Intracranial hypertension (IIH), a condition of raised intracranial pressure of unknown cause may be associated with significant retinal issues, a study in Ophthalmology Retina reports.

Researchers from Canada found individuals with IIH also commonly had choroidal neovascular membrane, macular exudate, subretinal fluid, venous stasis retinopathy, chorioretinal folds, choroidal infarction and branch retinal artery occlusion. These conditions may reduce visual acuity (VA) or cause visual field (VF) defects unrelated to papilledema, emphasizing the importance of a detailed dilated fundus exam, the investigators noted.

The retrospective institutional chart review used fundus photography and OCT images from neuro-ophthalmology assessments of 142 IIH patients. Of these, 10 (6.9%) and over 182 patients from the literature had retinal findings, including (case series, systematic review): subretinal fluid (30%, 9%), chorioretinal folds (30%, 68%), macular exudate (20%, 5%), choroidal neovascular membrane (10%, 15%), venous stasis retinopathy (10%, 2%), choroidal infarction (0%, 1%) and branch retinal artery occlusion (0%, 1%).

Eight clinical patients were female (80%), their average age was 32, and their body mass index was 40.63 ± 7.43 kg/m2. Additionally, baseline VA was 0.79±0.30 in both eyes, and VF was –9.89±11.52dB in both eyes. Among clinical patients, two (one subretinal fluid and one choroidal neovascular membrane) had distinctive retina-related VF defects at presentation.

The researchers also found outer retinal abnormalities persisted on OCT in patients after resolution of their subretinal fluid and papilledema. Surgical treatment (peritoneal shunt) was required for two patients (one venous stasis retinopathy and one subretinal fluid). Others were treated with weight loss and acetazolamide (Diamox) alone. The patient with significant macular exudate had hypertension, which was treated.

Consultation with a retina specialist is advised in patients with peripapillary choroidal neovascular membrane, the researchers noted.

Nichani P, Micieli JA. Retinal manifestations of idiopathic intracranial hypertension. Ophthalmology Retina. August 25, 2020. [Epub ahead of print].