Association of ganglion cell-inner plexiform layer thinning with visual function in pediatric papilledema

To characterize the association between macula ganglion cell-inner plexiform layer thickness (GCT) and visual loss in children with papilledema.

The medical records of pediatric patients (<18 years of age) presenting with papilledema at a single institution between 2012 and 2022 were reviewed retrospectively. Presenting age, sex, lumbar puncture opening pressure, and etiology were recorded in addition to initial and final best-corrected visual acuity, average peripapillary circumferential retinal nerve fiber layer (RNFL) thickness, and GCT. Clinical characteristics were compared between those with and without visual loss, defined as logMAR best-corrected visual acuity ≥0.3, Humphrey visual field mean deviation < -3.0, or abnormal Goldmann visual field.

A total of 160 eyes of 80 patients (53 female [67%]) were included. Mean patient age was 11.5 years (range, 4-18). Mean follow-up was 19.5 months. Primary pseudotumor cerebri was the diagnosis in 68 cases (85%); secondary, in 12 (15%). Of the 160 eyes, 22 (14%) experienced visual loss (visual acuity, 14; visual fields, 8). Those with visual loss had a significantly higher lumbar puncture opening pressure (41 vs 46 cm H₂O [P = 0.01]) and higher initial RNFL (242 μm vs 187 μm [P = 0.04]) on univariate analysis. No difference between groups was found for baseline GCT, age, sex or etiology. Average final mean GCT was 73 μm versus 83 μm (P < 0.001) in those with vision loss versus those without, respectively; average final minimum GCT was 68 μm versus 81 μm (P < 0.001) in those with vision loss versus those without, respectively.

In this cohort, final GCT was significantly reduced in pediatric patients with papilledema associated with visual loss compared with those without.