To compare the anterior lamina cribrosa (LC) surface position in patients with idiopathic intracranial hypertension (IIH), primary open-angle glaucoma (high-tension glaucoma [HTG] and normal-tension glaucoma [NTG]), and healthy controls using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT).
Methods
This was a retrospective, cross-sectional observational study of 11 eyes with IIH, 20 eyes with HTG, 20 eyes with NTG, and 37 control eyes. Serial horizontal B-scans of the optic nerve head were obtained using EDI-OCT. The LC depth, defined as the distance from the Bruch membrane opening plane to the anterior LC surface, was manually measured on selected B-scans covering the central three-quarters of the optic nerve head in each eye.
Results
Mean LC depth in patients with IIH (325.2 ± 92.1 µm) was significantly (p<0.01) decreased compared to control subjects (387.8 ± 53.9 µm). In HTG, the mean LC depth (493.0 ± 115.2 µm) was significantly increased compared to NTG (376.6 ± 27.1 µm, p<0.05) and control subjects (332.7 ± 53.1 µm, p<0.001). The trans-LC pressure difference (TLPD) (intraocular pressure − cerebrospinal fluid pressure) was positively correlated with the LC depth (r = 0.96, p<0.001) and inversely correlated with visual field perimetric mean deviation in patients with IIH (r = -0.88, p<0.001).
Conclusions
The LC is positioned anteriorly in patients with IIH and posteriorly in glaucomatous eyes compared to normal controls. The positional changes of the LC could be a result of the TLPD between the intraocular and intracranial pressure compartments.
BerdahlJPYuDYMorganWHThe translaminar pressure gradient in sustained zero gravity, idiopathic intracranial hypertension, and glaucoma.Med Hypotheses2012;79 (6):719–724
4.
FleischmanDBerdahlJPPosterior scleral biomechanics and the translaminar pressure difference.Int Ophthalmol Clin2014;54 (1):73–94
5.
QuigleyHAHohmanRMAddicksEMMassofRWGreenWRMorphologic changes in the lamina cribrosa correlated with neural loss in open-angle glaucoma.Am J Ophthalmol1983;95 (5):673–691
6.
BellezzaAJRintalanCJThompsonHWDownsJCHartRTBurgoyneCFDeformation of the lamina cribrosa and anterior scleral canal wall in early experimental glaucoma.Invest Ophthalmol Vis Sci2003;44 (2):623–637
7.
JonasJBBerenshteinEHolbachLAnatomic relationship between lamina cribrosa, intraocular space, and cerebrospinal fluid space.Invest Ophthalmol Vis Sci2003;44 (12):5189–5195
8.
BurgoyneCFDownsJCBellezzaAJSuhJKHartRTThe optic nerve head as a biomechanical structure: a new paradigm for understanding the role of IOP-related stress and strain in the pathophysiology of glaucomatous optic nerve head damage.Prog Retin Eye Res2005;24 (1):39–73
9.
BerdahlJPAllinghamRRJohnsonDHCerebrospinal fluid pressure is decreased in primary open-angle glaucoma.Ophthalmology2008;115 (5):763–768
10.
JonasJBRole of cerebrospinal fluid pressure in the pathogenesis of glaucoma.Acta Ophthalmol2011;89 (6):505–514
11.
BerdahlJPFautschMPStinnettSSAllinghamRRIntracranial pressure in primary open angle glaucoma, normal tension glaucoma, and ocular hypertension: a case-control study.Invest Ophthalmol Vis Sci2008;49 (12):5412–5418
12.
RenRJonasJBTianG et al. Cerebrospinal fluid pressure in glaucoma: a prospective study.Ophthalmology2010;117 (2):259–266
13.
RenRWangNZhangXCuiTJonasJBTrans-lamina cribrosa pressure difference correlated with neuroretinal rim area in glaucoma.Graefe's archive for clinical and experimental ophthalmology=. Albrecht Von Graefes Arch Klin Exp Ophthalmol2011;249 (7):1057–1063
14.
FurlanettoRLParkSCDamleUJ et al. Posterior displacement of the lamina cribrosa in glaucoma: in vivo interindividual and intereye comparisons.Invest Ophthalmol Vis Sci2013;54 (7):4836–4842
15.
JungKIJungYParkKTParkCKFactors affecting plastic lamina cribrosa displacement in glaucoma patients.Invest Ophthalmol Vis Sci2014;55 (12):7709–7715
16.
RhoCRParkHYLeeNYParkCKClock-hour laminar displacement and age in primary open-angle glaucoma and normal tension glaucoma.Clin Experiment Ophthalmol2012;40 (4):e183–e189
17.
MargolisRSpaideRFA pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes.Am J Ophthalmol2009;147 (5):811–815
18.
Perez-LopezMTingDSClarkeLLamina cribrosa displacement after optic nerve sheath fenestration in idiopathic intracranial hypertension: a new tool for monitoring changes in intracranial pressure?Br J Ophthalmol2014;98 (11):1603–1604
19.
Headache Classification Subcommittee of the International Headache Disorders. (2004).The International Classification of Headache Disorders. 2nd ed: Cephalalgia, v. 24, suppl. 1: 1-160. Oxford, UK; Blackwell Pub. (ISSN 0800-1952)
20.
ScottCJKardonRHLeeAGFrisenLWallMDiagnosis and grading of papilledema in patients with raised intracranial pressure using optical coherence tomography vs clinical expert assessment using a clinical staging scale.Archives of ophthalmology (Chicago, Ill: 1960)2010;128 (6):705–11
21.
VanVeldhuisenPCEThe AGIS Investigators.The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol2000;130 (4):429–440
22.
JanzNKWrenPALichterPRet al;CIGTS Study Group. The Collaborative Initial Glaucoma Treatment Study: interim quality of life findings after initial medical or surgical treatment of glaucoma.Ophthalmology2001;108 (11):1954–1965
23.
LeeEJKimTWWeinrebRNReversal of lamina cribrosa displacement and thickness after trabeculectomy in glaucoma.Ophthalmology2012;119 (7):1359–1366
24.
AbeggMFleischhauerJLandauKUnilateral papilledema after trabeculectomy in a patient with intracranial hypertension.Klin Monbl Augenheilkd2008;225 (5):441–442
25.
GreenfieldDSWanichwecharungruangBLiebmannJMRitchRPseudotumor cerebri appearing with unilateral papilledema after trabeculectomy.Archives of ophthalmology (Chicago, Ill: 1960)1997;115 (3):423–6
26.
YangHWilliamsGDownsJC et al. Posterior (outward) migration of the lamina cribrosa and early cupping in monkey experimental glaucoma.Invest Ophthalmol Vis Sci2011;52 (10):7109–7121
27.
StrouthidisNGFortuneBYangHSigalIABurgoyneCFLongitudinal change detected by spectral domain optical coherence tomography in the optic nerve head and peripapillary retina in experimental glaucoma.Invest Ophthalmol Vis Sci2011;52 (3):1206–1219
28.
LeeEJKimTWWeinrebRNKimHReversal of lamina cribrosa displacement after intraocular pressure reduction in open-angle glaucoma.Ophthalmology2013;120 (3):553–559
29.
ReisASO'LearyNStanfieldMJShubaLMNicolelaMTChauhanBCLaminar displacement and prelaminar tissue thickness change after glaucoma surgery imaged with optical coherence tomography.Invest Ophthalmol Vis Sci2012;53 (9): 5819–5826
30.
VolkovVV[Essential element of the glaucomatous process neglected in clinical practice].Oftalmol Zh1976;31 (7):500–504
31.
JonasJBNangiaVWangN et al. Trans-lamina cribrosa pressure difference and open-angle glaucoma.The central India eye and medical study. PLoS One2013;8 (12):e82284
32.
JonasJBWangNLWangYX et al. Estimated trans-lamina cribrosa pressure difference versus intraocular pressure as biomarker for open-angle glaucoma.The Beijing Eye Study 2011. Acta Ophthalmol2015;93 (1):e7–e13
33.
HeijlALeskeMCBengtssonBHymanLBengtssonBHusseinMReduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial.Archives of ophthalmology (Chicago, Ill: 1960)2002;120 (10):1268–79
34.
BurgoyneCFDownsJCBellezzaAJHartRTThree-dimensional reconstruction of normal and early glaucoma monkey optic nerve head connective tissues.Invest Ophthalmol Vis Sci2004;45 (12):4388–4399
35.
ChangROMarshallBKYahyaviN et al. Neuroimaging features of idiopathic intracranial hypertension persist after resolution of papilledema.eNeurologicalSci2016
