Br J Ophthalmol 1998;82:1301-1305 ( November )
Use of scanning laser ophthalmoscopy to monitor papilloedema in
idiopathic intracranial hypertension
D A Mulholland,a
J J Craig,b
S J A Rankina
a Department of Ophthalmology, Royal Victoria Hospital,
Belfast, b Department
of Neurology, Royal Victoria Hospital, Belfast
Correspondence to: Mr David A Mulholland,
Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, 32 Gisborne Street, Melbourne, Victoria 3002, Australia.
Accepted for publication 2 April 1998
AIMS To determine the sensitivity of confocal
scanning laser ophthalmoscopy (SLO) in detecting clinically significant
changes in papilloedema secondary to idiopathic intracranial
hypertension (IIH) and the correlation with visual field loss.
METHODSEight patientsthree new, two recurrent,
and three chronic cases of IIHwere examined over a 9 month period
with SLO (Heidelberg retina tomograph) of optic nerve head and 30-2
Humphrey visual fields (six cases). Optic disc swelling (volume) was
assessed in each eye using a circular contour line placed around the
swollen optic nerve head on the mean image of three topographic images. Nine volume measurements from single images in each eye of every patient were performed on one occasion to assess repeatability.
RESULTSIn the five acute cases optic disc volumes
(range 1-16 mm3) decreased with treatment to stable,
normal levels. Three of these had mild, reproducible, field defects
which resolved. Two chronic cases had stable or fluctuating disc volume
with no detectable change in grade of papilloedema and mild field
loss. In one case which underwent theco-peritoneal shunting both disc
volume and field worsened, indicating therapeutic failure. Both
improved postoperatively.
CONCLUSIONSSLO has a high sensitivity for
detecting small changes in disc volumes and correlates closely with
visual field change in the short term. It can confirm therapeutic
failure by detecting stable or increasing disc volume. Decreasing
volume may indicate resolution of papilloedema or secondary optic
atrophy, so accompanying funduscopy and visual fields remain essential.
Keywords:
intracranial hypertension;
scanning laser
ophthalmoscopy;
visual field;
optic disc
© 1998 by British Journal of Ophthalmology
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