Glaucoma in patients with shunt-treated normal pressure hydrocephalus

Abstract

A crucial risk factor for development of NTG in patients with shunt-treated NPH is the duration of optic nerve exposure to the lowering of ICP. Patients with NPH who are candidates for CSF shunting should be informed of the risk of incurring glaucoma. Longitudinal studies could provide estimates of tolerated times for a given ICP decrease.

In Vivo Evidence for Impaired Glymphatic Function in the Visual Pathway of Patients With Normal Pressure Hydrocephalus

“…12,13 Notably, an increased prevalence of glaucoma among iNPH patients has been found. 14,[17][18][19] A pathophysiological link between glymphatic dysfunction and glaucoma has been proposed. 4 In support of this hypothesis, abnormal glymphatic circulation in glaucoma has been demonstrated in animal models.…”

“…Indeed, impairment of the glymphatic system in the retina and optic nerve of rodents has been demonstrated in glaucoma. 7,8 An increased prevalence of glaucoma has been found in idiopathic normal pressure hydrocephalus (iNPH), a form of neurodegenerative disease and dementia subtype 14,[16][17][18][19] histologically overlapping with Alzheimer's disease. 20 Moreover, contrast-enhanced MRI of iNPH has indicated impaired glymphatic function in the brain.…”

Noninvasive intracranial pressure assessment using otoacoustic emissions: An application in glaucoma

“…Finally, it could be the case that the role of ICP in glaucoma is limited to a small subgroup of NTG patients, that is, those with an IOP at the lower end of the normal range (~10 mmHg; sometimes referred to as low tension glaucoma). These patients were not included in the current study (median sitting IOP 15.4 mmHg; Table 1), and also not in the study by Linden et al [7], where the mean sitting IOP was 15.1 mmHg. However, the mean IOP in the studies Berdahl et al [3] and Ren et al [5] were not clearly lower (14.3 and 16.1 mmHg, respectively).…”

“…It has been shown with lumbar punctures (LPs) that patients with glaucoma have a lower ICP than the healthy population and that those with NTG have the lowest [4–6]. As further evidence, patients with normal pressure hydrocephalus who received shunts, which can significantly lower ICP, had a 40 fold increase in the rate of NTG when compared with the general population [7]. There is, however, controversy over this theory [8].…”

Current concepts of cerebrospinal fluid dynamics and the translaminar cribrosa pressure gradient: a paradigm of optic disk disease

“…The authors recommended informing the risk of incurring glaucoma to patients with normal pressure hydrocephalus undergoing CSF diversion procedures. 53 A summary of important recent studies on TLPD in glaucoma is provided in Table 3 47 Another potential risk factor for glaucoma is the body mass index (BMI). Newman-Casey and colleagues found a positive correlation between increased BMI and open-angle glaucoma in women.…”