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Editors Selection IGR 17-3

Examination methods: IOP and CSF

Comment by Jost Jonas on:

14199 The relation between intracranial and intraocular pressures: Study of 50 patients, Sajjadi SA; Harirchian MH; Sheikhbahaei N et al., Annals of Neurology, 2006; 59: 867-870

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The relation between intracranial and intraocular pressures: Study of 50 patients. In the previous years, the role of the cerebrospinal fluid (CSF) pressure as counter-pressure against the intraocular pressure (IOP) in the pathogenesis of glaucomatous optic nerve damage has increasingly been discussed. In addition, neurologists have been seeking possibilities to measure the cerebrospinal fluid pressure non-invasively. Recently, ophthalmodynamometry has been used to estimate the pressure in the central retinal vein as hint of the CSFD pressure. In the present study, Sajjadi et al. (710)measured both, the IOP by Schiötz indentation tonometry and the CSF pressure by lumbar puncture in 50 patients with neurological diseases. They found a highly significant and strong correlation between both methods with a clinically extremely high correlation coefficient of r = 0955. They concluded that the IOP was strongly associated with the CSF pressure in their patients, and that an IOP measurement could be taken to get information about the CSF pressure. There is no doubt about the interpretation of the results since the statistical result is unequivocal.

A clinically extremely high correlation was found between Schiotz IOP measurement and the CSF pressure measured by lumbar puncture

Clinically, however, one may like to see some additional studies to confirm the findings. It Is not general clinical experience that patients with increased CSF pressure have high IOP (and vice versa, patients with an glaucoma attack usually do not have high CSF pressure). In addition, the current knowledge about the pathogenesis of papilledema in patients with raised CSF pressure may contradict the findings of Sajjadi´s and colleagues study on the very strong correlation between IOP and CSF pressure. Although the result, if generalizable, would have pronounced clinical and scientific impact and would markedly facilitate the care of neurological patients with presumably increased CSF pressure,further studies seem to be warranted before further conclusions can be drawn.

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