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Yuval Cohen, Muhammad Mahajnah, Rana Hanna, Michael Idel, Beatrice Tiosano; OCT Imaging of Papilledema in Pediatric Idiopathic Intracranial Hypertension. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4546.
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© ARVO (1962-2015); The Authors (2016-present)
Longitudinal clinical observation of optic nerve head, using slit lamp fundoscopy, guides therapy in pediatric idiopathic intracranial hypertension (IIH) patient; however, it remains a limited method of producing quantitative data in evaluating in patients with IIH.We sought to compare the mean RNFLT/TRT and 12 segmentation analysis of the optic nerve of newly diagnosed IIH children to a control group. Additionally, the change in RNFLT/TRT was measured during 3 months of IIH treatment with acetazolamide and weight reduction.
We used spectral domain optical coherence tomography (sdOCT) to evaluate retinal nerve fiber layer thickness (RNFLT) and total retinal thickness (TRT) of children presenting with clinically suspected IIH. Patients were evaluated by a pediatric neurologist, ophthalmologist and underwent sdOCT exam before and after lumbar puncture (LP), and after one and 3 month of follow-up. IIH was diagnosed based on modified Dandy Criteria. We compared the RNFLT and TRT of clinically diagnosed IIH children to an age matched controls group that did not have papilledema on fundoscopic exam.
Thirty one children were included (N=16 for the IIH group, N=17 for the control group). The mean RNFLT was 135.1±19.7 vs. 113±8.9 µm for the IIH and control groups (p=0.001), respectively. Segmental analysis of RNFLT showed that the nasal region was significantly different between the groups. Intracranial pressure <span style="line-height:20.8px">(range between 21-52 cmH</span>2<span style="line-height:20.8px">O) </span>measured in the IIH group was directly correlated with RNFLT at the nasal segment (r=0.64, p=0.03). Following 1 and 3 months of IIH treatment, RNFLT and TRT gradually decreased to 117.1±8.6 µm, and most patients returned to normal thickness.
The nasal part of the optic nerve was the most sensitive segment in detection of papilledema in IIH. We suggest that sdOCT can be used as a non-invasive method for diagnosis and follow-up of pediatric patients with IIH.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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