Case series and systematic review to understand significant retinal changes in patients with idiopathic intracranial hypertension (IIH) using fundus photography and optical coherence tomography (OCT).
IIH is a condition of raised intracranial pressure of unknown cause, usually observed in young, obese women. Ophthalmological manifestations of IIH such as papilledema and abducens nerve palsy are well-recognized, but less common retinal manifestations may occur.
A retrospective institutional chart review (July 2018 to 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 were included if they met the modified Dandy Criteria. A systematic review of observational studies was conducted using Ovid MEDLINE and EMBASE up to November 17, 2019 to supplement the case series data.
A total of 142 IIH clinical patients were reviewed of which 10 (6.9%) and over 182 patients from the literature had retinal findings (% in case series, % in systematic review): 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 female (80%), average age was 32.00 ± 13.99 years, body mass index was 40.63 ± 7.43 kg/m, baseline visual acuity (VA) was 0.79 ± 0.30 in both eyes (OU), and visual field (VF) was -9.89 ± 11.52 dB OU. Among clinical patients, two (one SRF, one CNVM) had distinctive retina-related VF defects at presentation. Outer retinal abnormalities persisted on OCT in patients after resolution of their SRF and papilledema. Surgical treatment (peritoneal shunt) was required for two patients (one VSR, one SRF); others were treated with weight loss and acetazolamide (Diamox) alone. The patient with significant ME had hypertension which was treated.
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.

Copyright © 2020. Published by Elsevier Inc.