Neuro-Ophthalmology

Case 3

Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.  

On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.

A dilated fundus examination was performed demonstrating the following:

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Question: Please describe the fundus photographs:

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Question: To further investigate the retinal folds, an OCT was performed in the area.  Based on the OCT, where are the folds located?

Question: On the raster protocol, there is an accompanying fundus photo that comes with the raster printout. To investigate the retinal folds, notice how the vertical raster lines have been applied to the area temporal to the right optic nerve where the retinal folds are most prominent. What type of ophthalmoscope was used to acquire this image?  

Retina 28-5.png
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Question: An OCT macula was subsequently performed demonstrating the following. What is the yellow arrow pointing to?

Retina 28-7.png

Question: After the VP shunt was placed, the patient was seen in follow-up and a repeat OCT macula of the right eye was performed, shown above. The orange arrow is pointing towards the ellipsoid zone. Why does it have this appearance?  

Of note, the RNFL and GCC OCT at the 1-month postoperative mark were conducted and included below. You can appreciate the optic atrophy with thinning of the RNFL and GCC OU.

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Learning Objectives:

1. To review the OCT retinal features of papilledema