Czech and Slovak Ophthalmology 17 Original article Intracranial Pressure Evaluation by Ophthalmologist Čmelo Jozef Illéš Róbert Šteňo Juraj 12 7 2018 2 3

The value of ICT is important in diagnosis of the diseases of the eye and orbit Methods for direct measurement of intracranial pressure (ICT) are exact, but they are invasive and there is some risk of infection and damage of the tissue. Currently there are 2 valid indirect methods of mesurement of IKT. Digital Ophthalmodynamometry (D-ODM) and Transcranial Doppler ultrasonography (TDU). D-ODM is a non-invasive method for measuring of the Pulsating Venous Pressure (VPT). We can measure VPT by the pulse phenomena. Physiologically (to be maintained blood flow) VPT not be less than the ICT and intraorbital pressure (IorbitT). If we raise the VPT to compensate the current IKT (or IorbitT) - there is a pulsation VCR. We can calculate aproxymative IKT with the formula: IKT = 0.903 - (VPT) - 8.87, or IKT = 0.29 + 0.74 (VOT / PI (AO)). [VOT = intraocular pressure. PI – pulsatility index arteriae ophthalmic from Color Doppler ultrasonography.] IKT can be approximate calculate with mathematical formulas: IKT = 0:55 × BMI (kg / m2) + 0.16 × KTD (mmHg) - 0:18 x age (years) - 1.91. [KTD - diastolic blood pressure, BMI - Body master index] or: IKT = 16.95 x 0.39 x OSASW09 + BMI + 0.14 + TKS - 20.90. [OSASW095: width of the orbital arachnoid space at a distance of 9 mm behind the eyeball (nuclear magnetic resonance). BMI: Body Mass Index. TKS: mean arterial pressure]. Normal values of VPT are under 15 torr. The risk of increased intracranial pressure is above 20 torr. Under physiological conditions, there is intraocular pressure lower in about 5 torr than VPT. Conclusion: D-ODM is a useful screening method in the evaluation of IKT for hydrocephalus, brain tumors, cerebral hemorrhage after brain trauma and also in ocular diseases: Glaucoma, Ocular hypertension, orbitopathy (endocrine orbitopathy), ischemic / non-ischemic occlusion of blood vessels of the eye, indirect detection ICT carotid artery-cavernous fistula, amaurosis fugax, optic neuropathy. D-ODM is suitable for immediate evaluation of IKT, but is not suitable for continuous monitoring. As it can be repeated, it is useful for a patient suspected of having an increased ICT.

 central retinal artery central retinal vein colour Doppler ultrasonography digital ophthalmodynamometry intracranial pressure pressure of cerebrospinal fluid transcranial Doppler ultrasonography intraocular pressure venous pulsation pressure References Andrews L.E., Liu G.T., Ko M.W.: Idiopathic intracranial hypertension and obesity. Horm Res Paediatr, 81(4), 2014: 217–225. Černák, M., Struhárová, K.: Current therapy for retinal vein occlusion. Bratisl lek listy, 113(4), 2012: 228–231. Čmelová: Machalová, S., Čmelová, E., Ďurovčíková, D., Pechová, M., Hikkelová, M.: Intrafamiliárna fenotypová variabilita klasického Marfanovho syndrómu. Čes Slov Pediat, 70(5), 2015: sure in the central retinal vein to evaluate intraorbital pressure in Graves’ ophthalmopathy: a preliminary report. Strabismus, 8(3), 2000: 187–93. Firsching, R., Schutze, M., Motschmann, M., Behrens-Baumann, W.: Venous ophthalmodynamometry: a noninvasive method for assessment of intracranial pressure. J. Neurosurg, 93, 2000, 33–36. Furdová, A., Chynoranský,M., Krajčová, P.: Orbital melanoma. Bratisl lek listy, 112(8), 2011: 466–468. Hartmann K, Meyer-Schwickerath R.: Measurement of venous outflow pres- Hlinomazová, Z., Vlková, E.: Endokrinní orbitopathie v ultrazvukovém obraze. In Bulletin - Slovenská sonografia 97. Piešťany: Slovenská sonografia, 1997. s. 32. Jonas, JB, Harder, B.: Ophthalmodynamometric differences between ischemic vs nonischemic retinal vein occlusion. Am J Ophthalmol, 143(1), 2007: 112–116. Jonas, JB., Harder, B.: Ophthalmodynamometric estimation of cerebrospinal fluid pressure in pseudotumor cerebri. Br J Ophthalmol, 87, 2003: 361–362. Jonas, JB.: Ophthalmodynamometric measurement of orbital tissue pressure in thyroid-associated orbitopathy. Letters to the Editor, Acta Ophthalmol Scand, 82(2), 2004: 239. Karhanová M., Kovář R., Fryšák Z., Zapletalová J., Marešová K., Šín M., Heřman M.: Postižení okohybných svalů u pacienta s endokrinní orbitopatii. Čes a Slov Oftal, 70(2), 2014: 66–71. Li, Z., Yang, Y., Lu, Y., Liu, D., Xu, E., Jia, J., Yang, D., Zhang, X., Yang, H., Ma, D., Wang, N.: Intraocular pressure vs intracranial pressure in disease conditions: A prospective cohort study (Beijing iCOP study). BMC Neurology [online]. 2012 [cit. 2016-5-12]. Dostupné na WWW: http://bmcneurol.biomedcentral.com/ articles/10.1186/1471-2377-12-66.10.1186/1471-2377-12-66 Magnaes, B: Body position and cerebrospinal fluid pressure. Part 2: clinical studies on orthostatic pressure and the hydrostatic indifferent point. J Neurosurg, 44(6), 1976: 698–705. Meyer-Schwickerath, R., Kleinwächter T., Papenfuß HD., Firsching R.: Central retinal venous outflow pressure. Graefes Arch Clin Exp Ophthalmol, 233(12), 1995: 783–788. Morgan, VW., Balaratnasingam, CH., Lind, ChRP, Colley, S., Kang, MH., House, PH., Yu, DY.: Cerebrospinal fluid pre - ssure and the eye. Br J Ophthalmol, 100, 2016: 71–77. Morgan, WH., House , PH., Hazelton , ML., Betz-Stablein, BD., Chauhan, BC, Viswanathan, A., Dao-Yi Yu.: Intraocular Pressure Reduction Is Associated with Reduced Venous Pulsation Pressure. PLoS One [online]. 2016 11(1) [cit. 2016-5-12]. Dostupné na WWW: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0147915.10.1371/journal.pone.0147915 Motschmann M, Muller C, Kuchenbecker J, Walter S, Schmitz K, Schutze M, Behrens-Baumann W, Firsching R.: Ophthalmodynamometry: a reliable method for measuring intracranial pressure. Strabismus, 9(1), 2001: 13–16. Podoba, J.: Aktuálna epidemiológia, diagnostika a liečba ochorení štítnej žľazy. In Interná medicína. Kniha, 2002, 106–112. Querfurth HW, Arms SW, Lichy CM, Irwin WT, Steiner T: Prediction of in - tracranial pressure from noninvasive transocular venous and arterial hemodynamic measurements: a pilot study. Neurocrit Care, 1(2), 2004: 183–194. 20 . Querfurth, HW., Lieberman, P., Arms, S., Mundell, S., Bennett, M., van Horne, C.: Ophthalmodynamometry for ICP prediction and pilot test on Mt. Everest. BMC Neurology, 10, 2010: 106. Siaudvytyte, L., Januleviciene, I., Ragauskas, A., Bartusis, L., Siesky, B., Harris, A.: Update in intracranial pressure evaluation methods and translaminar pressure gradient role in glaucoma. Acta Ophthalmol, 93(1), 2015, 9–15. Šteňo, A., Matejčík, V., Šteňo, J.: Intraoperative ultrasound in low-grade glioma surgery. Clin. Neurol. Neurosurg, 135, 2015: 96–99. Yablonski M., Ritch R., Pakorny K.: Effect of decreased intracranial pressure on optic disc. Invest Ophthalmol Vis Sci, 18, 1979: 165. Zhao, D., Zheng He, Algis J. Vingrys, Bang V. Bui, Christine T. O. Nguyen: The effect of intraocular and intracranial pressure on retinal structure and function in rats. Physiol Rep [online]. 2015 3 [cit. 2016-5-12]. Dostupné na WWW: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562590/ .