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M. Montolio, M. Poca, M. Morral, A. Dou, C. Macia, A. Verdugo, J. Garcia–Arumi; Follow up of Papilledema with Optical Coherence Tomography in Patients with Intracranial Hypertension . Invest. Ophthalmol. Vis. Sci. 2006;47(13):743.
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To describe the retinal nerve fiber layer evolution by Optical Coherence Tomography (OCT) in 5 patients with papilledema treated with acetazolamide or ventriculoperitoneal shunting.
Five patients with papilledema underwent complete neuro–ophthalmological examination including visual acuity, retinographies, visual field testing Sita Standard 30.2 and OCT fast retinal nerve fiber layer (FRNFL) analysis. All tests were performed at the onset of the disease and one, three and six months later. Lumbar puncture was performed to diagnose intracranial hypertension.
A correlation between OCT retinal nerve fiber layer thickness and clinical evolution was observed. In acute phase, an increased thickness of RNFL was observed in all patients. In four patients, resolution of papilledema with medical or ventriculoperitoneal shunting correlated with a decreased thickness of the retinal nerve fiber layer to normal values. In three cases, resolution of papilledema was associated with atrophy (decreased thickness) of the retinal nerve fiber layer in the superior pole of the optic disc. This was seen by OCT, but was not clinically significant by funduscopy. Papilledema persisted in one case in spite of maximum medical treatment. In this latter case, retinal nerve fiber layer remained thickened and visual field showed a progresion of the visual field defect during follow up.
In these cases, OCT has proved as a rapid and non–invasive technique to diagnose and follow up papilledema. RNFL thickness has correlated well with the register of intracranial pressure previous to and after treatment. On the other hand, lumbar puncture is not free of complications and requires hospitalization, especially in patients with ventriculoperitoneal shunting (headache, infection of the shunt and other life threatening complications). OCT is not an absolute substitute for lumbar puncture because the increase of retinal nerve fiber layer depends on several factors such as anatomical features of the optic nerve, previous episodes of papilledema and chronicity of papilledema.
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