Acquired optociliary shunt vessels in papilloedema.

Abstract

SUMMARY Seven cases are presented in which prolonged papilloedema led to the development of acquired optociliary shunt vessels. These vessels may also be found with optic nerve tumours, particularly spheno-orbital meningiomas, optic nerve drusen, glaucoma, and after central retinal vein occlusion. Two A 37-year-old housewife was admitted for increasing weakness of the left arm and leg of 2 years duration and several recent attacks of focal epilepsy. Her past history included migraine episodes for the past 6 years. The general physical examination was unremarkable. Neurological examination showed left pyramidal tract signs and diminished 2-point discrimination in the left hand. There was a loud bruit audible all over the skull. The ocular examination showed a corrected visual acuity of 6/6, N6 in the right eye and 6/5, N5 in the left. There was a right relative afferent pupillary defect. Perimetry showed the visual field of the left eye to be full, but there was some constriction of the nasal field of the right eye. The optic discs had blurred margins and were somewhat pale. The right was paler than the left. There were small drusen-like bodies at the disc margins and tortuous optociliary shunt vessels on both discs. Fluorescein angiography in both eyes showed mild dilatation of the radial peripapillary capillary plexus overlying the disc and nearby retina and leakage of dye into the surrounding retina, confirming the presence of papilloedema (Fig. 1). The shunt vessels filled from the retinal circulation. Arteriography demonstrated a massive superficial arteriovenous malformation in the right middle cerebral artery territory. CASE 2 A 37-year-old electrician was evaluated for diminished visual acuity in the left eye of indeterminate duration and 3 months of intermittent visual obscurations of both eyes. The obscurations were consistently brought on by running down stairs or bending over. The general and neurological examinations were normal except for bilateral papilloedema. Corrected visual acuity was 6/6 in the right eye and 6/18 left. There was a left relative afferent pupillary defect. Perimetry showed the visual field of the right eye to be moderately constricted in a concentric pattern, and the visual field of the left eye to be markedly constricted, especially nasally. There was bilateral papilloedema with tortuous optociliary shunts and temporal pallor of the left disc (Fig. 2). Fluorescein angiography showed profuse dye leakage at both discs and demonstrated the shunt vessels in the left eye to fill from the retinal veins. At operation a colloid cyst of the third ventricle was removed. 267 on 11 April 2019 by guest. Protected by copyright.

Rapid Regression of Retinochoroidal Venous Collaterals Following Optic Nerve Sheath Fenestration in Idiopathic Intracranial Hypertension

“…There are few reports describing regression of these retinochoroidal venous collaterals including: following decompression of orbito-cranial tumor, 3,15 after optic nerve sheath fenestration, 1,12 post-shunting procedures, 2 and treatment with lumbar puncture and acetazolamide. 13 In our patient, fundus photographs taken just three days postoperatively showed dramatic decrease in caliber of the retinociliary collaterals in both eyes.…”

Optical Coherence Tomography Angiography Findings in Optic Nerve Sheath Meningioma

“…A review by Dutton [1] found primary ONSMs to represent 1.3% (22 of 1,723) of all meningiomas with an identifiable site of origin. The presence of optociliary shunts in ONSM, as a chronic sign of the disease, is well known; they represent collateral vessels connecting the choroidal and the retinal vasculature [2]. In our patient, optociliary shunt vessels were not seen because of the moderate edema and the short course of the disease.…”

Optic Disc Edema From Papilledema

“…[9][10][11] Funduscopic examination of the optic discs should include an assessment of specific features of disc edema including the degree of disc swelling, optic disc color, peripapillary retinal nerve fiber layer opacification, loss of spontaneous venous pulsations, choroidal folds, and hemorrhage or nerve fiber layer infarction around the optic disc. [12][13][14][15] Clinically, papilledema is classified into 4 different stages-early, fully developed, chronic, and atrophic. There are grading scales, including the Frisen scale, that judge the severity of optic disc edema using ophthalmoscopy.…”