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Lamina cribrosa displacement after optic nerve sheath fenestration in idiopathic intracranial hypertension: a new tool for monitoring changes in intracranial pressure?
  1. Marta Perez-Lopez1,2,
  2. Darren S J Ting1,
  3. Lucy Clarke1
  1. 1Newcastle Upon Tyne Hospitals NHS trust, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
  2. 2Fisabio Oftalmología Médica (FOM), Valencia, Spain
  1. Correspondence to Dr Marta Perez-Lopez, Fisabio Oftalmología Médica (FOM), C/Vicente Tormo Alfonso n°2, Valencia 46015, Spain; martaperezoftalmo{at}gmail.com

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Introduction

Imaging in patients with idiopathic intracranial hypertension (IIH) is by definition normal but MRI may show dilatation of the subarachnoid space (SAS) around the optic nerve and a secondary flattening of the posterior sclera.1 Because of the existence of a trans-lamina cribrosa (LC) gradient, in patients with IIH the disc surface and thus the LC should be anteriorly displaced secondary to the raised intracranial pressure (ICP).

In patients with glaucoma, an anterior displacement of the LC after lowering intraocular pressure (IOP) using spectral domain optical coherence tomography (SD-OCT) has been recently demonstrated.2–4 However, changes in the LC position after IIH treatment have not been reported previously.

Case report

A 28-year-old woman diagnosed with IIH and treated with lumbo-peritoneal shunt presented with progressive visual loss despite well-controlled ICP. Bilateral sequential optic nerve sheath fenestration was planned and the patient underwent SD-OCT imaging using enhanced depth imaging technique3 (figure 1) of the …

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