Usefulness of optic nerve sheath diameter measurement in hypertensive patients during pregnancy and the puerperium

Pre-eclampsia/eclampsia during pregnancy and the puerperium are major risk factors for maternal and perinatal morbidity and mortality worldwide. Early diagnosis followed by appropriate treatment can prevent neurological disorders, considered one of the most serious sequelae of the disease. The detection of increased intracerebral pressure through the use of ocular ultrasonography could be considered an effective method for its diagnosis, since it has the advantage of being a noninvasive technique, easy to perform at the patient's bedside and with a high sensitivity and specificity for the detection of intracranial hypertension.

Diagnosis of traumatic scleral perforation in a dog using ocular ultrasound and ultrasound biomicroscopy

A 10-year-old spayed female Maltese dog was presented for hypotony of the right eye (OD) with decreased vision. The dorsomedial region of conjunctiva was partially swollen but the globe remained intact. Slit-lamp biomicroscopy revealed intraocular haemorrhage, uveitis, and a limbal, corneoconjunctival ulcer near the swollen conjunctiva. During ocular ultrasonography (OUS), the sclera became indented and hypotony occurred, implicating a full-thickness scleral wound. Ultrasound biomicroscopy (UBM) confirmed a full-thickness scleral defect, which was surgically apposed. The intraocular pressure normalised and the uveitis subsided post-operatively. OUS and UBM were helpful in suggesting and definitively diagnosing scleral perforation, leading to accurate treatment and good prognosis.

Optic Nerve Sheath Diameter: A Cross-Sectional Study of Ultrasonographic Measurement in Healthy Black South African Adults

Ultrasonographic optic nerve sheath diameter (ONSD) measurement is an accurate, portable, and non-invasive method of detecting raised intracranial pressure that can also reflect dynamic, real-time changes in intracranial pressure fluctuations. Various studies have shown the mean range of ONSD to vary greatly across different population groups. This study aimed to determine the mean ONSD in healthy Black South African adults. In this cross-sectional study, healthy black South African adult participants underwent optic nerve sheath ultrasound of the right eye, with the diameter being measured at 3 mm behind the retina in two different planes. The average of the two measurements was used to find the mean optic nerve sheath diameter. This measurement was compared to that found in a Canadian adult population, and the effect of age, gender, and co-morbidities on ONSD was assessed. A total of 99 participants were included in this study, of which 39 were male and 60 were female. The mean ONSD was found to be 5.1 mm (SD ± 0.33). This value was significantly higher than the mean ONSD observed in the Canadian population (p < 0.001). There was no significant difference found between the mean ONSD in males and females (p = 0.652), and both age and presence of co-morbidities were not found to significantly correlate with ONSD. (p = 0.693 and p = 0.974, respectively).

Electroretinography, Ocular Ultrasonography, and Phacoemulsification of Bilateral Cataracts in Two Juvenile Loggerhead Sea Turtles (Caretta caretta) of the Mediterranean Region

Bilateral cataracts were diagnosed in two rescued juvenile, immature loggerhead sea turtles (Caretta caretta), weighing 1.65 and 1.7 kg. Both animals showed vision impairment and difficulty in feeding without assistance. In fact, they did not notice the presence of the food in the tank unless it was brought close to touching the mouth. Ocular ultrasonography and electroretinography showed no lesions of the vitreal body and retinal layer, therefore, both animals were candidates for bilateral cataract surgery. Topical administration of tropicamide + phenylephrine alternating with rocuronium resulted in only minimal mydriasis. Administration of intracameral rocuronium did not improve mydriasis. Phacoemulsification using a one-handed technique was performed bilaterally with a phacoemulsification device (Sovereign, AMO (Abbott Medical Optics^®). After surgery, the systemic anti-inflammatory drug (dexamethasone 0.2 mg/kg, IM daily for one week) and antibiotics (enrofloxacin 10 mg/kg IM q 72 h, for 4 weeks; ceftazidime 20 mg/kg IM q 72 h for 3 weeks) were administered. Topical ofloxacin, flurbiprofen and tobramycin/dexamethasone were instilled TID for 4 weeks. Both turtles regained vision in both eyes. Results at a 10-month follow-up were satisfactory. This is the first report of cataracts in turtles rescued in the Mediterranean Sea and the first description of surgical treatment of cataracts in loggerhead turtles so young.

Diagnostic Accuracy of Optic Nerve Sheath Diameter Measured With Ocular Ultrasonography in Acute Attack of Chronic Obstructive Pulmonary Disease

OBJECTIVE

The study aimed to evaluate intracranial pressure changes by measuring ONSD before and after treatment in patients with chronic obstructive pulmonary disease (COPD).

METHODS

The study was designed as a prospective analysis, in which 56 COPD in acute exacerbation and 50 volunteers. COPD severity was determined by the Dyspnea Scale of Modified Medical Research Council (mMRC). Measurements were made with ocular ultrasonography and linear probe in both eyes.

RESULTS

Both the right and left ONSDs were higher in the patient compared to the control (P = .017) and regressed after the treatment (P = .021). In the ROC analysis for the predictability of COPD, right eye ONSDs showed a predictive potential for COPD with %75.7 specificity and %68.1 sensitivity at 0.455 cut-off (AUC: 0.727; P = .0001; %95CI: 0.609-0.833). Similar to the right eye, the left ONSD presented %74.4 specificity and %67 sensitivity at 0.505 cut-off value (AUC: 0.718; P = .0001; %95CI: 0.608-0.841).

CONCLUSION

The ONSD measurement that was with the help of ocular ultrasonography can be a useful diagnostic tool for symptomatic COPD presenting with an acute attack.

Bedside ocular ultrasonography for diagnosing increased intracranial pressure in patients with leptomeningeal metastases from non-small-cell lung cancer

OBJECTIVES

To explore the diagnostic accuracy of ultrasound measurement of optic nerve sheath diameter (ONSD) and optic disc height (ODH) in detecting intracranial hypertension in non-small-cell lung cancer (NSCLC) patients with leptomeningeal metastases (LM).

METHODS

Seventy-two patients with NSCLC-LM and 65 patients with NSCLC were enrolled. The ONSD, ODH, eyeball transverse diameter (ETD), and eyeball vertical diameter (EVD) were measured by ultrasound. Subsequently, lumbar puncture was performed in NSCLC-LM patients to measure cerebrospinal fluid pressure (CSFP), and intrathecal chemotherapy was regularly implemented. Pearson's correlation analysis was used to analyze the relationship between CSFP and ultrasound findings. The diagnostic accuracy of ONSD, ODH, and combined ONSD and ODH was evaluated by receiver operating characteristic (ROC) curve analysis and the corresponding area under the ROC curve (AUC).

RESULTS

The ONSD, ODH, ONSD/ETD, and ONSD/EVD values were higher in the NSCLC-LM group (all p < 0.05). The ONSD, ODH, ONSD/ETD, and ONSD/EVD values were all elevated in the abnormally elevated CSFP group (all p < 0.05). ONSD, ODH, ONSD/ETD, and ONSD/EVD were positively correlated with CSFP (r = 0.531, 0.383, 0.534, and 0.535, all p < 0.0001). The AUCs for ONSD, ODH, ONSD/ETD, and ONSD/EVD to detect CSFP >280 mmH2O were 0.787 (95% CI: 0.64-0.93, sensitivity 68.75%, specificity 91.07%), 0.885 (95% CI: 0.81-0.96, sensitivity 100%, specificity 69.64%), 0.765 (95% CI: 0.64-0.89, sensitivity 81.25%, specificity 64.29%), and 0.788 (95% CI: 0.64-0.93, sensitivity 56.25%, specificity 91.07%), respectively. When ONSD was combined with ODH, the AUC was 0.913 (95% CI: 0.83-0.99, sensitivity 87.85%, specificity 85.70%). Furthermore, intrathecal chemotherapy was associated with a downtrend in CSFP and ultrasound findings.

CONCLUSION

There are important advantages of using bedside ultrasonography for detecting elevated CSFP in NSCLC-LM patients. Further research should be performed to evaluate the clinical significance of an enlarged ONSD and increased ODH in NSCLC-LM.

Long-term evaluation of the effects of vitreous degeneration on cataracts and retinal detachment in dogs

OBJECTIVE

We aimed to track and evaluate the association between vitreous degeneration and the development of cataracts or retinal detachments in dogs over a long period.

ANIMAL STUDIED

Data on vitreous degeneration, cataracts, and retinal detachment in 102 eyes were collected from 68 dogs who underwent ocular ultrasonography at least twice between March 2017 and November 2021 at the Veterinary Medical Teaching Hospital, Konkuk University. The mean follow-up time was 515 ± 256 (mean ± standard deviation; range: 81-1196) days.

PROCEDURE

Development of cataracts and retinal detachment, according to the severity of vitreous degeneration grade (VDG), was evaluated during long-term follow-up.

RESULTS

In the cataract study (87 eyes, 61 dogs), the number of cataracts developed according to VDG (grade: 0-3) were as follows: VDG 0: 1 in 10 (10%) eyes, VDG 1: 15 in 35 (43%) eyes, VDG 2: 15 in 30 (50%) eyes, and VDG 3: 10 in 12 (83%) eyes. It was significantly different among grades (p = .026). In the retinal detachment study (95 eyes, 64 dogs), the number of retinal detachments developed according to each VDG were as follows: VDG 0: 0 in 11 (0%) eyes, VDG 1: 1 in 36 (3%) eyes, VDG 2: 5 in 35 (14%) eyes, and VDG 3: 4 in 13 (30%) eyes. It was also significantly different among grades (p = .019).

CONCLUSIONS

During long-term follow-up, dogs with severe vitreous degeneration had an increased risk of cataract and retinal detachment development than those without or with mild vitreous degeneration.

Clinical presentation and treatment outcomes of an algorithmic approach to uveal effusion syndrome

Purpose

To describe the clinical features and treatment outcomes in spontaneous uveal effusion syndrome (UES).

Methods

A 10-year retrospective chart review of UES patients from a tertiary eye center was carried out. Optical coherence tomography (OCT), fundus fluorescein angiography, and ultrasound biomicroscopy (UBM) scans were performed. UES was managed based on presenting best-corrected visual acuity (BCVA), symptoms, and fundus findings. Patients with secondary causes of uveal effusion were excluded.

Results

Twenty-five eyes of 16 patients were included. Of the 16 patients, 14 (88%) were male and 9 (56%) had bilateral disease. Fifteen of 25 affected eyes had nanophthalmos (axial length (AL) <20.5 mm) and 6 had hyperopia with AL >20.5 mm. The presenting mean distance BCVA was 0.74 ± 0.64 logMAR (mean Snellen: 20/100). Eleven eyes had exudative retinal detachment, and 4 also had exudative choroidal detachment (CD). Choroidal thickness (CT) was increased in 11 eyes on B-scan ultrasonography, and the mean CT was 1.74 ± 0.38 mm. Sub-retinal fluid (SRF) and retinal folds were the most common OCT findings. UBM findings included shallow angles, peripheral CD, and supra-ciliary effusion. A combination of local and systemic corticosteroids was used to successfully treat 12 eyes, 6 needed surgery, and 7 were observed. Partial sclerectomy with anterior chamber maintainer-assisted SRF drainage was the favored surgery. The median period of follow-up was 6.5 months (0.1-76 months), and the mean distance BCVA at the last follow-up was 0.58 ± 0.42 logMAR (mean Snellen: 20/80).

Conclusion

UES can be suitably managed both medically and surgically based on clinical presentation.

Correlation between cerebral biomarkers and optic nerve sheath diameter in patients with severe preeclampsia

Objective: To examine the correlation between plasma cerebral biomarkers (S100B and neuron-specific enolase (NSE)) and ultrasonographic optic-nerve-sheath-diameter (ONSD) in preeclampsia. Methods: Thirty preeclampsia patients and 27 controls were included. Mann-Whitney-U test was used for comparison of S100B, NSE, and ONSD in preeclampsia vs. controls. Kendall's tau was used to assess the correlation between biomarkers and ONSD (p < 0.05 significant). Results: ONSD, S100B and NSE were significantly higher in preeclampsia (p < 0.001, p = 0.004, and p < 0.001, respectively). There was significant correlation between NSE levels and ONSD: Kendall's tau = 0.26; p = 0.01. Conclusions: S100B and NSE are elevated in severe preeclampsia. NSE correlates with increased ONSD suggesting cerebral edema.

The Measurement of Elderly Volunteers' Optic Nerve Sheath Diameters by Ocular Ultrasonography

BACKGROUND AND OBJECTIVES

The optic nerve is a component of the central nervous system, and the optic nerve sheath is connected to the subarachnoid space. For this reason, intracranial pressure (ICP) increases are directly transmitted to the optic nerve sheath. Knowing the normal optic nerve sheath diameter (ONSD) range in a healthy population is necessary to interpret this measurement as a sign of intracranial pressure in clinical practice and research. In this study, we aimed to determine the standard ONSD value in healthy adultsaged65 years of age or older who had not previously been diagnosed with a disease that could increase the ICP.

MATERIALS AND METHODS

The right and left ONSD values and ONSD differences were compared, according to the gender of the patients. The patients were divided into 3 groups, according to their age. The age groups were assigned as follows: Group 1: 65-74 years of age; Group 2: 75-84 years of age; and Group 3: 85 years of age or older. The ONSDs and the ONSD difference between the left and right eyes of Group 1, Group 2 and Group 3 were compared.

RESULTS

The study included 195 volunteers. The mean ONSD of both eyes was 4.16±0.69 mm, and the difference between the ONSD of the left and right eyes was 0.16±0.18 mm. There was no difference between genders in terms of right ONSD, left ONSD, mean ONSD and ONSD difference between the left and right eyes. There was no correlation between age and ONSD and ONSD difference. When the age groups and ONSD were compared, no difference was found between the groups.

CONCLUSIONS

In conclusion, the ONSDs of both eyes do not vary with age in healthy adults aged65 years or older. ONSD does not vary between genders. The calculation of ONSD difference can be used to determine ICP increase.