Departments of Neurology, Ophthalmology, and Neurosurgery (MJK), New York Eye and Ear Infirmary and Icahn School of Medicine at Mount Sinai, New York, New York; and Department of Ophthalmology (PSS), State University of New York at Stony Brook, Stony Brook, New York.
J Neuroophthalmol. 2021 Sep 1;41(3):321-328. doi: 10.1097/WNO.0000000000001074.
Abnormal forces around the optic nerve head (ONH) due to orbital diseases, intracranial hypertension (IH), glaucoma, and space travel, are associated with alterations of the ONH shape. Elevated cerebral and ophthalmic venous pressure can contribute to stress and strain on the ONH and peripapillary retina. We hypothesize that IH and elevated ophthalmic venous pressure without IH cause different ONH and retinal changes.
We compared MRI and spectral domain optical coherence tomography (SDOCT) findings in patients with cavernous sinus arteriovenous shunts (CSAVSs), where orbital venous pressure is known to be elevated, with patients with intracranial dural venous sinus thrombosis and secondary IH. We also compared the results to those obtained in the Idiopathic IH (IIH) Treatment Trial.
Among 18 patients with dural venous sinus thrombosis, the MRI/magnetic resonance venography displayed partial empty sella (61%) and optic nerve sheath distension (67%). None exhibited ophthalmic vein dilation or signs of orbital congestion. SDOCT of these eyes and IIH eyes showed a similar frequency of abnormal thickening of the mean retinal nerve fiber layer, anterior displacement of the basement membrane opening, peripapillary wrinkles, retinal folds (RF), and choroidal folds (CF). Among 21 patients with CSAVSs, MRI showed ipsilateral dilated superior ophthalmic vein (76%) and orbital congestion (52%) without distension of the optic nerve sheath or globe distortion. SDOCT showed CF (19%), one with overlying RF, and no ONH deformations.
SDOCT findings for dural venous sinus thrombosis are similar to those seen with IIH but distinct from changes due to local ophthalmic venous hypertension. These data support the concept that IH even if due to a vascular cause and local orbital venous hypertension cause different stresses and strains on the ONH.
由于眼眶疾病、颅内压升高（IH）、青光眼和太空旅行导致的视神经头（ONH）周围异常力与 ONH 形状的改变有关。颅内和眼静脉压升高可导致 ONH 和视盘周围视网膜的应力和应变。我们假设 IH 和升高的眼静脉压而没有 IH 会导致不同的 ONH 和视网膜变化。
我们比较了海绵窦动静脉瘘（CSAVS）患者的 MRI 和谱域光学相干断层扫描（SDOCT）结果，已知眶内静脉压升高，与颅内硬脑膜静脉窦血栓形成和继发性 IH 患者进行比较。我们还将结果与特发性 IH（IIH）治疗试验的结果进行了比较。
在 18 例硬脑膜静脉窦血栓形成患者中，MRI/磁共振静脉造影显示部分空蝶鞍（61%）和视神经鞘扩张（67%）。没有患者表现出眼静脉扩张或眶内充血的迹象。这些眼和 IIH 眼的 SDOCT 显示出相似频率的平均视网膜神经纤维层异常增厚、基底膜开口前移位、视盘周围皱纹、视网膜皱褶（RF）和脉络膜皱褶（CF）。在 21 例 CSAVS 患者中，MRI 显示同侧扩张的上眼静脉（76%）和眶内充血（52%），但视神经鞘无扩张或眼球变形。SDOCT 显示 CF（19%），其中一个伴有 RF 重叠，没有 ONH 变形。
硬脑膜静脉窦血栓形成的 SDOCT 发现与 IIH 所见相似，但与局部眼静脉高压引起的变化不同。这些数据支持这样的概念，即 IH，即使是由于血管原因和局部眶内静脉高压，也会导致 ONH 承受不同的压力和应变。
