Optic nerve head quantification in idiopathic intracranial hypertension by spectral domain OCT.

Falko Kaufhold,Konrad Polthier,Hanna Zimmermann,Timm Oberwahrenbrock,Lutz Harms,Friedemann Paul,Alexander U Brandt,Ella Maria Kadas,Hagen Kunte,Jan Hoffmann,Christoph Schmidt,Martin Stangel

doi:10.1371/journal.pone.0036965

Abstract

ObjectiveTo evaluate 3D spectral domain optical coherence tomography (SDOCT) volume scans as a tool for quantification of optic nerve head (ONH) volume as a potential marker for treatment effectiveness and disease progression in idiopathic intracranial hypertension (IIH).Design and PatientsCross-sectional pilot trial comparing 19 IIH patients and controls matched for gender, age and body mass index. Each participant underwent SDOCT. A custom segmentation algorithm was developed to quantify ONH volume (ONHV) and height (ONHH) in 3D volume scans.ResultsWhereas peripapillary retinal nerve fiber layer thickness did not show differences between controls and IIH patients, the newly developed 3D parameters ONHV and ONHH were able to discriminate between controls, treated and untreated patients. Both ONHV and ONHH measures were related to levels of intracranial pressure (ICP).ConclusionOur findings suggest 3D ONH measures as assessed by SDOCT as potential diagnostic and progression markers in IIH and other disorders with increased ICP. SDOCT may promise a fast and easy diagnostic alternative to repeated lumbar punctures and could therefore ease monitoring of treatment or disease progression.

Highlights

Idiopathic intracranial hypertension (IIH), known as pseudotumor cerebri (PTC), is a clinical syndrome of unknown etiology characterized by increased intracranial pressure (ICP) which typically affects young, obese women of childbearing age [1,2,3,4,5]
Whereas peripapillary retinal nerve fiber layer thickness did not show differences between controls and IIH patients, the newly developed 3D parameters ONH volume (ONHV) and ONHH were able to discriminate between controls, treated and untreated patients
Both ONHV and ONHH measures were related to levels of intracranial pressure (ICP)

Summary

Introduction

Idiopathic intracranial hypertension (IIH), known as pseudotumor cerebri (PTC), is a clinical syndrome of unknown etiology characterized by increased intracranial pressure (ICP) which typically affects young, obese women of childbearing age [1,2,3,4,5]. Papilledema with subsequent visual field loss is the most feared clinical consequence, which mainly determines the therapy and outcome of the syndrome [6,7,8,9]. Detection of papilledema by an experienced ophthalmologist is a powerful tool in primary diagnosis, it remains a limited method in producing quantitative data to evaluate longitudinal optic disc changes in patients with IIH [10,11]. OCT has become a valuable tool for assessing retinal axonal damage in several neurological diseases such as optic neuritis, multiple sclerosis, neuromyelitis optica, spinocerebellar ataxia, and Parkinson’s disease [13,14,15,16,17,18,19,20]. OCT is associated both with morphologic and metabolic changes in brain, providing an easy accessible window into the brain in neurologic diseases [21,22,23]

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Conclusion