Background. The underlying mechanisms of papilledema associated with intracranial hypertension remain unclear. A case of bilateral papillary edema in a patient with chronic idiopathic intracranial hypertension who was asymptomatic during her two pregnancies is reported. Case Presentation. A 19-year-old Caucasian female, in her third month of pregnancy, complained of difficulties with close reading. The patients visual acuity was 20/20 on the Snellen chart and improved with a 0.50D correction in both eyes. Near vision and slit lamp examinations revealed normal findings bilaterally. However, a fundus examination showed bilateral papillary edema without evidence of hemorrhages or neovascularization. Blood tests were unremarkable, except for a slight increase in C-reactive protein levels. The patient had a prepregnancy weight of 63 kilograms, with a BMI of 24.91kg/m². Magnetic resonance imaging of the brain revealed features consistent with chronic idiopathic intracranial hypertension, which resolved after delivery. Two and a half years later, during a subsequent pregnancy, the patient experienced a recurrence of bilateral papillary edema due to the IIH. It was managed similarly as the first occurrence, resulting in bilateral anatomical and functional recovery. Recent research revealed that, during pregnancy, hormones interact with the central nervous system, leading to an increase in the size of neurons which could potentially result in intracranial hypertension. Conclusions. The influence of hormonal fluctuations during pregnancy on the development of transient central nervous system abnormalities in individuals with chronic intracranial hypertension, leading to papillary edema, remains a matter of debate.

Background: Despite the high closure rate of large macular hole (LMH) after surgery, visual recovery is often worse than expected. Microperimetric biofeedback can improve visual function in macular pathologies. We evaluated the efficacy of biofeedback on macular function after successful inverted flap technique for LMH. Methods: In this prospective comparative study, 26 patients after LMH surgical closure were enrolled. The whole sample was equally divided into two groups. In Group 1 (trained), patients underwent a double cycle of microperimetric biofeedback, using structured light stimulus plus acoustic tone; in Group 2 (control), patients underwent scheduled visits. We analyzed visual acuity, retinal sensitivity at central 12° (macular sensitivity, MS) and 4° (central macular sensitivity, CMS), and fixation stability over twelve months. Results: Visual acuity improved mainly in the trained group, without any significant differences between the groups (p > 0.05). Only after training did MS significantly improve (p = 0.01). CMS more significantly improved in the trained (p < 0.001) than the control group (p < 0.01) (Group 1 vs. 2, p = 0.004). Only in the trained group did fixation significantly improve (3 months, p ≤ 0.03; 12 months, p ≤ 0.01). An equality test on matched data confirmed a greater significant improvement of CMS (p ≤ 0.02) at all follow-up and fixation (p ≤ 0.02) at last follow-up after training. Conclusions: Microperimetric biofeedback consolidates and increases the improvement of retinal sensitivity and fixation gained after successful inverted flap technique.

Purpose: Pre-retinal cysts are rare and poorly characterized clinical entities. Unlike intraretinal cysts commonly associated with macular diseases, pre-retinal cysts have distinct etiologies and require specific diagnostic and therapeutic strategies. Proper differentiation and comprehension of glial retinal homeostasis are key to appropriate management. Case presentation: We report the case of a 65-year-old man with a history of post-traumatic retinal detachment treated surgically, and a subluxated intraocular lens (IOL) replaced with an iris-clipped lens for UGH syndrome. The patient experienced multiple episodes of spontaneously resolving vitreous hemorrhage. Inter-episode fundus examination revealed three large pre-retinal cysts in the superotemporal quadrant, located along the edges of the reattached retina, associated with intermittent intracystic hemorrhages. Management involved surgical excision, coagulation, and en bloc excision of the cysts. Pathologic examination of the cyst showed a glial proliferation, with a pilocytic astrocytic morphology, consistent with a benign proliferation. Discussion: After an in-depth etiological and pathological investigation, tumoral, infectious, and congenital causes were ruled out. This case represents a unique manifestation of multiple pre-retinal cystic astrocytic glial proliferations, complicated by recurrent intra-cystic and vitreous hemorrhages, successfully managed with surgical en-bloc excision.