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Management of the regression of papilledema with regional axon loss in idiopathic intracranial hypertension patients.
Int Ophthalmol. 2021 Apr; 41(4):1467-1477.IO

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.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33481155

Citation

Kabatas, Naciye, et al. "Management of the Regression of Papilledema With Regional Axon Loss in Idiopathic Intracranial Hypertension Patients." International Ophthalmology, vol. 41, no. 4, 2021, pp. 1467-1477.
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. 2021;41(4):1467-1477.
Kabatas, N., Eren, Y., Nalcacioglu, P., Caliskan, S., Bicer, T., Comoglu, S. S., & Gurdal, C. (2021). Management of the regression of papilledema with regional axon loss in idiopathic intracranial hypertension patients. International Ophthalmology, 41(4), 1467-1477. https://doi.org/10.1007/s10792-021-01711-6
Kabatas N, et al. Management of the Regression of Papilledema With Regional Axon Loss in Idiopathic Intracranial Hypertension Patients. Int Ophthalmol. 2021;41(4):1467-1477. PubMed PMID: 33481155.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of the regression of papilledema with regional axon loss in idiopathic intracranial hypertension patients. AU - Kabatas,Naciye, AU - Eren,Yasemin, AU - Nalcacioglu,Pinar, AU - Caliskan,Sinan, AU - Bicer,Tolga, AU - Comoglu,Selim Selcuk, AU - Gurdal,Canan, Y1 - 2021/01/22/ PY - 2020/08/25/received PY - 2021/01/09/accepted PY - 2021/1/23/pubmed PY - 2021/1/23/medline PY - 2021/1/22/entrez KW - Axonal loss KW - Idiopathic intracranial hypertension KW - Mean peripapillary retina nerve fiber layer thickness KW - Opening pressure of cerebrospinal fluid KW - Subclinical segmental optic atrophy SP - 1467 EP - 1477 JF - International ophthalmology JO - Int Ophthalmol VL - 41 IS - 4 N2 - 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. SN - 1573-2630 UR - https://www.unboundmedicine.com/medline/citation/33481155/Management_of_the_regression_of_papilledema_with_regional_axon_loss_in_idiopathic_intracranial_hypertension_patients_ L2 - https://doi.org/10.1007/s10792-021-01711-6 DB - PRIME DP - Unbound Medicine ER -