Abstract

P 158

Monitoring papilledema with OCT in patients with pseudotumor cerebri

Fatmire Berisha, Ulrike Kottler, Norbert Pfeiffer, Susanne Pitz
Universitäts-Augenklinik Mainz

Objective
To evaluate peripapillary retinal nerve fiber layer (RNFL) changes in patients with pseudotumor cerebri using OCT and to investigate the feasibility of this technique for monitoring the effectiveness of therapy in these patients.
Methods
This study included 10 patients with pseudotumor cerebri (6 children and 4 adults, mean age 26 years, range 10 to 48 years) and 10 age matched control subjects. All study subjects underwent a complete eye examination, and the OCT measurements were performed by an experienced operator (F.B.) using Stratus OCT. Peripapillary RNFL was measured using the standard 3.4 mm diameter circular scan protocol and the values for four quadrants (superior, inferior, temporal and nasal) as well as overall values were analyzed. The eye with more severe swelling of the disc was included in the analysis. We performed optic nerve sheath decompression in 3 adult patients with more severe papilledema and visual loss. The other 7 patients were treated with acetazolamide. Repeated OCT measurements were performed in 7 patients according to the individual clinical course.
Results
Mean visual acuity in patients with pseudotumor cerebri was 0.63, range 0.05 to 1.0 (decimal units). A significant thickening of the RNFL was observed in all quadrants in the patient group compared to the control group (superior 191.3 ± 88.3 mm vs. 119.7 ± 12.4 mm, p=0.02; inferior 163.3 ± 53.0 mm vs. 124 ± 12.6 mm, p=0.03; temporal 101.1 ± 42 mm vs. 71.6 ± 9.7 mm, p=0.04 and nasal 112.4 ± 51.6 mm vs. 70.8 ± 9.5 mm, p=0.02). When comparing overall RNFL thickness between the groups, the difference was also statistically significant (144.5 ± 58.2 mm in pseudotumor cerebri patients vs. 96.5 ± 6.7 mm in controls, p=0.02). In patients who underwent surgery a significant reduction of the RNFL thickness compared to preoperative measurements was observed 4 weeks postopearatively. Accordingly, a significant improvement of the disc edema and visual function corresponding to the OCT data was observed in these patients.
Conclusions
Our data demonstrate that RNFL thickness measured using OCT can be clinically used as an accurate parameter for quantitative and objective evaluation of papilledema in patients with pseudotumor cerebri. This noninvasive technique may be particularly useful in clinical management of children with papilledema and pseudotumor cerebri.

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