Huang-Link Yu-Min, Al-Hawasi Abbas, Oberwahrenbrock Timm, Jin Ya-Ping
Division of Neurology, Department of Clinical and Experimental Medicine, Linköping University, 581 85 Linköping, Sweden.
Division of Ophthalmology, Department of Clinical and Experimental Medicine, Linköping University, 581 85 Linköping, Sweden.
Clin Neurol Neurosurg. 2015 Mar;130:122-7. doi: 10.1016/j.clineuro.2014.12.021. Epub 2015 Jan 7.
Severity of papilledema and vision loss constitute a basis for therapeutic intervention in idiopathic intracranial hypertension (IIH), but both are often subjective and insensitive in guiding clinical management. The aim of this study was to identify reliable and sensitive measurements of optic nerve head (ONH) and macula, to provide objective guidance for prognostic evaluation and treatment in IIH. We analyzed potential of spectral domain optical coherence tomography (SD-OCT), to measure neuro-retinal rim thickness and area, optic cup-to-disc ratio (C/D) and cup volume of ONH which have not previously been reported in IIH. In parallel, thickness of peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell layer (GCL) together with inner plexiform layer (IPL) (GCL-IPL) were examined.
All 7 enrolled IIH patients had increased neuro-retinal rim thickness (p<0.01 for both eyes) and rim area (p<0.05), decreased C/D (p<0.01) and optic cup volume (p<0.01) when compared to findings in 18 sex- and age-matched healthy controls (HC). In a longitudinal study, two IIH patients were followed repetitively by SD-OCT before and after measurement of intracranial pressure (ICP) and removal of cerebrospinal fluid (CSF) by lumbar puncture. Rim thickness and area, C/D and optic cup volume remained altered. RNFL thickness may change with very high ICP, but not immediately after CSF removal. GCL-IPL thickness was unchanged irrespective of ICP change or CSF removal.
SD-OCT allows detection of ONH changes even in subtle IIH without papilledema and has potential for routine use in IIH.
视乳头水肿的严重程度和视力丧失是特发性颅内高压（IIH）治疗干预的依据，但二者在指导临床管理方面往往具有主观性且不敏感。本研究的目的是确定对视神经乳头（ONH）和黄斑进行可靠且敏感的测量方法，为IIH的预后评估和治疗提供客观指导。我们分析了频域光学相干断层扫描（SD-OCT）测量神经视网膜边缘厚度和面积、视杯与视盘比值（C/D）以及视杯体积的潜力，这些指标在IIH中此前尚未见报道。同时，还检测了视乳头周围视网膜神经纤维层（RNFL）和黄斑神经节细胞层（GCL）以及内丛状层（IPL）（GCL-IPL）的厚度。
与18名年龄和性别匹配的健康对照者（HC）相比，所有7例纳入研究的IIH患者的神经视网膜边缘厚度（双眼p<0.01）和边缘面积（p<0.05）增加，C/D（p<0.01）和视杯体积（p<0.01）减小。在一项纵向研究中，两名IIH患者在测量颅内压（ICP）和通过腰椎穿刺去除脑脊液（CSF）之前和之后通过SD-OCT进行了重复随访。边缘厚度和面积、C/D和视杯体积仍有改变。RNFL厚度可能在ICP非常高时发生变化，但在去除CSF后不会立即改变。无论ICP变化或CSF去除情况如何，GCL-IPL厚度均无变化。
即使在没有视乳头水肿的轻微IIH中，SD-OCT也能检测到ONH的变化，并且有在IIH中常规使用的潜力。
