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case_images: Case 1 (images after bilateral ONSF). (A) Right eye fundoscopy showing choroidal folds and optic nerve pallor. (B) 24-2 Visual field of the left eye and the right eye. A concentric contraction of the visual fields, more pronounced in the right eye, is shown. (C) ONH and macular OCT scans of the right eye with RNFL layer atrophy and choroidal folds in the posterior pole. (D) Orbital MRI. Axial and coronal view in T2 with fat suppression showing the marked dilatation of optic nerve sheath in both eyes.
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case_images: Central 24-2 perimetry (Humphrey-Zeiss field analyzer) showed concentric visual field (VF) reduction in both eyes ( Figure 1 ).
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case_images: CASE 2 (images from 2023:3 years of follow-up showing no evidence of progression since the diagnosis). (A) Right and left eye fundoscopy. (B) 24-2 Visual field of both eyes with peripheral inferior nasal defect in the left eye. (C) ONH OCT scan. (D) GCL sectors of both eyes. (E) MRI axial view in T1 dark fluid with bilateral optic nerve sheath dilatation and optic nerve tortuosity. (F) Orbital MRI, sagittal view in T1 at the right orbit plane.
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case_images: The structural OCT scans have also remained stable since the initial diagnosis ( Figure 2 ).
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case_images: Case 3 (images from 2023:10 years of follow-up showing no progression in the VF, OCTs, or MRI since the initial diagnosis). (A) Ganglion cell layer sectors of both eyes. Left eye is artifacted. (B) 24-2 Visual field of both eyes with unspecific nasal and superior defects. (C) ONH OCT scan shows no optic disc edema, with normal RNFL. (D) MRI sagittal (left, T1-weighted), axial (middle, T1-weighted), and frontal (right, T2-weighted) views show bilateral optic nerve sheath dilatation and optic nerve tortuosity (red arrows).
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case_images: The MRI showed increased sheath size and tortuosity and kinking of both intraorbital optic nerves associated with increased CSF ( Figure 3 ).