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The Translaminar Pressure Gradient

Papilledema After Trabeculectomy Treated With Optic Nerve Sheath Fenestration

Radke, Phillip M., MD*,†; Rubinstein, Tal J., MD*,†; Hamilton, Steven R., MD; Jamil, Annisa L., MD§; Sires, Bryan S., MD, PhD*,†

doi: 10.1097/IJG.0000000000001021
Online Articles: Case Report/Small Case Series

Introduction: Trans-lamina cribrosa pressure has been postulated to be a contributor in the development of a glaucomatous optic nerve versus optic nerve edema, depending on the pressure gradient. Uncertainty remains in the therapeutic outcome of adjusting this gradient.

Case Report: We discuss a unique case of idiopathic intracranial hypertension presenting as asymmetric optic disc edema following trabeculectomy. It was treated via optic nerve fenestration due to the patient remaining symptomatic on maximum tolerated acetazolamide. Intraocular pressure stabilized into target range and the optic nerve edema resolved.

Conclusions: Rarely, intraocular pressure reduction can unmask elevated intracranial pressure, leading to optic nerve edema. Optic nerve sheath fenestration is a practical therapeutic modality to consider when treating this occurrence.

*Allure Laser Center & Medispa, Kirkland

Department of Ophthalmology, University of Washington

Neuroscience Institute, Swedish Medical Center

§Glaucoma Consultants Northwest at The Polyclinic, Seattle, WA

Disclosure: The authors declare no conflict of interest.

Reprints: Bryan S. Sires, MD, PhD, 625 4th Avenue, Suite 301, Kirkland, WA 98033 (e-mail:

Received April 19, 2018

Accepted June 25, 2018

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