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Management of the regression of papilledema with regional axon loss in idiopathic intracranial hypertension patients

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Abstract

Purpose

To use optic coherence tomography (OCT) to evaluate idiopathic intracranial hypertension (IIH) patients with subclinical segmental optic atrophy despite being under apparently effective treatment.

Methods

IIH patients underwent an OCT examination including the peripapillary retina never fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, focal loss volume (FLV) and global loss volume (GLV) of the GCC, and total macular thickness measurements at presentation and at 3, 6, 9, and 12 months after the diagnosis. The obtained data were compared with healthy subjects. Subjects with and without subclinical segmental atrophy at the 12th month were compared according to the demographics, clinical findings, and the OCT parameters recorded at the beginning of the disease.

Results

Both eyes of 56 patients with papilledema due to IIH and 50 age- and sex-matched control subjects were included in this prospective case–control study. Regression of papilledema with regional axon loss on the peripapillary RNFL thickness map was found in 37 (33%) eyes in the IIH group. IIH patients with segmental atrophy had the following characteristics when compared to those without segmental atrophy at the beginning of the disease: higher CSF opening pressure, higher grade of papilledema, thicker mean peripapillary RNFL thickness, thinner GCC layer, greater FLV and GLV loss, and severe visual field loss.

Conclusions

Axonal loss occurred in the patients despite apparent treatment. It would be appropriate to follow-up with aggressive medical treatment those patients who present with the following characteristics: higher CSF opening pressure, higher grade of papilledema, thicker mean peripapillary RNFL thickness, and thinner GCC.

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Authors and Affiliations

  1. Department of Ophthalmology, Diskapi Yildirim Beyazit Research and Education Hospital, University of Health Sciences, Ziraat Mahallesi Şehit Ömer Halisdemir Caddesi, No: 20, Ankara, Turkey

    Naciye Kabatas, Pinar Nalcacioglu, Sinan Caliskan, Tolga Bicer & Canan Gurdal

  2. Department of Neurology, Diskapi Yildirim Beyazit Research and Education Hospital, University of Health Sciences, Ankara, Turkey

    Yasemin Eren & Selim Selcuk Comoglu

Authors
  1. Naciye Kabatas
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  2. Yasemin Eren
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  3. Pinar Nalcacioglu
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  4. Sinan Caliskan
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  5. Tolga Bicer
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  6. Selim Selcuk Comoglu
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  7. Canan Gurdal
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Naciye KABATAS, Yasemin EREN, Pinar NALCACIOGLU, Sinan CALISKAN, Tolga BİCER]. The first draft of the manuscript was written by [Naciye KABATAS, Yasemin EREN, Pinar NALCACIOGLU] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Naciye Kabatas.

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Conflict of interest

The authors declare that they have no conflict of interest.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Consent to Publish

Informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Local Ethics Committee of Diskapi Yildirim Beyazit Research and Education Hospital. Decision number: 76/09–25.11.2019.

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Kabatas, N., Eren, Y., Nalcacioglu, P. et al. Management of the regression of papilledema with regional axon loss in idiopathic intracranial hypertension patients. Int Ophthalmol 41, 1467–1477 (2021). https://doi.org/10.1007/s10792-021-01711-6

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  • DOI: https://doi.org/10.1007/s10792-021-01711-6

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