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Anatomic and visual function outcomes in paediatric idiopathic intracranial hypertension.
Br J Ophthalmol. 2016 Apr; 100(4):505-9.BJ

Abstract

BACKGROUND

There is a paucity of literature describing risk factors for vision loss in paediatric idiopathic intracranial hypertension (IIH). We investigate the final visual function, spectral domain optical coherence tomography (SD-OCT) and enhanced depth imaging (EDI)-OCT findings in children with papilledema caused by IIH.

METHODS

Medical records of 31 patients with paediatric IIH (age ≤17 years) were retrospectively reviewed. Optic disc photographs on presentation and automated perimetry, SD-OCT and EDI-OCT imaging on final follow-up visit were statistically analysed to identify patient characteristics and anatomic findings associated with irreversible vision loss.

RESULTS

Permanent visual acuity or visual field loss developed in 19% of study eyes. Papilledema of modified Frisén grade ≥3 on presentation was highly predictive of permanent vision loss (p<0.001), while associations between pubertal status and visual function outcome failed to reach statistical significance. SD-OCT revealed optic atrophy in 13% and photoreceptor loss in 19% of eyes, with both findings highly associated with vision loss (p<0.0001). Optic disc drusen was noted in 48% of study eyes by EDI-OCT but was not found to be predictive of visual outcome.

CONCLUSIONS

Clinical observation of high papilledema grade on presentation is predictive of poor visual outcomes. Vision loss is associated not only with optic atrophy but also with photoreceptor damage. Interestingly, a high proportion of study eyes had optic disc drusen, which was not associated with vision loss, but can be a diagnostic challenge in distinguishing true papilledema from pseudopapilledema.

Authors+Show Affiliations

Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina USA.Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina USA Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA.Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26269534

Citation

Gospe, Sidney M., et al. "Anatomic and Visual Function Outcomes in Paediatric Idiopathic Intracranial Hypertension." The British Journal of Ophthalmology, vol. 100, no. 4, 2016, pp. 505-9.
Gospe SM, Bhatti MT, El-Dairi MA. Anatomic and visual function outcomes in paediatric idiopathic intracranial hypertension. Br J Ophthalmol. 2016;100(4):505-9.
Gospe, S. M., Bhatti, M. T., & El-Dairi, M. A. (2016). Anatomic and visual function outcomes in paediatric idiopathic intracranial hypertension. The British Journal of Ophthalmology, 100(4), 505-9. https://doi.org/10.1136/bjophthalmol-2015-307043
Gospe SM, Bhatti MT, El-Dairi MA. Anatomic and Visual Function Outcomes in Paediatric Idiopathic Intracranial Hypertension. Br J Ophthalmol. 2016;100(4):505-9. PubMed PMID: 26269534.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anatomic and visual function outcomes in paediatric idiopathic intracranial hypertension. AU - Gospe,Sidney M,3rd AU - Bhatti,M Tariq, AU - El-Dairi,Mays A, Y1 - 2015/08/12/ PY - 2015/04/17/received PY - 2015/07/29/accepted PY - 2015/8/14/entrez PY - 2015/8/14/pubmed PY - 2016/8/3/medline KW - Imaging KW - Macula KW - Optic Nerve KW - Vision SP - 505 EP - 9 JF - The British journal of ophthalmology JO - Br J Ophthalmol VL - 100 IS - 4 N2 - BACKGROUND: There is a paucity of literature describing risk factors for vision loss in paediatric idiopathic intracranial hypertension (IIH). We investigate the final visual function, spectral domain optical coherence tomography (SD-OCT) and enhanced depth imaging (EDI)-OCT findings in children with papilledema caused by IIH. METHODS: Medical records of 31 patients with paediatric IIH (age ≤17 years) were retrospectively reviewed. Optic disc photographs on presentation and automated perimetry, SD-OCT and EDI-OCT imaging on final follow-up visit were statistically analysed to identify patient characteristics and anatomic findings associated with irreversible vision loss. RESULTS: Permanent visual acuity or visual field loss developed in 19% of study eyes. Papilledema of modified Frisén grade ≥3 on presentation was highly predictive of permanent vision loss (p<0.001), while associations between pubertal status and visual function outcome failed to reach statistical significance. SD-OCT revealed optic atrophy in 13% and photoreceptor loss in 19% of eyes, with both findings highly associated with vision loss (p<0.0001). Optic disc drusen was noted in 48% of study eyes by EDI-OCT but was not found to be predictive of visual outcome. CONCLUSIONS: Clinical observation of high papilledema grade on presentation is predictive of poor visual outcomes. Vision loss is associated not only with optic atrophy but also with photoreceptor damage. Interestingly, a high proportion of study eyes had optic disc drusen, which was not associated with vision loss, but can be a diagnostic challenge in distinguishing true papilledema from pseudopapilledema. SN - 1468-2079 UR - https://www.unboundmedicine.com/medline/citation/26269534/Anatomic_and_visual_function_outcomes_in_paediatric_idiopathic_intracranial_hypertension_ L2 - https://bjo.bmj.com/lookup/pmidlookup?view=long&amp;pmid=26269534 DB - PRIME DP - Unbound Medicine ER -