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Glaucoma in patients with shunt-treated normal pressure hydrocephalus
- Publication Year :
- 2018
-
Abstract
- OBJECTIVEChanges in the pressure gradient between intraocular and intracranial compartments at the lamina cribrosa level are a possible explanation of normal tension glaucoma (NTG). Shunt-treated normal pressure hydrocephalus (NPH) is a model for testing whether the increase (time from disease onset to CSF shunt placement, i.e., “protection period”) and decrease (time from shunt placement to observation, i.e., “exposure period”) in intracranial pressure (ICP) are glaucoma protective or risk factors, respectively. The authors estimated the prevalence of NTG in patients with shunt-treated NPH and calculated the extent of optic nerve exposure to changes in the trans–lamina cribrosa gradient.METHODSData obtained in patients with NPH who had undergone ventriculoperitoneal (VP) shunt placement were analyzed. Patients with more than 6 months’ follow-up, no pathologies associated with ICP changes or CSF dynamics disturbances, and no surgical or valve-related complications were scheduled for ophthalmic evaluation.RESULTSNine of 22 patients had NTG, which is about a 40-fold increase in rate compared with the rate in the general elderly population without hydrocephalus (p < 0.001). The median protection period was 12.0 months in patients with NTG and 18.0 months in those without NTG (p = 0.033). The median ICP decrease multiplied by duration of exposure in months was 76.0 mm Hg × months in the NTG group and 24.1 mm Hg × months in the no-NTG group (p = 0.048). The patients’ median adjusted age (adjusted for “protection” and “exposure” times) was 85.1 years in the NTG group and 78.8 years in the no-NTG group (p = 0.001).CONCLUSIONSA 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.
- Subjects :
- Male
Intracranial Pressure
genetic structures
CSF diversion
ICP = intracranial pressure
IOP = intraocular pressure
NPH = normal pressure hydrocephalus
NTG = normal tension glaucoma
VP = ventriculoperitoneal
intracranial hypotension
normal pressure hydrocephalus
normal tension glaucoma
trans–lamina cribrosa gradient
Glaucoma
Ventriculoperitoneal Shunt
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Reference Values
Risk Factors
Normal pressure hydrocephalus
Normal tension glaucoma
Humans
Medicine
In patient
Low Tension Glaucoma
Intracranial Hypotension
Intraocular Pressure
Aged
Intracranial pressure
Aged, 80 and over
business.industry
Optic Nerve
General Medicine
medicine.disease
Hydrocephalus, Normal Pressure
eye diseases
Anesthesia
030221 ophthalmology & optometry
Optic nerve
Female
sense organs
business
030217 neurology & neurosurgery
Shunt (electrical)
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....0e1afda1c3d2534fed116038a34949c8