Can Intraocular Pressure be a Predictor of Intracranial Pressure in Pediatric Patients with Pseudotumor Cerebri Syndrome?

Purpose: Pseudotumor cerebri syndrome (PTCS) causes patients to have increased intracranial pressure (ICP), often measured by lumbar puncture opening pressure (LPOP). However, some studies have suggested a linear relationship between intraocular pressure (IOP) and ICP, which would be a less invasive and safer measurement than LPOP. This study aimed to evaluate the relationship between ICP and IOP among children with PTCS.

Methods/Materials: A retrospective chart review was conducted on pediatric patients with PTCS that received both LPOP and IOP readings between November 2017 and November 2022. LPOP and IOP readings needed to be within 100 days of each other.

Results: 85 patients met inclusion criteria. The mean age at the time of LPOP measurement was 13.52 years and the mean time difference between IOP and LPOP measurements was 19.18 days. The mean LPOP was 24.41 mmHg and the mean IOP was 16.59 mmHg. A linear regression demonstrated LPOP and IOP are not correlated (R2 = 1.43 x 10-5, P-value = 0.973). Age differences within the study were not found to significantly affect differences in intracranial pressure. A subgroup analysis comprised of 48 patients who had both LPOP and IOP measurements within 14 days (mean time difference 5.25 of days) did not yield significant correlation (R2 = 0.060, P-value = 0.051).

Conclusions: No significant correlation between IOP and ICP was discovered. Due to the retrospective nature of this study, the time difference between LPOP and IOP measurements is a limitation and may impair an accurate correlation between the two pressures. Compared to previous studies that claim a correlation between LPOP and IOP, this study had a considerably higher mean LPOP and lower mean age. Therefore, prospective studies are warranted that simultaneously measure IOP and LPOP to further evaluate IOP’s ability to measure ICP status in pediatric patients with PTCS.