Abstract
Background Idiopathic intracranial hypertension (IIH) is rising in prevalence, with significant morbidity typically affecting overweight women of reproductive age. There is a paucity of data regarding longitudinal clinical outcomes in Australia.
Objectives To describe longitudinal clinical and paraclinical changes in a tertiary cohort of IIH patients.
Methods A retrospective analysis was performed on adult patients diagnosed with definite IIH (Friedman criteria), prospectively enrolled in the neuro-ophthalmology database (NODE) at a single tertiary centre in Victoria. Demographic data obtained at baseline with sequential visits including clinical evaluation, automated perimetry and optical coherence tomography. Multivariate statistical analysis was performed in R.
Results 116 patients were included; 93.1% were female. Mean(+/- standard deviation) time from first consultation to diagnosis was 6.72(43.16) days, with average follow-up duration of 352.7 days (range 0–1232) over 4.73 visits. Mean age at diagnosis was 28.8(6.8) years with mean body mass index (kg/m2) of 39.1(9.7). Papilloedema was found in 96.5%, mean Frisen grade of 1.96(0.98). Mean CSF opening pressure was 31.29(4.90) cmH20. No visual acuity change was observed over time (mean LogMAR 0.02 right eye, 0.05 left eye). Time was associated with reduced retinal nerve fibre layer thickness (p=0.02) and papilloedema grade (p<0.001). BMI at diagnosis strongly correlated with mean perimetric mean deviation (PMD) where each one-unit increase in BMI produced a 0.10 decrease in PMD (p=0.01).
Conclusions Our demographic and clinical phenotype data are comparable with international cohorts. The main predictor of worse visual outcome was baseline BMI, providing a strong rationale for focused weight loss interventions.
