Abstract

SA.15.04

Detection of edema and nerve fibre atrophy in idiopathic intracranial hypertension

Robert Lämmer1, Alexandra Lämmer1, Josef Heckmann2, Stefan Schwab3, Christian Mardin1
1Universitäts-Augenklinik Erlangen; 2Neurologische Klinik, Klinikum Landshut; 3Neurologische Klinik, Universitätsklinikum Erlangen

Objective
Idiopathic intracranial hypertension is a common disease characterized by increased intracranial pressure, headache and visual obscuration. Serious complication of a lasting elevated intracranial pressure is a visual field loss due to pressure induced axon loss.
Methods
Seventeen patients (age 27.9±7.9) with idiopathic intracranial hypertension received a clinical neurological and ophthalmological examination, diagnostic of cerebrospinal fluid including opening pressure, ophthalmoscopy, stereographic optic disc photographs, 90° visual field and scanning laser polarimetry. Patients have been divided into two groups depending on the presence of papilledema (group 1) or resolution of the papilledema (group 2) after initiation of treatment. Results were compared with healthy volunteers matched for age and gender.
Results
Scanning laser polarimetry showed an increased retinal nerve fibre thickness in patients with idiopathic intracranial hypertension and papilledema (group 1: 68.06±4.71 µm; p<0.01) and a reduction of the nerve fibre thickness in patients with resolution of the papilledema (group 2: 46.72±8.96 µm; p<0.001) in comparison to healthy controls (59.02±6.12 µm). Six of seven patients in group 2 with signs of visual field damage showed a Nerve Fiber Index above 30, but none of the patients in the group 1 and none of the volunteers in the control group. All patients with resolution of papilledema (group 2) and coincidence of visual field damage and pale optic disc appearance as clinical sign of optic disc atrophy had a pathologic result in the scanning laser polarimetry examination, but only 4 of 9 patients with a pathologic scanning laser polarimetry result showed pallor of the optic disc.
Conclusions
In patients with idiopathic intracranial hypertension and apparently effective treatment of the clinical symptoms a premature loss of retinal axons as an indicator of beginning optic nerve atrophy after resolution of papilledema can be detected by Scanning laser polarimetry.

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