Optical coherence tomography in idiopathic intracranial hypertension

N Venugopal

doi:10.4103/aian.AIAN_43_21



LETTERS TO THE EDITOR

Year : 2022 \| Volume : 25 \| Issue : 1 \| Page : 138

Optical coherence tomography in idiopathic intracranial hypertension

N Venugopal
A.G. Eye Hospital, Puthur, Trichy, Tamil Nadu, India

Date of Submission	15-Jan-2021
Date of Acceptance	21-Mar-2021
Date of Web Publication	12-Aug-2021

Correspondence Address:
N Venugopal
A.G. Eye Hospital, Puthur, Trichy - 620017. Tamil Nadu
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/aian.AIAN_43_21

How to cite this article:
Venugopal N. Optical coherence tomography in idiopathic intracranial hypertension. Ann Indian Acad Neurol 2022;25:138

How to cite this URL:
Venugopal N. Optical coherence tomography in idiopathic intracranial hypertension. Ann Indian Acad Neurol [serial online] 2022 [cited 2022 May 19];25:138. Available from: https://www.annalsofian.org/text.asp?2022/25/1/138/323756

In the article titled “Idiopathic Intracranial Hypertension: The Monster within” Takkar and Lal^[1] have highlighted the importance of recognizing subgroup of idiopathic intracranial hypertension (IIH) patients with “eye at risk” to salvage vision. We would like to highlight few points regarding optical coherence tomography (OCT) to identify the eye at risk in IIH. OCT is noninvasive diagnostic procedure useful in evaluating retinal changes causing defective vision in IIH.^[2] Defective vision in IIH is due to optic neuropathy, macular subretinal fluid (SRF), and rarely due to choroidal neovascularization. OCT is useful in identifying these retinal changes and guiding appropriate treatment protocol. SRF is a reversible condition managed by medical treatment alone.^[3] OCT is useful in measuring ganglion cell layer-inner plexiform layer (GCL-IPL) thickness which predicts optic neuropathy in IIH. A GCL-IPL thickness of <70 μm early in disease course or early progressive thinning of >10 μm during the first 2 or 3 weeks of presentation is correlated with poor visual outcome (optic neuropathy) and may indicate the need for more aggressive treatment.^[3]

Peripapillary choroidal neovascular membrane (PCNVM) may cause severe visual loss in IIH. Kumar et al.^[4] reported a case of PCNVM, SRF, and subretinal hemorrhage secondary to IIH treated with intravitreal ranibizumab. Authors have concluded that accurate diagnosis and intravitreal injection in IIH patients who develop fovea involving PCNVM lead to favorable outcome. A multicentric study^[5] recommended intravitreal ranibizumb in vision-threatening PCNVM in IIH patients.

Clinical diagnosis is the gold standard in diagnosing recurrence of pediatric IIH and OCT can serve as an important adjunctive tool in the detection of the recurrence by providing noninvasive and objective assessment.^[6]

To conclude, ocular examination with OCT is useful in identifying eye at risk among IIH patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Takkar L, Lal V. Idiopathic intracranial hypertension: The monster within. Ann Indian Acad Neurol 2020;23:159-66. [Full text]
2.	Chen JJ, Trobe JD. Optical coherence tomography should be used routinely to monitor patients with idiopathic intracranial hypertension. J Neuroophthalmol 2016;36:453-9.
3.	Chen JJ, Thurtell MJ, Longmuir RA, Garvin MK, Wang JK, Wall M, et al. Causes and prognosis of visual acuity loss at the time of initial presentation in idiopathic intracranial hypertension. Invest Ophthalmol Vis Sci 2015;56:3850-9.
4.	Kumar N, Tigari B, Dogra M, Singh R. Successful management of peripaillary choroidal neovascular membrane secondary to idiopathic intracranial hypertension with intravitreal ranibizumab. Indian J Ophthalmol 2018;66:1358-60. [PUBMED] [Full text]
5.	Ozgunul C, Moinuddin O, Munie M, Lee MS, Bhatti MT, Landu K. Management of peripapillary choroidal neovascular membrane in patients with idiopathic intracranial hypertension. J Neuroophthalmol 2019;39:451-7.
6.	Loo KGB, Lim SA, Lim ILZ, Chan DWS. Guiding follow up of pediatric intracranial hypertension with optic coherence tomography. BMJ Case Rep 2016;2016:bcr2015213070.

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