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Fig. 4 | Orphanet Journal of Rare Diseases

Fig. 4

From: Reliability of optic disc edema area in estimating the severity of papilledema in patients with POEMS syndrome

Fig. 4

Fundus photography indicating ODE area and ODE grade change through treatment. Four patients’ fundus photographs with amplification of edematous optic disc was shown in the Figure (a right eye before treatment, b left eye before treatment, C. right eye after treatment, D. left eye after treatment), ODE grades were marked with yellow number. Compared to optic disc regions before treatment, remarkable declination of ODE area after treatment were seen in both eyes of these 4 patients. Before treatment, ODE grades of these four patients’ eyes were ranged 3–5. ODE in A2 was grade 5, with obscuration of all major vessels on the optic disc. ODE in B1, A2, B2, A3 and B4 were grade 4, with relatively wide discontinuity of the major vessels at different areas surrounding optic disc: A1, B2 at nasal side; A2 at three quadrants except the inferior temporal quadrant; A3, B4 at superior nasal quadrant. ODE in B3 and A4 were grade 3, with only segmental discontinuity of vessels at margin of optic disc marked with yellow arrows. After treatment, except both eyes of the first patient still had circumferential opaque area and were rated grade 2 ODE, all the other patients’ eyes’ ODE grades declined to 1. C-shaped halo of opacification in each patient’s eye was at different sides of optic border: C2, nasal, superior and inferior side; D2, nasal and inferior side; C3, temporal side; D3, nasal, superior and inferior side; C4, nasal, superior and inferior side; D4, temporal and inferior side. The changes of ODE area and grade convincingly prove the effectiveness of lenalidomide in terms of ocular symptom

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