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Zhanhan Tu, Viral Sheth, Jack Gormley, Chatonda Manda, Frank A Proudlock, Karl Seydel, Terrie Taylor, Simon P Harding, Irene Gottlob; Hand-held Optical Coherence Tomography – A New Biomarker of Brain Swelling in Cerebral Malaria. Invest. Ophthalmol. Vis. Sci. 2018;59(9):612.
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© ARVO (1962-2015); The Authors (2016-present)
Cerebral malaria (CM) remains a major public health challenge, especially in children in Sub-Saharan Africa. CM causes death in approximately 15-25% of cases and 30% of patients have long-term neurological sequelae. Coma and death in paediatric CM are strongly associated with brain swelling. Brain swelling can result in raised intracranial pressure (ICP) and papilledema. Clinically, cerebrospinal fluid opening pressure (CSF-OP) is a marker of raised ICP and this is increased in the majority of children with CM. However, only 10-15% of cases demonstrate papilledema by fundoscopy on admission. For the first time, hand-held optical coherence tomography (HH-OCT) was used to demonstrate and quantify papilledema in children with CM. The association between these optic nerve head and peripapillary retinal nerve fibre layer (ppRNFL) changes and ICP measured by lumbar puncture has been investigated.
Thirty-five children with malarial retinopathy (MR) positive CM were recruited (age range = 7-131 months, mean age = 56.1 months) from the Queen Elizabeth Central Hospital, Blantyre, Malawi. On admission, lumbar punctures were performed on comatose CM children in the lateral recumbent position, and the CSF-OP were measured with a manometer. Volumetric scans of the optic nerve head and ppRNFL were obtained from each participant using HH-OCT (12 x 8 x 2mm volume, 80 A scans, 600 A scans per B scan).
CSF-OP demonstrated significant positive correlations with optic nerve head rim volume (r = 0.582, p = 0.0002) and rim area (r = 0.504, p = 0.002). Cup parameters including maximum cup depth (r = -0.432, p = 0.01), cup volume (r = -0.390, p = 0.02), cup/disc ratio (r = -0.498, p = 0.002) and cup area (r = -0.422, p = 0.012) were negatively correlated with CSF-OP. Average thickness of ppRNFL was also significantly positively correlated with CSF-OP (r = 0.397, p = 0.022). ppRNFL thicknesses in superior (r = 0.479, p = 0.004) quadrants shared the same trend as average ppRNFL thickness. However, ppRNFL thickness of the nasal, temporal and inferior quadrant showed no correlation with CSF-OP.
Overall, HH-OCT can detect ONH changes and ppRNFL changes associated with raised CSF-OP in children with CM. As a non-invasive, highly repeatable and rapid test, the HH-OCT scan is a reliable biomarker and diagnostic alternative to lumbar punctures for management of CM patients.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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