Optical coherence tomography represents a sensitive and reliable tool for routine monitoring of idiopathic intracranial hypertension with and without papilledema

Abstract

Background and purpose We previously reported that certain optical coherence tomography (OCT) measures were sensitive and reliable in identifying idiopathic intracranial hypertension (IIH). This prospective study aimed to define OCT measures that allow differentiation of IIH with and without papilledema, thereby helping clinical decision‐making. Methods Eight patients with IIH with papilledema, nine without papilledema and 19 with other neurological diseases were included. OCT measures were obtained before lumbar puncture and within 2 h, 1, 3 and 6 months after lumbar puncture with cerebrospinal fluid (CSF) removal. Results All patients with papilledema had increased retinal nerve fiber layer (RNFL) thickness and elevated CSF pressure. All patients without papilledema had normal RNFL but elevated CSF pressure. After CSF removal, reduced RNFL thickness was registered in all eight patients with IIH with papilledema. No significant change in RNFL thickness after CSF removal was observed in IIH without papilledema or in patients with other neurological diseases, although reduced CSF pressure was documented. RNFL thickness tended to be normal in patients with IIH with papilledema at 3–6 months after CSF removal. All patients with IIH showed increased rim area and rim thickness, but reduced optic cup volume regardless of RNFL thickness or papilledema. Conclusions Retinal nerve fiber layer thickness is sensitive for monitoring acute IIH and evaluating treatment effect. Increased rim area and rim thickness and decreased optic cup volume are reliable parameters that indicate persistently increased CSF pressure and risk of relapse. OCT measures are sensitive and reliable for diagnosing subtle IIH even in the absence of papilledema.

Retinal thinning and brain atrophy in early MS and CIS

“…Our results showed that GCIPL is more stable, with less deviation. GCIPL is less affected by papilledema or disk swelling 37 . In acute ON, RNFL undergoes pseudo‐thinning which can last 3‐9 months before real thinning can be demonstrated 38 .…”

Visual evoked potentials follow-up in idiopathic intracranial hypertension

“…10 There is a paucity of precisely sensitive and objective indicators of the disease for monitoring relapses and remission. 11,12 Moreover, no sensitive and objective methods have been established yet to determine the disease severity in order to decide whether surgery should be performed in these patients. [12][13][14] Despite the potential of IIH to cause visual morbidity, only a limited number of studies are available in the literature to predict the potential impact of IIH on the vision.…”

“…11,12 Moreover, no sensitive and objective methods have been established yet to determine the disease severity in order to decide whether surgery should be performed in these patients. [12][13][14] Despite the potential of IIH to cause visual morbidity, only a limited number of studies are available in the literature to predict the potential impact of IIH on the vision. 13 The findings obtained by VEP reflect the functions of the visual pathways extending from the retina to the occipital cortex.…”

Retinal correlates of neurological disorders

“…Retinal correlates have been observed in a range of some of the most common neurological disorders, some of which are not commonly associated with visual symptoms. Further to those conditions discussed, retinal correlates have been found in other neurological diseases such as idiopathic intracranial hypertension (IIH), 348 chronic migraines, 349–351 and a range of psychiatric conditions. 352,353 The majority of evidence exists in the form of cross-sectional studies comparing disease groups and healthy controls; however, further work must be done to take advantage of the unique opportunity the eye provides to serially image subjects through time.…”