Detection of intracranial hypertension in children using optical coherence tomography: a systematic review

Abstract

ObjectivesTo evaluate the diagnostic capability of optical coherence tomography (OCT) in children aged under 18 years old with intracranial hypertension (IH).DesignSystematic review.MethodsWe conducted a systematic review using the following platforms to search the keywords ‘optical coherence tomography’ and ‘intracranial hypertension’ from inception to 2 April 2020: Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, PubMed and Web of Science, without language restrictions. Our search returned 2729 records, screened by two independent screeners. Studies were graded according to the Oxford Centre for Evidence-Based Medicine and National Institutes of Health Quality Assessment Tool for observational studies.ResultsTwenty-one studies were included. Conditions included craniosynostosis (n=354 patients), idiopathic IH (IIH; n=102), space-occupying lesion (SOL; n=42) and other pathology (n=29). OCT measures included optic nerve parameters, rim parameters (notably retinal nerve fibre layer thickness) and retinal parameters. Levels of evidence included 2b (n=13 studies), 3b (n=4) and 4 (n=4). Quality of 10 studies was fair and 11 poor. There was inconsistency in OCT parameters and reference measures studied, although OCT did demonstrate good diagnostic capability for IH in craniosynostosis, IIH and SOL.ConclusionsThis systematic review identified various studies involving OCT to assist diagnosis and management of IH in children with craniosynostosis, IIH, SOL and other pathology, in conjunction with established clinical measures of intracranial pressure. However, no level 1 evidence was identified. Validating prospective studies are, therefore, required to determine optimal OCT parameters in this role and to develop formal clinical guidelines.PROSPERO registration numberCRD42019154254.

Optical coherence tomography angiography findings in optic disc drusen and idiopathic intracranial hypertension

“…In our study, as in literature, RNFL thickness in patients with IIH was significantly higher in each quadrants tham among controls. 16,17 Studies on RNFL thickness in patients with ODD, however, have shown varying results. [18][19][20][21] Allegrini et al emphasized that ODD patients had a thinning of the RNFL and thought that this was due to the compression of the drusen material causing axonal damage.…”

Improved feasibility of handheld optical coherence tomography in children with craniosynostosis

“…Direct monitoring of intracranial pressure (ICP) is invasive and carries risks. Optical coherence tomography (OCT) is non-invasive and has demonstrated good potential as a surrogate measure of ICP in craniosynostosis [3,4]. Our group found good feasibility of handheld OCT in 50 children with craniosynostosis, demonstrating 86% success rate in at least one eye and 76% in both eyes [5].…”

Preterm infant retinal OCT markers of perinatal health and retinopathy of prematurity

“…We have also demonstrated visualization of papilledema and RNFL loss in a preterm born child with obstructive hydrocephalus ( 33 ). More recently, investigators have suggested that OCT measures of the RNFL and retina may be a potentially sensitive indicator of elevated intracranial pressure in infants and young children such as with craniosynostosis ( 92 , 93 ); this remains to be validated, and we are not aware of reports for the preterm population. Others have shown that OCT imaging of RNFL thickness in infants and young children enables earlier identification of damage from optic nerve glioma, with ongoing validation studies ( 94 – 96 ).…”