exams and grading of Papilledema according to modified Frisen scale. Very asymmetric Papilledema (VAP) defined as a ≥2 grade difference between the two eyes. Clinical features, cerebrospinal fluid opening pressure (CSF OP), best corrected visual acuity, Humphery visual field, and brain magnetic resonance imaging (MRI) and MR venography was performed for all patients. Spiral orbital computed tomography (CT) scan which is the choice method for details of bony structures with axial, coronal and sagittal planes was done in patients with VAP. Result 59 patients with IIH were diagnosed that 18.6% of them (n = 11) had VAP. There was no IIH patient with strictly unilateral Papilledema. Presenting symptoms and CSF OP was not significantly different between patients with symmetric and asymmetric Papilledema. In patients with VAP, bony optic canal size was not statistically significant different in axial, coronal and sagittal plane when comparing the eye with higher grade edema to the fellow eye. Conclusion Our study showed that bony optic canal size evaluated by orbital CT scan was not different in VAP in IIH patients. Finding the exact pathophysiology of AP need further studies.
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optic nerve head and macular optical coherence tomography measurements in Papilledema compared with pseudoPapilledema
Journal of Neuro-ophthalmology, 2019Co-Authors: Masoud Aghsaei Fard, Sara Okhravi, Sasan Moghimi, Prem S SubramanianAbstract:BACKGROUND To compare macular and optic nerve head optical coherence tomography (OCT) measurements in mild to moderate Papilledema and pseudoPapilledema. METHODS One hundred nineteen eyes of 61 patients with mild to moderate Papilledema, 84 eyes of 48 patients with pseudoPapilledema, and 60 eyes of 60 healthy normal individuals were enrolled in this cross-sectional study. Using Spectralis SD-OCT, macular scans with macular ganglion cell-inner plexiform layer (GCIPL) and macular retinal nerve fiber layer (RNFL) segmentation were performed and divided into 2 regions (inner and outer, with a diameter of 3 and 6 mm, respectively); in addition, Bruch membrane opening (BMO) area and peripapillary RNFL thickness were obtained. RESULTS BMO area was similar in Papilledema (1.83 ± 0.34 mm), pseudoPapilledema (1.85 ± 0.37 mm), and controls (1.85 ± 0.32 mm). Average inner region macular GCIPL thickness in the Papilledema, pseudoPapilledema, and control groups was 87.2 ± 14.4 μm, 90.8 ± 6.1 μm, and 91.2 ± 9.8 μm, respectively (P > 0.05). Outer temporal region macular GCIPL was significantly thinner in the Papilledema group compared with control group (P = 0.01). By contrast, outer inferior and outer nasal macular RNFL sectors were significantly thicker in the Papilledema group compared with control groups (P = 0.01 and P < 0.01, respectively). Those measures were not different between pseudoPapilledema and control eyes. CONCLUSIONS In Papilledema eyes, outer temporal region macular GCIPL thickness decreased and outer inferior and outer nasal macular RNFL sectors thickness increased compared with the control group. These changes were not observed in the pseudoPapilledema group.
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Optical Coherence Tomography Angiography in Papilledema Compared With PseudoPapilledema
Investigative Opthalmology & Visual Science, 2019Co-Authors: Masoud Aghsaei Fard, Alireza Sahraiyan, Jalil Jalili, Marjane Hejazi, Yanin Suwan, Robert Ritch, Prem S SubramanianAbstract:Purpose The purpose of this study is to evaluate differences in optical coherence tomography angiography (OCT-A) findings between patients with Papilledema and pseudoPapilledema. Methods In this prospective, comparative study, 41 eyes of 21 subjects with Papilledema, 27 eyes of 15 subjects with pseudoPapilledema, and 44 eyes of 44 healthy normal subjects were included and were imaged using OCT-A. In addition to peripapillary total vasculature maps obtained with commercial vessel density mapping, major vessel removal using customized image analysis software was also used to measure whole image capillary density and peripapillary capillary density (PCD). Peripapiilary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) were recorded. Results Average RNFL thicknesses were greater in Papilledema eyes than in pseudoPapilledema and control subjects. GCC thickness was not different among three groups. Peripapillary vasculature values were significantly lower in Papilledema (58.5 ± 6.1%) and pseudoPapilledema (58.9 ± 4.7%) eyes compared with healthy eyes (63.2 ± 3.1%) using commercial machine software, without a difference between Papilledema and pseudoPapilledema eyes. However, using our customized software, peripapillary "capillary" density of Papilledema eyes was 29.8 ± 9.4%, which was not significantly different from healthy subjects (31.8 ± 7.4%; P = 0.94). PseudoPapilledema eyes with peripapillary density of 25.5 ± 8.3% had significantly lower capillary values compared with control eyes (P = 0.01). There was a significantly lower whole image and nasal sector peripapillary capillary density of inner retina in pseudoPapilledema eyes than Papilledema eyes (P = 0.03 and P = 0.02, respectively). Conclusions Whole image and nasal peripapillary sector capillary densities using OCT-A had diagnostic accuracy for differentiating true and pseudo-disc swelling.
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quantification of peripapillary total retinal volume in pseudoPapilledema and mild Papilledema using spectral domain optical coherence tomography
American Journal of Ophthalmology, 2014Co-Authors: Masoud Aghsaei Fard, Sara Fakhree, Parisa Abdi, Narges Hassanpoor, Prem S SubramanianAbstract:Purpose To distinguish differences in retinal nerve fiber layer (RNFL) thickness and peripapillary total retinal volume between eyes with Papilledema, pseudoPapilledema, and normal findings. Design Cohort study. Methods Forty-two eyes with mild Papilledema, 37 eyes with congenitally elevated optic disc (pseudoPapilledema), and 34 normal eyes met the inclusion criteria at 1 academic institution (in Iran) and underwent neuro-ophthalmic examination. Spectral-domain optical coherence tomography scans surrounding the optic disc were performed in each eye of patients and subjects. Main outcome measures were mean RNFL thickness and peripapillary total retinal volume measurements (inner and outer ring volumes) that were compared between groups, using the generalized estimating equation approach. Area under receiver operating characteristic curves were also calculated. Results A statistically significant difference was found in mean RNFL thickness between both groups of patients with Papilledema and pseudoPapilledema and normal subjects. Average inner peripapillary total retinal volume in the Papilledema, pseudoPapilledema, and control groups were 1.95 ± 0.24 mm 3 , 1.81 ± 0.23 mm 3 , and 1.06 ± 0.10 mm 3 , respectively. Average outer peripapillary total retinal volume in the Papilledema and pseudoPapilledema groups were 2.68 ± 0.49 mm 3 and 2.03 ± 0.24 mm 3 , respectively ( P 3 ) eyes ( P = .17). Area under the curve to discriminate pseudoPapilledema vs Papilledema eyes for average RNFL thickness and inner and outer peripapillary total retinal volumes was 0.82, 0.68, and 0.88, respectively. Conclusion Outer peripapillary total retinal ring volumes might be useful in differentiating Papilledema from pseudoPapilledema.
Xiaoming Zhang - One of the best experts on this subject based on the ideXlab platform.
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evaluation of posterior sclera viscoelasticity in eyes with Papilledema by using ultrasound vibro elastography
Journal of the Acoustical Society of America, 2019Co-Authors: John J. Chen, Boran Zhou, Arthur J. Sit, Arash Kazemi, Xiaoming ZhangAbstract:Papilledema is optic nerve swelling caused by increased intracranial pressure, which has the potential to cause significant vision loss. Papilledema is typically bilateral and symmetric but can sometimes be asymmetric and even unilateral. The cause for this asymmetry is unknown. The purpose of this study was to utilize ultrasound vibro-elastography (UVE) to assess for biomechanical differences in eyes with Papilledema. Nine patients with Papilledema and 9 age-matched controls were enrolled. An external harmonic vibration was used to generate wave propagation through the eyelid with three excitation frequencies of 100, 150, and 200 Hz. A 6.4 MHz ultrasound probe was used to noninvasively measure the wave propagation in the posterior sclera to provide shear wave speeds and viscoelasticity (fit with Voigt model). The magnitudes of the shear wave speed and viscoelasticity of the idiopathic intracranial hypertension patients’ posterior sclera were significantly higher than those of healthy subjects. Moreover, for patients with unilateral Papilledema, the magnitudes of wave speed and viscoelasticity of the posterior sclera were statistically higher in eyes with Papilledema than in the contralateral eyes without Papilledema. UVE provides a noninvasive technique to measure the viscoelastic properties of the posterior sclera, which is stiffer in eyes with Papilledema.Papilledema is optic nerve swelling caused by increased intracranial pressure, which has the potential to cause significant vision loss. Papilledema is typically bilateral and symmetric but can sometimes be asymmetric and even unilateral. The cause for this asymmetry is unknown. The purpose of this study was to utilize ultrasound vibro-elastography (UVE) to assess for biomechanical differences in eyes with Papilledema. Nine patients with Papilledema and 9 age-matched controls were enrolled. An external harmonic vibration was used to generate wave propagation through the eyelid with three excitation frequencies of 100, 150, and 200 Hz. A 6.4 MHz ultrasound probe was used to noninvasively measure the wave propagation in the posterior sclera to provide shear wave speeds and viscoelasticity (fit with Voigt model). The magnitudes of the shear wave speed and viscoelasticity of the idiopathic intracranial hypertension patients’ posterior sclera were significantly higher than those of healthy subjects. Moreover, ...
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An Ultrasound Vibro-Elastography Technique for Assessing Papilledema.
Ultrasound in Medicine & Biology, 2019Co-Authors: Boran Zhou, Arthur J. Sit, John J. Chen, Arash Kazemi, Xiaoming ZhangAbstract:Abstract Papilledemais optic nerve swelling caused by increased intracranial hypertension, which has the potential to cause significant vision loss. Papilledema from idiopathic intracranial hypertension (IIH) is typically bilateral and symmetric, but can be asymmetric and even unilateral. The purpose of this study was to develop ultrasound vibro-elastography (UVE) for non-invasive measurement of ocular tissue wave speed for patients with Papilledema. A total of 9 patients with Papilledema from IIH and 9 age-matched healthy control patients were enrolled in this study. A local, gentle, 0.1-s harmonic vibration was applied on the eyelid to generate wave propagation in the ocular tissue. We used 3 excitation frequencies of 100, 150 and 200 Hz to measure the wave speeds. A 6.4-MHz ultrasound probe was used to non-invasively measure wave propagation in the ocular structures. Wave speeds were analyzed in the posterior sclera of the maculae of the eyes. The magnitudes of wave speed at each frequency of the IIH patients’ posterior sclera were significantly higher than those of healthy patients. It was found that the magnitudes of wave speed at each frequency were statistically higher in the eyes with Papilledema than in the contralateral eyes without Papilledema for the patients with unilateral Papilledema. UVE provides a non-invasive technique to measure the wave speed of posterior sclera, which may be useful for assessing patients with Papilledema.
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An Ultrafast Ultrasound Microvessel Imaging Technique for Assessing Patients with Unilateral Papilledema
2018 IEEE International Ultrasonics Symposium (IUS), 2018Co-Authors: Boran Zhou, Arash Kazami, Arthur J. Sit, John J. Chen, Xiaoming ZhangAbstract:Objective: The purpose of this study was to develop an ultrafast ultrasound microvessel imaging technique for assessing patients with unilateral Papilledema or choroidal folds. Methods: Two patients with unilateral Papilledema were enrolled in this study. An ultrasound probe was used to evaluate the hemodynamic properties in the eye structures noninvasively. Results: For patients with unilateral Papilledema, the magnitudes of blood volume of the optic disc are statistically lower in the eye with Papilledema than a normal eye. Conclusion: significant differences in power Doppler intensity were found between the eye with Papilledema and control eye for patients with unilateral Papilledema. Significance: Ultrafast ultrasound microvessel imaging provides a noninvasive technique to measure the hemodynamic properties of the optic disc, which is useful for assessing patients with unilateral Papilledema.
John J. Chen - One of the best experts on this subject based on the ideXlab platform.
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Etiology of Papilledema in Patients in the Eye Clinic Setting
JAMA Network Open, 2020Co-Authors: Olivia M. Crum, Collin M. Mcclelland, M. Tariq Bhatti, Michael S. Lee, Khin P. Kilgore, Rishi Sharma, Matthew R. Spiegel, John J. ChenAbstract:Importance The study of health conditions associated with Papilledema will augment the clinical judgment of eye care professionals treating patients with optic disc edema in determining the urgency of additional evaluation and counseling patients accordingly. Objectives To determine the incidence, demographic characteristics, and etiologies of Papilledema based on a unique records–linkage research platform; and to describe the demographic and clinical differences between patients with idiopathic intracranial hypertension (IIH) and other causes of Papilledema. Design, Setting, and Participants Retrospective population-based cross-sectional study of patients treated for Papilledema at outpatient eye clinics in Olmsted County, Minnesota, using the Rochester Epidemiology Project. Data were collected from January 1990 to December 2014 and analyzed from September 2018 to April 2019. Main Outcomes and Measures Etiologies of Papilledema, body mass index, incidence of headache, or localizing neurologic signs. Results Eighty-six patients were diagnosed with Papilledema during the 24-year period, providing an age- and sex-adjusted incidence of 2.5 individuals per 100 000 per year; 68 patients (79%) were women, 73 (85%) were white patients, and the median (range) age was 27.7 (6.2-64.2) years. Nineteen patients (22%) presented with a previously diagnosed attributable cause (eg, trauma or intracranial tumor). Among patients presenting with Papilledema without a previously diagnosed attributable cause, 58 patients (87%) had IIH, and 9 patients (13%) were found to have a secondary cause of raised intracranial pressure, such as intracranial tumor, cerebral venous sinus thrombosis, or granulomatous meningitis. Patients with IIH had a higher median (range) body mass index (37.5 [20.4-55.7] vs 27.4 [16.6-40.1];P = .003) and headache prevalence (54 of 58 patients [93%] vs 6 of 9 patients [67%];P = .004) than patients with other causes of Papilledema. Of 9 patients with Papilledema but no IIH, 2 (22%) had localizing neurologic signs, such as gait abnormalities, hearing loss, focal weakness or numbness, visual field defects, or aphasia. Among 42 patients with demographic characteristics typically associated with IIH (female sex, with obesity, aged 15 to 45 years, and absent localizing neurologic signs or symptoms), 40 (95%) had Papilledema that was associated with IIH. Conversely, among the 19 patients without these demographic characteristics, 7 (37%) had an alternative cause. Conclusions and Relevance In this study, most patients who presented to the eye clinic with Papilledema without a previously known cause were found to have IIH. These patients were more likely to present with headaches and had statistically higher body mass index. Clinicians should take these findings into account when determining the pretest probability of a patient having IIH or an alternative cause of Papilledema.
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Presentation and Progression of Papilledema in Cerebral Venous Sinus Thrombosis
American Journal of Ophthalmology, 2020Co-Authors: Katy C. Liu, John J. Chen, Collin M. Mcclelland, M. Tariq Bhatti, Aaron M. Fairbanks, Rod Foroozan, Michael S. Lee, Celine E. Satija, Courtney E. Francis, Michael T. WildesAbstract:Purpose To determine the natural history and visual outcomes of Papilledema in cerebral venous sinus thrombosis (CVST). Design Retrospective observational case series. Methods This multicenter study included 7 tertiary care neuro-ophthalmology clinics. Sixty-five patients with CVST were identified who received serial eye examinations with documented Papilledema from 2008-2016. Outcome measures included time from diagnosis to Papilledema documentation, Papilledema progression, time to Papilledema resolution, treatment interventions and final visual outcomes. Results Papilledema was present on initial presentation in 54% of patients or detected later during the course of the disease in 46% of patients. The average time from CVST diagnosis to Papilledema documentation was 29 days with a mean (SD) initial Frisen grade of 2.7 (1.3). In 21.5% of cases, Papilledema progressed over an average of 55.6 (56.6) days. Time to Papilledema resolution was approximately 6 months. Final visual acuity ranged from 20/20 to light perception, with 40% of patients having residual visual field defects on standard automated perimetry. Frisen grade ≥3 (odds ratio [OR] 10.21, P Conclusions Our study indicates the importance of serial ophthalmic evaluation in all cases of CVST. Follow-up fundoscopy is critical given that a subset of cases can show delayed onset and/or worsening of Papilledema with time. Specifically, we recommend an ophthalmic examination at the time of initial diagnosis, with repeat examination within a few weeks and further follow-up depending on the level of Papilledema or vision changes.
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evaluation of posterior sclera viscoelasticity in eyes with Papilledema by using ultrasound vibro elastography
Journal of the Acoustical Society of America, 2019Co-Authors: John J. Chen, Boran Zhou, Arthur J. Sit, Arash Kazemi, Xiaoming ZhangAbstract:Papilledema is optic nerve swelling caused by increased intracranial pressure, which has the potential to cause significant vision loss. Papilledema is typically bilateral and symmetric but can sometimes be asymmetric and even unilateral. The cause for this asymmetry is unknown. The purpose of this study was to utilize ultrasound vibro-elastography (UVE) to assess for biomechanical differences in eyes with Papilledema. Nine patients with Papilledema and 9 age-matched controls were enrolled. An external harmonic vibration was used to generate wave propagation through the eyelid with three excitation frequencies of 100, 150, and 200 Hz. A 6.4 MHz ultrasound probe was used to noninvasively measure the wave propagation in the posterior sclera to provide shear wave speeds and viscoelasticity (fit with Voigt model). The magnitudes of the shear wave speed and viscoelasticity of the idiopathic intracranial hypertension patients’ posterior sclera were significantly higher than those of healthy subjects. Moreover, for patients with unilateral Papilledema, the magnitudes of wave speed and viscoelasticity of the posterior sclera were statistically higher in eyes with Papilledema than in the contralateral eyes without Papilledema. UVE provides a noninvasive technique to measure the viscoelastic properties of the posterior sclera, which is stiffer in eyes with Papilledema.Papilledema is optic nerve swelling caused by increased intracranial pressure, which has the potential to cause significant vision loss. Papilledema is typically bilateral and symmetric but can sometimes be asymmetric and even unilateral. The cause for this asymmetry is unknown. The purpose of this study was to utilize ultrasound vibro-elastography (UVE) to assess for biomechanical differences in eyes with Papilledema. Nine patients with Papilledema and 9 age-matched controls were enrolled. An external harmonic vibration was used to generate wave propagation through the eyelid with three excitation frequencies of 100, 150, and 200 Hz. A 6.4 MHz ultrasound probe was used to noninvasively measure the wave propagation in the posterior sclera to provide shear wave speeds and viscoelasticity (fit with Voigt model). The magnitudes of the shear wave speed and viscoelasticity of the idiopathic intracranial hypertension patients’ posterior sclera were significantly higher than those of healthy subjects. Moreover, ...
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An Ultrasound Vibro-Elastography Technique for Assessing Papilledema.
Ultrasound in Medicine & Biology, 2019Co-Authors: Boran Zhou, Arthur J. Sit, John J. Chen, Arash Kazemi, Xiaoming ZhangAbstract:Abstract Papilledemais optic nerve swelling caused by increased intracranial hypertension, which has the potential to cause significant vision loss. Papilledema from idiopathic intracranial hypertension (IIH) is typically bilateral and symmetric, but can be asymmetric and even unilateral. The purpose of this study was to develop ultrasound vibro-elastography (UVE) for non-invasive measurement of ocular tissue wave speed for patients with Papilledema. A total of 9 patients with Papilledema from IIH and 9 age-matched healthy control patients were enrolled in this study. A local, gentle, 0.1-s harmonic vibration was applied on the eyelid to generate wave propagation in the ocular tissue. We used 3 excitation frequencies of 100, 150 and 200 Hz to measure the wave speeds. A 6.4-MHz ultrasound probe was used to non-invasively measure wave propagation in the ocular structures. Wave speeds were analyzed in the posterior sclera of the maculae of the eyes. The magnitudes of wave speed at each frequency of the IIH patients’ posterior sclera were significantly higher than those of healthy patients. It was found that the magnitudes of wave speed at each frequency were statistically higher in the eyes with Papilledema than in the contralateral eyes without Papilledema for the patients with unilateral Papilledema. UVE provides a non-invasive technique to measure the wave speed of posterior sclera, which may be useful for assessing patients with Papilledema.
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An Ultrafast Ultrasound Microvessel Imaging Technique for Assessing Patients with Unilateral Papilledema
2018 IEEE International Ultrasonics Symposium (IUS), 2018Co-Authors: Boran Zhou, Arash Kazami, Arthur J. Sit, John J. Chen, Xiaoming ZhangAbstract:Objective: The purpose of this study was to develop an ultrafast ultrasound microvessel imaging technique for assessing patients with unilateral Papilledema or choroidal folds. Methods: Two patients with unilateral Papilledema were enrolled in this study. An ultrasound probe was used to evaluate the hemodynamic properties in the eye structures noninvasively. Results: For patients with unilateral Papilledema, the magnitudes of blood volume of the optic disc are statistically lower in the eye with Papilledema than a normal eye. Conclusion: significant differences in power Doppler intensity were found between the eye with Papilledema and control eye for patients with unilateral Papilledema. Significance: Ultrafast ultrasound microvessel imaging provides a noninvasive technique to measure the hemodynamic properties of the optic disc, which is useful for assessing patients with unilateral Papilledema.
Ahmara G Ross - One of the best experts on this subject based on the ideXlab platform.
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utility of spectral domain optical coherence tomography in differentiating Papilledema from pseudoPapilledema a prospective longitudinal study
Journal of Neuro-ophthalmology, 2020Co-Authors: Imran Jivraj, Robert A. Avery, Cesar A Cruz, Maxwell Pistilli, Anita A Kohli, Grant T Liu, Kenneth S Shindler, Mona K Garvin, Juikai Wang, Ahmara G RossAbstract:Background Prospective and longitudinal studies assessing the utility of spectral-domain optical coherence tomography (SD-OCT) to differentiate Papilledema from pseudoPapilledema are lacking. We studied the sensitivity and specificity of baseline and longitudinal changes in SD-OCT parameters with 3D segmentation software to distinguish between Papilledema and pseudoPapilledema in a cohort of patients referred for evaluation of undiagnosed optic disc elevation. Methods Fifty-two adult patients with optic disc elevation were enrolled in a prospective longitudinal study. A diagnosis of Papilledema was made when there was a change in the appearance of the optic disc elevation on fundus photographs as noted by an independent observer at or before 6 months. The degree of optic disc elevation was graded using the Frisen scale and patients with mild optic disc elevation (Frisen grades 1 and 2) were separately analyzed. SD-OCT parameters including peripapillary retinal nerve fiber layer (pRNFL), total retinal thickness (TRT), paracentral ganglion cell layer-inner plexiform layer (GCL-IPL) thickness, and optic nerve head volume (ONHV) at baseline and within 6 months of follow-up were measured. Results Twenty-seven (52%) patients were diagnosed with Papilledema and 25 (48%) with pseudoPapilledema. Among patients with mild optic disc elevation (Frisen grades 1 and 2), baseline pRNFL (110.1 µm vs 151.3 µm) and change in pRNFL (ΔpRNFL) (7.3 µm vs 52.3 µm) were greater among those with Papilledema. Baseline and absolute changes in TRT and ONHV were also significantly higher among patients with Papilledema. The mean GCL-IPL thickness was similar at baseline, but there was a small reduction in GCL-IPL thickness among patients with Papilledema. Receiver operator curves (ROCs) were generated; ΔpRNFL (0.93), ΔTRT (0.94), and ΔONHV (0.95) had the highest area under the curve (AUC). Conclusions The mean baseline and absolute changes in SD-OCT measurements (pRFNL, TRT, and ONHV) were significantly greater among patients with Papilledema, and remained significantly greater when patients with mild optic disc elevation were separately analyzed. ROCs demonstrated that ΔpRNFL, ΔTRT, and ΔONHV have the highest AUC and are best able to differentiate between Papilledema and pseudoPapilledema.
