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Idiopathic intracranial hypertension (IIH) is a clinical syndrome characterised by headache and papilloedema that can lead to significant visual morbidity. IIH is diagnosed by the modified Dandy criteria, which include normal neuroimaging and cerebrospinal fluid (CSF) composition, high CSF opening pressure (OP) and no other neurological signs except those related to high intracranial pressure. There are limited studies in the literature focusing on visual outcomes and predictors of visual outcomes in IIH. In this study visual outcome for IIH in patients referred to the large tertiary neurology and neuro-ophthalmology referral centre in Kuwait was examined. A retrospective medical records review took place from 76 patients with IIH according to the modified Dandy criteria. Patients with any ocular condition or a disease of the retina or optic nerve or any intervening procedure during the follow-up that could have altered their visual outcome and patients who were on tetracycline medication at the time of diagnosis were excluded. Multivariable regression analysis was performed to determine if there was an independent effect of the clinical variables and predictors on the final visual field mean deviation (MD) in the study or on attaining a favourable visual outcome defined as a final MD better than −3 decibels (dB) in the study eye. Results showed there was a significant improvement in the Humphrey 24-2 MD in the study eyes (worse affected eye at presentation) in both the medically treated group (+2.0 dB; from −5.60 dB at baseline to −3.60 dB at final follow-up, p < .01) and in the fellow eyes in the medically treated group (+1.70 dB, from −4.40 dB at baseline to −2.74 dB at final follow-up, p < .01). Higher papilloedema grade (beta −0.66, p < .001) and age (p < .02) were inversely correlated with the final visual field MD in the study eye. In summary, the visual outcome for the IIH patients in this study was predominantly favourable, but patients with high-grade papilloedema had a worse visual prognosis and required more aggressive treatment.

Course and predictors of visual outcome of idiopathic intracranial hypertension.
Behbehani R, Ali A, Al-Moosa A.
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Claire Howard

Salford Royal NHS Foundation Trust, Salford, UK.

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