Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Department of Ophthalmology, Poznan City Hospital, Poznan, Poland.
Br J Ophthalmol. 2020 Jul;104(7):887-892. doi: 10.1136/bjophthalmol-2019-314704. Epub 2019 Nov 8.
Assessment and monitoring of intracranial pressure (ICP) are important in the management of traumatic brain injury and other cerebral pathologies. In the eye, ICP elevation and depression both correlate with optic neuropathies, the former because of papilledema and the latter related to glaucoma. While the relationship between ICP elevation and papilledema is well established, the relationship between low ICP and glaucoma is still poorly understood. So far, ICP monitoring is performed invasively, but this entails risks including infection, spurring the study of non-invasive alternatives. We review 11 methods of non-invasive estimation of ICP including correlation to optic nerve sheath diameter, intraocular pressure, ophthalmodynamometry and two-depth transcranial Doppler of the ophthalmic artery. While none of these methods can fully replace invasive techniques, certain measures show great potential for specific applications. Although only used in small studies to date, a MRI based method known as MR-ICP, appears to be the best non-invasive technique for estimating ICP, with two-depth transcranial ultrasound and ophthalmodynamometry showing potential as well.
颅内压（ICP）的评估和监测在创伤性脑损伤和其他脑部病变的治疗中非常重要。在眼部，ICP 的升高和降低都与视神经病变相关，前者是因为视乳头水肿，后者与青光眼有关。虽然 ICP 升高与视乳头水肿之间的关系已经得到很好的确立，但 ICP 降低与青光眼之间的关系仍然知之甚少。到目前为止，ICP 监测是侵入性的，但这涉及到感染等风险，这促使人们研究非侵入性的替代方法。我们回顾了 11 种非侵入性估计 ICP 的方法，包括与视神经鞘直径、眼内压、眼动力学和眼动脉双深度经颅多普勒的相关性。虽然这些方法都不能完全替代侵入性技术，但某些措施在特定应用中显示出很大的潜力。尽管到目前为止，只有少数小型研究使用了一种称为 MR-ICP 的基于 MRI 的方法，但它似乎是估计 ICP 的最佳非侵入性技术，双深度经颅超声和眼动力学也显示出了潜力。
