Relationship between the optic nerve sheath diameter and lumbar cerebrospinal fluid pressure in patients with normal tension glaucoma

• Published in: Eye (London) Vol. 31; no. 9; pp. 1365 - 1372
• Main Authors: Pircher, A, Montali, M, Berberat, J, Remonda, L, Killer, H E
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.09.2017; Nature Publishing Group
• Subjects: 59/57; 631/378/1689; 631/378/2613; 692/420; Aged; Cerebrospinal fluid; Cerebrospinal Fluid Pressure - physiology; Clinical Study; Computed tomography; European Continental Ancestry Group; Female; Glaucoma; Humans; Intraocular Pressure - physiology; Laboratory Medicine; Low Tension Glaucoma - physiopathology; Male; Medical records; Medicine; Medicine & Public Health; Myelin Sheath - pathology; Ophthalmology; Optic nerve; Optic Nerve - diagnostic imaging; Optic Nerve - pathology; Pharmaceutical Sciences/Technology; Pressure; Retrospective Studies; Spinal Puncture; Statistical analysis; Subarachnoid Space; Surgery; Surgical Oncology; Tomography, X-Ray Computed; Tonometry, Ocular; Visual Field Tests; White people
• ISSN: 0950-222X; 1476-5454; 1476-5454
• DOI: 10.1038/eye.2017.70

Purpose To investigate on the relationship between the optic nerve sheath diameter (ONSD) and the lumbar cerebrospinal fluid pressure (CSF-p) in Caucasian patients with normal tension glaucoma (NTG). Patients and methods Retrospective analysis of medical records of patients with open-angle glaucoma in the period from 2005 to 2015 from the Ophthalmology Department, Cantonal Hospital Aarau, Switzerland was performed. A total of 38 patients (mean age 68.6±11.3 years, 21 females and 17 males) fulfilled the diagnostic criteria of NTG and underwent computed tomography (CT) of the orbit and lumbar puncture (LP). In total, 38 age- and gender-matched Caucasian subjects (mean age: 68.9±10.9 years) without known ON diseases served as controls for ONSD measurements. ONSDs were measured at a distance of 3 mm from the posterior globe and lumbar CSF-p was related to the measurements. Statistical analysis was performed by using the independent two-tailed t -test and the non-parametric Spearman's correlation test. Results The mean ONSD in NTGs measured 6.4±0.9 mm and in controls 5.4±0.6 mm. The difference between NTGs and controls showed statistical significance ( t -test: P <0.000). The mean CSF-p in NTG was 11.6±3.7 mm Hg. There was no statistical significant correlation between ONSD and CSF-p (Spearman's correlation coefficient ρ =0.06, P =0.72). Conclusions This study demonstrates enlarged ONSDs and normal lumbar CSF-p in 38 Caucasian NTG patients. As enlarged ONSDs generally are associated with increased intracranial CSF-p, these results can be explained by a disturbed communication of CSF-p between the intracranial and intraorbital subarachnoid spaces.