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J Neurol. 2017 Jul;264(7):1370-1380. doi: 10.1007/s00415-017-8532-x. Epub 2017 Jun 5.

Optical coherence tomography for the diagnosis and monitoring of idiopathic intracranial hypertension.

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Department of Neurology, Heinrich Heine University, Medical Faculty, Moorenstrasse 5, 40225, Düsseldorf, Germany.
Department of Neurology, Heinrich Heine University, Medical Faculty, Moorenstrasse 5, 40225, Düsseldorf, Germany.
Department of Ophthalmology, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany.
NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Department of Ophthalmology, University Medical Center, Freiburg, Germany.
Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité Universitätsmedizin Berlin, Berlin, Germany.
Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (RMN(2)), Department of Neurology, Johannes Gutenberg University Medical Center, Mainz, Germany.


The objectives of the study were to investigate the value of optical coherence tomography in detecting papilledema in patients with idiopathic intracranial hypertension (IIH), a disease which is difficult to monitor and which can lead to permanent visual deficits; to analyze retinal changes over time. In this non-interventional case-control study, spectral-domain optical coherence tomography (SD-OCT) was used to analyze the retinal and optic nerve head (ONH) morphology of 21 patients with IIH and 27 age- and sex-matched healthy controls over time. We analyzed the ONH volume using a custom-made algorithm and employed semi-automated segmentation of macular volume scans to assess the macular retinal nerve fiber layer (RNFL) and ganglion cell layer and inner plexiform layer complex as well as the total macular volume. In IIH patients, the ONH volume was increased and correlated with cerebrospinal fluid (CSF) pressure. The ONH volume decreased after the initiation of treatment with acetazolamide. The macular RNFL volume decreased by 5% in 3.5 months, and a stepwise multivariate regression analysis identified CSF pressure as the main influence on macular RNFL volume at diagnosis. The only factor predicting macular RNFL volume loss over time was ONH volume. SD-OCT can non-invasively monitor changes in retinal and ONH morphology in patients with IIH. Increased ONH volume leads to retinal atrophy in the form of macular RNFL volume loss, presumably due to mechanic jamming of the optic nerve at the disc and subsequent axonal loss.


Idiopathic intracranial hypertension; Optical coherence tomography

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