Optical Coherence Tomography (OCT) As a Tool to Identify Idiopathic Intracranial Hypertension in Pediatric Patients Under GH Therapy

Presentation Number: MON-0140
Date of Presentation: June 23rd, 2014

Thais Kataoka Homma1, Rafael Estevão de Angelis1, Cristiane Kochi1, Eduarda Tebet Ajeje1, Marco Bonini Filho1, Davi Chen Wu1 and Carlos Alberto Longui*2
1Santa Casa SP, Sao Paulo, Brazil, 2Santa Casa SP School of Medical Sciences, Sao Paulo, Brazil

Abstract

BACKGROUND: Headache is a common complaint in children, and its onset or worsening can occur during GH treatment, requiring differential diagnosis with idiopathic intracranial hypertension (IIH) (1). Complete ophthalmologic examination, angiography, SNCMRI and cerebrospinal fluid pressure measurement have been used to confirm the diagnosis. The availability of third-generation equipments and reference values for children (2), allowed the use of optical coherence tomography (OCT) as tool to identify IIH (3). AIM: To determine the retinal nerve fiber layer (RNFL) thickness measured by OCT in patients treated with GH. PATIENTS AND METHODS: 43 patients aged between 5.6 and 19.7 years, 24 boys and 19 girls, with no ocular disease, receiving GH for 1.83 (0.25-7.4) years. Clinically relevant headache was present in only 2 girls. Papilledema was detected by direct ophthalmoscopy in 18/43 patients (9M:9F). RNFL thickness were determined by using the OCT device TOPCON 3D OCT 1000, Japan. The RNFL results were corrected according to the reference values for age and expressed as SDS scores (2). RESULTS: Average RNFL: -0.67(±1.40); Superior RNFL: -0.87(±1.14); Temporal RNFL: -0.24(±1.3); Nasal RNFL 0.72(±1.8); Inferior RNFL 1.14(±1.1). There was no correlation of RNFL thickness with BMI, height, duration of GH therapy, GH peak or IGF1 values. Comparing patients with and without papilledema we found significant differences between the two groups, with higher values of average RNFL thickness (-0.17 vs 1.13; t test, p:0.016); nasal RNFL (1.5 vs 0.26; t test, p:0.029) and superior RNFL (-0.5 vs -1.27; t test, p:0.027) in the papilledema group. There was no correlation between clinical features and the presence of papilledema. The broad dispersion of RNFL thickness did not allow the definition of a cut off value to identify papilledema risk, although the majority of patients with papilledema had RNFL nasal values higher than zero SDS. Prospective studies comparing OCT RNFL values before and after GH therapy should discriminate better those patients under risk of relevant clinical papilledema. We concluded that OCT is a noninvasive method that can be used to identify incipient IIH in pediatric patients under GH therapy, allowing the selection of those who need invasive CSF measurement.

 

Nothing to Disclose: TKH, RED, CK, ETA, MB, DCW, CAL