Peripapillary retinal nerve fiber layer thickness, papilledema grading, and opening pressure in first and recurrent attacks in idiopathic intracranial hypertension patients

Aim To assess the correlation between clinical papilledema grading, in cases of idiopathic intracranial hypertension (IIH), noninvasive retinal nerve fiber layer (RNFL) thickness using optical coherence tomography (OCT) and the interventional cerebrospinal (CSF) opening pressure. Also, to evaluate the difference between measurements in both first and recurrent attack of IIH. Patients and methods Analytical prospective cross-sectional study. A total of 36 IIH cases and 30 controls were studied from November 2023 to 2024. IIH patients were subdivided into 20 first-attack and 16 recurrent-attack subgroups. Clinical grading of papilledema using the Frisen scale and opening CSF pressure was done to cases only. RNFL protocol using spectral Domain OCT was done for all participants. Results In IIH cases, grade 2 was the most common (41.7%) and mean opening pressure was 40±9.5 cmH 2 O. IIH cases had higher RNFL thickness in all sectors when compared with controls. RNFL showed a positive correlation with both clinical papilledema grading and CSF pressure. The first attack subgroup showed not only higher RNFL thickness when compared with recurrent subgroup, but it also showed a positive correlation with papilledema and opening pressure. This correlation was not detected in the recurrent subgroup. Conclusion RNFL thickness in first-attack patients shows a good positive correlation with both disc edema and opening pressure. OCT is a potential imaging tool for the diagnosis and monitoring of papilledema secondary to IIH, especially in low grades.