Purchase this article with an account.
Heather Moss, Gautam Vangipuram, Justin Wanek, Mahnaz Shahidi; Retinal vessel diameters change within 1 hour of intracranial pressure lowering. Invest. Ophthalmol. Vis. Sci. 201657(12):.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Previous studies have demonstrated that retinal vein diameters are larger in patients with idiopathic intracranial hypertension (IIH) with elevated intracranial pressure (ICP) and that retinal vein diameters decrease in patients with IIH within months following treatment of ICP. We sought to determine if retinal artery and vein diameters change rapidly following lowering of ICP via lumbar puncture (LP) in subjects with and without high ICP.
Scanning laser ophthalmoscopy images of the optic nerve head (Spectralis, Heidelberg Engineering) were obtained within 1 hour pre and post LP in both eyes of 18 subjects (23-86 years old, LP opening pressure (ICP) 10-55cm H2O). Diameters of the 2 largest arteries and veins in a ring region of interest with inner and outer radii of 2.0 and 2.75 mm from the optic nerve head center in each eye were measured using previously validated semi-automated customized image analysis software. Relationships between ICP and 1) artery and vein diameters prior to LP and 2) change in artery and vein diameters after LP, were modeled using generalized estimating equations (GEE), which account for within subject correlations.
Neither retinal artery nor vein diameters prior to LP were associated with ICP (p=0.21, 0.87). Subjects with lower ICP had increases in both artery and vein diameters after LP, while those with higher ICP had decreases in both artery and vein diameters after LP. For retinal artery diameter change, the GEE model had a slope of -2.2μm (95% CI 1.1-3.4 μm, p<0.0005) per 10 cm H2O increase in initial ICP, and an x intercept of 27cm. For retinal vein diameter change, the GEE model had a slope of -2.2μm (95% CI 0.9-3.6 μm, p=0.001) for each 10 cm H2O increase in initial ICP, and an x intercept of 22cm.
Retinal artery and vein diameters were not associated with ICP, in contrast to prior observations of retinal vein dilation associated with high ICP. In subjects with high ICP, vein diameters decreased within 1 hour following acute ICP lowering, in agreement with prior observations of retinal vein constriction in IIH subjects following months of ICP lowering. Rapid retinal vessel diameter changes in response to ICP lowering have not been previously reported and suggest a rapid retinal hemodynamic response to ICP lowering. Further studies are needed to determine the utility of retinal vessel diameter measurements for monitoring ICP and IIH.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
This PDF is available to Subscribers Only