Retinal nerve fiber layer characteristics in patients with spontaneous intracranial hypotension: a retrospective case series

Abstract

Objective To evaluate changes in retinal nerve fiber layer (RNFL) and macular thicknesses, included ganglion cell-inner plexiform layer (GCIPL) thickness, in patients with spontaneous intracranial hypotension (SIH). Methods This was a retrospective, nonrandom, observational case series study. Comprehensive ophthalmic examinations and systemic examinations were performed. Spectral domain optical coherence tomography angiography scanning was used to measure peripapillary RNFL thickness and macular volume. Results In total, 108 eyes in 54 patients with SIH were evaluated; these were compared with 108 eyes in 54 healthy controls. The mean ages were 38.2 ± 9.4 years (patients with SIH) and 38.9 ± 9.4 years (healthy controls). In both groups, 33 patients were women (61.1%). The peripapillary RNFL and GCIPL were thinner in patients with SIH than in healthy controls (100.08 ± 9.94 µm vs 104.83 ± 8.35 µm and 81.46 ± 5.67 µm vs 85.67 ± 4.57 µm, respectively). Among patients with SIH, the GCIPL was thinner in patients with visual field defects (79.81 ± 5.62 µm vs 82.39 ± 5.12 µm). Conclusions The RNFL and GCIPL were thinner in patients with SIH than in healthy controls. The GCIPL was thinner in eyes with visual field defects among patients with SIH.

Case Report: Unilateral Cranial Nerve VI Palsy Secondary to Intracranial Hypotension

“…This study concluded that retinal nerve fiber layer and ganglion cell–inner plexiform layer thickness was thinner in patients with intracranial hypotension versus a healthy control 13 . Patients with visual field defects also had thinner ganglion cell–inner plexiform layer thickness, suggesting that changes to the ganglion cell layer may play a role in visual field loss 13 . Further research needs to be conducted to investigate the pathogenesis of how low intracranial pressure impacts retinal structures.…”

“…Unlike intracranial hypertension, there is no visual field pattern characteristic of intracranial hypotension. Horton and Fishman 4 discussed two cases of blurry vision with visual obscurations and noted binasal visual field defects in these patients 13 . Groth et al 14 discussed a case of decreased bilateral visual acuity and noted temporal quadrant constriction on visual field testing 13,14 .…”

“…Horton and Fishman 4 discussed two cases of blurry vision with visual obscurations and noted binasal visual field defects in these patients 13 . Groth et al 14 discussed a case of decreased bilateral visual acuity and noted temporal quadrant constriction on visual field testing 13,14 . These case reports suggest that low intracranial pressure may affect the retina and optic nerve.…”

“…A retrospective case study was performed on 54 Chinese patients to evaluate how intracranial hypotension impacted retinal nerve fiber layer and ganglion cell–inner plexiform layer thickness in patients with and without visual field defects versus a healthy control group 13 . Only 32 patients had visual field defects, most commonly peripheral depressions, followed by quadrant depressions, central scotomas, and arcuate defects 13 . It is important to note that one of these patients had normal tension glaucoma 13 .…”

“…13 Groth et al 14 discussed a case of decreased bilateral visual acuity and noted temporal quadrant constriction on visual field testing. 13,14 These case reports suggest that low intracranial pressure may affect the retina and optic nerve. A retrospective case study was performed on 54 Chinese patients to evaluate how intracranial hypotension impacted retinal nerve fiber layer and ganglion cell-inner plexiform layer thickness in patients with and without visual field defects versus a healthy control group.…”