Unilateral papilledema after trabeculectomy in a patient with intracranial hypertension

Abegg, Mathias; Fleischhauer, J; Landau, K (2008). Unilateral papilledema after trabeculectomy in a patient with intracranial hypertension. Klinische Monatsblätter für Augenheilkunde, 225(5), pp. 441-2. Stuttgart: Ferdinand Enke Verlag 10.1055/s-2008-1027307

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BACKGROUND: Increased intracranial pressure usually leads to bilateral disc swelling. HISTORY AND SIGNS: A patient presented with recurrent visual disturbances following trabeculectomy in the right eye. Intraocular pressure in the right and left eye were 11 and 24 mmHg, respectively. The optic nerve head was swollen in the right, but not in the left eye. Lumbar puncture showed an opening pressure of 32 cmH (2)O. Magnetic resonance imaging, neurological examination and composition of cerebrospinal fluid were normal. According to the modified Dandy criteria, an idiopathic intracranial hypertension was diagnosed. THERAPY AND OUTCOME: Treatment with acetazolamide led to resolution of papilledema in the right eye within six months. CONCLUSION: The intracranial-intraocular pressure gradient in the right eye was markedly higher as compared to that of the left eye. We suggest that this pressure gradient induced the collapse of axoplasmatic transport at the lamina cribrosa with subsequent disc swelling. As no significant pressure gradient was present in the left eye, the optic disc remained normal. Based on analogous calculations in three additional published cases of unilateral papilledema we thus suggest that intraocular pressure should be taken into account when evaluating patients with papilledema.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Ophthalmology

UniBE Contributor:

Abegg, Mathias and Fleischhauer, Johannes M.C.

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0023-2165

ISBN:

18454392

Publisher:

Ferdinand Enke Verlag

Language:

English

Submitter:

Mathias Abegg

Date Deposited:

04 Oct 2013 15:05

Last Modified:

04 May 2018 09:11

Publisher DOI:

10.1055/s-2008-1027307

PubMed ID:

18454392

Web of Science ID:

000256237600030

URI:

https://boris.unibe.ch/id/eprint/28220 (FactScience: 118870)

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