Kim Jiramongkolchai

Temporary Lumbar Drain as Treatment for Pediatric Fulminant Idiopathic Intracranial Hypertension.

Fulminant idiopathic intracranial hypertension (FIIH) is a subtype of idiopathic intracranial hypertension (IIH) characterized by rapid, severe, progressive vision loss. Surgical intervention is often performed either as a cerebrospinal fluid (CSF) shunt procedure or an optic nerve sheath fenestration or, at times, both. These surgical procedures carry a significant risk of morbidity and failure. We present 2 patients in whom a temporary lumbar drain was successfully used in the management of medically undertreated pediatric FIIH, and circumvented the need for surgical intervention.

Choroidal Thickness and En Face Optical Coherence Tomography Imaging in Autoimmune Retinopathy.

A 57-year-old white woman developed autoimmune retinopathy (AIR) in both eyes associated with bilateral autoimmune sensorineural hearing loss. Laboratory testing was positive for 68kDa (heat-shock protein) and 136kDa (human interstitial retinoid-binding protein). Extensive cancer screening was negative. Spectral-domain optical coherence tomography enhanced depth imaging demonstrated a markedly thickened choroid in both eyes. En face imaging showed a distinctive pattern of granular hyperreflective foveal dots. The concurrent sensorineural hearing loss was thought to be of autoimmune origin and also responded to immunosuppressive treatment. Eyes with non-paraneoplastic, seropositive AIR may have associated increased choroidal thickness. Audiology testing should be considered.

Endodermal Cyst of the Third Nerve in a Child

Endodermal cysts, also known as neurogenic, neuroenteric, foregut, bronchogenic, respiratory, epithelial, teratomatous, or gastrocytoma cysts, can be found in the central nervous system, predominantly in the subarachnoid space of the cervical and thoracic spinal cord. We describe a child with an endodermal cyst of the third nerve and highlight neuroimaging findings, pathological correlation, clinical course, and patient management.

Retinal nerve fiber layer and ganglion cell-inner plexiform layer measurements using handheld optical coherence tomography in normal children

➢ On-going, prospective observational study ➢ Inclusion criteria: ❖ Healthy children ≤ 5 years-old with normal eyes ❖ Gestational age ≥ 37 weeks ❖ Normal retina, optic nerve, and anterior segment ❖ Undergoing sedation or general anesthesia for examination under anesthesia (EUA) or extraocular ophthalmic surgery ➢ Exclusion criteria: ❖ Prematurity (<37 weeks) ❖ Ophthalmic disease affecting the retina or optic nerve ❖ Neurologic or genetic disease affecting the optic nerve (i.e. seizure, Chiari malformation, malignancy) ➢ Data collected: demographic, axial length (Master-Vu Sonomed Escalon, Lake Success, NY), and HH-OCT macular rectangular volume scans at 0 degrees (Bioptigen, Inc, Morrisville, NC) ➢ DOCTRAPv60.6 (Duke-developed software) used to segment retina and analyze retinal thickness. ❖ All volumes reviewed and best foveal volume scan of one eye per patient selected for automated segmentation ❖ Each segmented volume scan was then manually corrected by study personnel ❖ An ETDRS map was used to eliminate scan areas of poor or unreadable quality (Figure 1).