Tags

Type your tag names separated by a space and hit enter

Retinal Manifestations of Idiopathic Intracranial Hypertension.
Ophthalmol Retina. 2021 05; 5(5):429-437.OR

Abstract

TOPIC

This review presents a case series and systematic review to understand retinal changes in patients with idiopathic intracranial hypertension (IIH) using fundus photography and OCT.

CLINICAL RELEVANCE

IIH is a condition of raised intracranial pressure of unknown cause, usually observed in young, obese women. Ophthalmologic manifestations of IIH such as papilledema and abducens nerve palsy are well recognized, but less common retinal manifestations may occur.

METHODS

A retrospective institutional chart review (July 2018-March 2020) was performed on consecutive IIH patients. Fundus photographs were obtained followed by neuro-ophthalmology assessment to elicit clinical characteristics and for diagnosis. Patients who met the modified Dandy criteria were included. A systematic review of observational studies was conducted using Ovid MEDLINE and EMBASE to November 17, 2019, to supplement the case series data.

RESULTS

Of 144 consecutive IIH clinical patients reviewed, 10 (6.9%) and over 182 patients from the literature showed retinal findings (% in case series, % in literature, respectively): subretinal fluid (SRF; 30,9), chorioretinal folds (30,68), macular exudate (ME; 20,5), choroidal neovascular membrane (CNVM; 10,15), venous stasis retinopathy (VSR; 10,2), choroidal infarction (0,1), and branch retinal artery occlusion (BRAO; 0,1). Eight clinical patients were women (80%), average age was 32.00 ± 13.99 years, body mass index was 40.63 ± 7.43 kg/m2, baseline visual acuity (VA) was 0.79 ± 0.30 in both eyes, and visual field (VF) results were -9.89 ± 11.52 dB in both eyes. Among clinical patients, 2 (1 with SRF, 1 with CNVM) had distinctive retina-related VF defects at presentation. Outer retinal abnormalities persisted on OCT in patients after resolution of SRF and papilledema. Surgical treatment (peritoneal shunt) was required for 2 patients (1 with VSR, 1 with SRF); others were treated with weight loss and acetazolamide alone. The patient with significant ME had hypertension that was treated.

DISCUSSION

Significant retinal manifestations associated with IIH include CNVM, ME, SRF, VSR, chorioretinal folds, choroidal infarction, and BRAO. These may reduce VA or cause VF defects unrelated to papilledema, emphasizing the importance of a detailed dilated fundus examination. Consultation with a retina specialist is advised in patients with peripapillary CNVM.

Authors+Show Affiliations

Faculty of Medicine, University of Toronto, Toronto, Canada.Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada; Kensington Vision and Research Centre, Toronto, Canada. Electronic address: jmicieli@kensingtonhealth.org.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32860958

Citation

Nichani, Prem, and Jonathan A. Micieli. "Retinal Manifestations of Idiopathic Intracranial Hypertension." Ophthalmology. Retina, vol. 5, no. 5, 2021, pp. 429-437.
Nichani P, Micieli JA. Retinal Manifestations of Idiopathic Intracranial Hypertension. Ophthalmol Retina. 2021;5(5):429-437.
Nichani, P., & Micieli, J. A. (2021). Retinal Manifestations of Idiopathic Intracranial Hypertension. Ophthalmology. Retina, 5(5), 429-437. https://doi.org/10.1016/j.oret.2020.08.016
Nichani P, Micieli JA. Retinal Manifestations of Idiopathic Intracranial Hypertension. Ophthalmol Retina. 2021;5(5):429-437. PubMed PMID: 32860958.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Retinal Manifestations of Idiopathic Intracranial Hypertension. AU - Nichani,Prem, AU - Micieli,Jonathan A, Y1 - 2020/08/26/ PY - 2020/04/04/received PY - 2020/08/12/revised PY - 2020/08/19/accepted PY - 2020/8/30/pubmed PY - 2021/12/22/medline PY - 2020/8/30/entrez KW - Choroidal neovascular membrane KW - Idiopathic intracranial hypertension KW - Papilledema KW - Retinopathy SP - 429 EP - 437 JF - Ophthalmology. Retina JO - Ophthalmol Retina VL - 5 IS - 5 N2 - TOPIC: This review presents a case series and systematic review to understand retinal changes in patients with idiopathic intracranial hypertension (IIH) using fundus photography and OCT. CLINICAL RELEVANCE: IIH is a condition of raised intracranial pressure of unknown cause, usually observed in young, obese women. Ophthalmologic manifestations of IIH such as papilledema and abducens nerve palsy are well recognized, but less common retinal manifestations may occur. METHODS: A retrospective institutional chart review (July 2018-March 2020) was performed on consecutive IIH patients. Fundus photographs were obtained followed by neuro-ophthalmology assessment to elicit clinical characteristics and for diagnosis. Patients who met the modified Dandy criteria were included. A systematic review of observational studies was conducted using Ovid MEDLINE and EMBASE to November 17, 2019, to supplement the case series data. RESULTS: Of 144 consecutive IIH clinical patients reviewed, 10 (6.9%) and over 182 patients from the literature showed retinal findings (% in case series, % in literature, respectively): subretinal fluid (SRF; 30,9), chorioretinal folds (30,68), macular exudate (ME; 20,5), choroidal neovascular membrane (CNVM; 10,15), venous stasis retinopathy (VSR; 10,2), choroidal infarction (0,1), and branch retinal artery occlusion (BRAO; 0,1). Eight clinical patients were women (80%), average age was 32.00 ± 13.99 years, body mass index was 40.63 ± 7.43 kg/m2, baseline visual acuity (VA) was 0.79 ± 0.30 in both eyes, and visual field (VF) results were -9.89 ± 11.52 dB in both eyes. Among clinical patients, 2 (1 with SRF, 1 with CNVM) had distinctive retina-related VF defects at presentation. Outer retinal abnormalities persisted on OCT in patients after resolution of SRF and papilledema. Surgical treatment (peritoneal shunt) was required for 2 patients (1 with VSR, 1 with SRF); others were treated with weight loss and acetazolamide alone. The patient with significant ME had hypertension that was treated. DISCUSSION: Significant retinal manifestations associated with IIH include CNVM, ME, SRF, VSR, chorioretinal folds, choroidal infarction, and BRAO. These may reduce VA or cause VF defects unrelated to papilledema, emphasizing the importance of a detailed dilated fundus examination. Consultation with a retina specialist is advised in patients with peripapillary CNVM. SN - 2468-6530 UR - https://www.unboundmedicine.com/medline/citation/32860958/Retinal_Manifestations_of_Idiopathic_Intracranial_Hypertension_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2468-6530(20)30348-1 DB - PRIME DP - Unbound Medicine ER -