Neuro-ophthalmological biomarkers of visual outcome in newly diagnosed idiopathic intracranial hypertension

Abstract

Background: Idiopathic intracranial hypertension (IIH) is a disorder of unidentified etiology characterized by raised intracranial pressure (ICP) without clinical, laboratory, or radiological evidence of intracranial pathology. The aim of this work was to determine the visual outcome in newly diagnosed IIH patients. Methods: The study included 68 IIH patients; 59 responded to medical treatment and nine needed lumboperitoneal shunting (LPS). Patients were submitted to papilledema grading using Frisén Scale, water CSF manometry, brain MRI/ MRV, mean deviation of visual field examination (MD-VFE), optic nerve sheath diameter (ONSD), average optic disc optical coherence tomography–retinal nerve fiber layer (OCT–RNFL) thickness, and pattern–reversal visual evoked potential (VEP). Results: Patients needed LPS showed statistically significant increase in baseline papilledema grade, MD-VFE, ONSD, average OCT–RNFL thickness, and P100 VEP latency. On the other hand, both studied groups showed statistically non-significant differences regarding the patients’ ages and opening CSF pressure. Conclusion: Newly diagnosed IIH patients’ evaluation must be based on multimodality neuro-ophthalmological assessment where papilledema grade, MD-VFE, and OCT–RNFL are valuable biomarkers of PVD while P100 VEP latency delay is a predictor of poor visual outcome and ONSD is an early indicator of elevated ICP regression after LPS surgery.