OCT measurements of optic nerve head changes in idiopathic intracranial hypertension
OCT measurements of optic nerve head changes in idiopathic intracranial hypertension
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DOI：
10.1016/j.clineuro.2014.12.021
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发表时间：
2015-03-01
影响因子：
1.9
通讯作者：
Jin, Ya-Ping
中科院分区：
文献类型：
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作者：
Huang-Link, Yu-Min;Al-Hawasi, Abbas;Jin, Ya-Ping
目标：视神经乳头水肿和视力丧失的严重程度构成了特发性颅内高压（IIH）治疗干预的基础，但两者在指导临床管理时往往是主观和不敏感的。本研究的目的是确定可靠和敏感的测量视乳头（ONH）和黄斑，提供客观的指导预后评估和治疗IIH。我们分析了光谱域光学相干断层扫描（SD-OCT）的潜力，以测量神经视网膜边缘厚度和面积，光学杯盘比（C/D）和杯体积的ONH，以前没有报道在IIH。同时测量视乳头周围视网膜神经纤维层（RNFL）、黄斑神经节细胞层（GCL）和内丛状层（IPL）的厚度。所有7例入组的IIH患者均出现神经视网膜边缘厚度增加与18名性别和年龄匹配的健康对照（HC）相比，患者的C/D（p <0.01）和视杯体积（p < 0.01）降低。在一项纵向研究中，2例IIH患者在测量颅内压（ICP）和通过腰椎穿刺清除脑脊液（CSF）之前和之后重复进行SD-OCT随访。边缘厚度和面积、C/D和视杯体积保持改变。RNFL厚度可能会随着非常高的ICP而改变，但不会在CSF移除后立即改变。GCL-IPL厚度不变，无论ICP的变化或CSFremoved.Conclusion：SD-OCT允许检测ONH的变化，即使在轻微IIH没有视乳头水肿，并有可能在IIH的常规使用。(C)2015 Elsevier B. V.版权所有。
Objective: 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.Results: 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.Conclusion: SD-OCT allows detection of ONH changes even in subtle IIH without papilledema and has potential for routine use in IIH. (C) 2015 Elsevier B.V. All rights reserved.