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Publications

Journal Article Ppublish

PubMed: 40015673 DOI: 10.1016/j.wneu.2025.123829

Open-Angle Glaucoma in Idiopathic Normal Pressure Hydrocephalus Before and After Ventriculo-Peritoneal Shunt Surgery: An Interventional Prospective Study.

World Neurosurg 196:123829

Authors: Nicola Valsecchi, Matilde Roda, Simone Febbraro, Matteo Elifani, Eleonora Trolli, Matteo Nicolò Russo, Giorgio Palandri, Giulia Giannini, David Milletti, Costantino Schiavi, Luigi Fontana, Antonio Moramarco

Affiliations

  • Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
  • Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
  • Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
  • Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
  • Unit of Rehabilitation Medicine, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.

Abstract

OBJECTIVE

To assess the frequency of open-angle glaucoma in Caucasian patients affected by idiopathic normal pressure hydrocephalus (iNPH) prior to ventriculo-peritoneal shunt surgery, and to evaluate the progression of optic nerve damage 1-year postsurgery.

METHODS

Thirty-five consecutive patients diagnosed with iNPH were prospectively recruited between November 2021 and June 2023. Assessments included visual acuity, intraocular pressure, macular ganglion cell complex thickness, retinal nerve fiber layer thickness, visual field test, central corneal thickness, axial length, and corneal hysteresis. Patients with newly diagnosed open-angle glaucoma were initiated on intraocular pressure-lowering medications. Eighteen patients were re-evaluated after a mean of 1 year postshunt surgery to assess the progression of optic nerve damage.

RESULTS

A total of 35 eyes of 35 iNPH patients were included. The mean age of participants was 75.75 ± 6.67 years, with 34.3% being females. Primary open-angle glaucoma was identified in 22.8% of nonshunted iNPH patients, including 11.4% who received a new diagnosis. After a mean follow-up of 14.9 ± 4.8 months postsurgery, there were no significant changes in retinal nerve fiber layer and ganglion cell complex thickness, nor were there any observed progressions in visual field defects or significant alterations in corneal biomechanics (P > 0.05).

CONCLUSIONS

Approximately 1 in 5 nonshunted iNPH patients exhibited primary open-angle glaucoma, with 50% being undiagnosed. These findings indicate the importance of conducting ophthalmological evaluations at the time of iNPH diagnosis, as early intervention may mitigate optic nerve damage progression following shunt surgery.

MeSH

Cells, Glaucoma, Open-Angle, Nerve Fibers, Optic Nerve, Visual Fields, Glaucoma, Hydrocephalus, Normal Pressure, Ventriculoperitoneal Shunt, Diagnosis, Neurosurgical Procedures, Ganglion Cysts, Retinaldehyde, Hydrocephalus, Prospective Studies, Intraocular Pressure