Monitoring Papilledema with Heidelberg Retina Tomograph in a Patient with Ruptured Aneurysm: a Case Report.

BACKGROUND: Heidelberg Retina Tomograph is a scanning laser ophthalmoscope that is routinely used for the assessment and serial measurement of optic nerve morphology and nerve fiber layer anatomy in the setting of elevated intraocular pressure typically encountered in glaucoma. Recent studies have explored the use of this device in the objective assessment of optic nerve head swelling occurring in the setting of elevated intracranial pressure, also known as papilledema. We explore the utility of HRT as a complementary evaluation to serial fundoscopic examination of the optic nerve head in a patient with a high-grade SAH, raised intracranial pressure, and papilledema secondary to rupture of a giant intracranial aneurysm. To our knowledge, this represents the first report of the use of this technology as an objective assessment of papilledema in the setting of SAH. CASE DESCRIPTION: A 23-year-old man presented with spontaneous SAH secondary to a ruptured giant internal carotid artery aneurysm. The patient underwent endovascular embolization to prevent further hemorrhage and was monitored with HRT on a monthly basis. Severe papilledema, present at the outset and confirmed by the neuro-ophthalmologic consultant, was followed by serial examination with the device. CONCLUSION: Heidelberg Retina Tomograph is a promising device for the analysis of optic nerve head topography in the setting of papilledema in SAH. Worsening or resolution of papilledema can be qualitatively demonstrated with serial studies using this device

Monitoring Papilledema in a Patient with Pineal Pilocytic Astrocytoma by using Heidelberg Retina Tomograph II. Case report.

The Heidelberg Retina Tomograph (HRT) II is a confocal scanning laser device used to acquire images of the optic nerve head. In this paper the authors report a novel use of this device in the assessment of papilledema in a patient with pilocytic astrocytoma of the pineal region. They also present a new technique to objectively produce 3D data of the optic nerve head. An 11-year-old girl presented with headache and bilateral papilledema; magnetic resonance imaging revealed a lesion in the pineal region. A suboccipital craniectomy was performed, and HRT images were obtained both before (baseline) and after (follow-up) the operation. The authors analyzed the height variation of the retinal surface along the vertical and horizontal cross-lines passing the center of the optic nerve head. The postoperative images, studied on the 2nd day after operation, demonstrated visible reduction of the papilledema. The height variation of the retinal surface along the contour line created by the software demonstrated that elevation of the optic nerve head became depressed due to resolved swelling. The height variation of the retinal surface along vertical and horizontal cross-lines demonstrated significant differences between the elevated preoperative curve and the postoperative curve (p \u3c 0.001), consistent with improvement of her symptoms. Initial data suggest that changes in the optic nerve head topography after surgical decompression can be quantitatively documented by 3D data from the HRT II