Optic disc haemorrhages at baseline as a risk factor for poor outcome in the Idiopathic Intracranial Hypertension Treatment Trial

Wall, Michael; Thurtell, Matthew J.; Banik, Rudrani; Kedhar, Sanjay; Levin, Flora; Feistmann, Jonathan; Tai, Katy; Yang, Alex; Tobias, Karen M.; Rivas, Melissa; Dominguez, Lorena; Perez, Violete; Longmuir, Reid; Eden, Trina; Kardon, Randy H.; Lesser, Robert L.; O'Neil, Yanina; Heaton, Sue; Gintowt, Nathalie; Rudich, Danielle S.; Digre, Kathleen B.; Warner, Judith E. A.; Hart, Barbara; Wegner, Kimberley; Carlstrom, Bonnie; Allman, Susan; Katz, Bradley J.; Haroldsen, Anne; Lam, Byron L.; Pasol, Joshua; Rosa, Potyra R.; Morante, Alexis; Verriotto, Jennifer; Katz, David M.; Asbury, T.; Gerwin, Robert D.; Barnett, Mary; Hamilton, Steven R.; Tongco, Caryl; Gangadharan, B.; May, Eugene; Patel, Anil D.; Farris, Bradley K.; Siatkowsk, R. Michael; Miller, Heather; Bergman, Vanessa; White, Kammerin; O'Dell, Steven; Andrezik, Joseph A.; Tytle, Timothy; Shindler, Kenneth S.; DuPont, Joan; Salvo, Rebecca; Drossner, Sheri; Ward, Susan; Lo, Jonathan; Engelhard, Stephanie B; Windsor, Elizabeth A. M.; Khella, Sami; Tamhankar, Madhura A.; Stavern, Gregory Van; Kambarian, Jamie; Stavern, Renee Van; Civitelli, Karen; Shepherd, James; Bruce, Beau B; Biousse, Valérie; Newman, Nancy J.; Brower, Judy; Curtis, Linda; Vaphiades, Michael S.; Searcey, Karen; Kline, Lanning B.; McDonald, Roy P.; Givre, Syndee; Hales, Tippi; Bye, Penni; Fuller, Keisha; Carnes, Kenneth M.; James, Kimberly; Ragland, Marisol; Chung, Sophia M.; Govreau, Dawn; Lind, John T.; Williams, Zoë; O'Gara, George W.; Steinmetz, Kari M.; Perevich, Mare; Skrine, Karen; Carter, Elizabeth A.; Ramchandran, Rajeev S.; Katz, Steven E.; Criden, Marc; Coman, Gina; McGregor, John M.; Inman, Andrea; Subramanian, Prem S.; Hoffman, Paul N.; Medura, Marianne; Hartnett, M. Michaele; Siddiqui, Madiha; Brown, Diane; Arnold, Ellen; Boring, Jeff; Miller, Neil R.; Quirós, Peter A.; Ramos, Sylvia M.; Padilla, Margaret; Cisneros, Lupe; Kao, Anne R.; Chicani, Carlos Filipe; Na, Kevin; Tang, Rosa A.; Frishman, Laura J.; Cajavilca, Priscilla; Newland, Sheree; Gantz, Liat; Prieto, Maria Guillermo; Pass, Anastas F.; Holdeman, Nicky R.; Lee, Michael S.; Roemhild, Helen; Elasky, Wendy; Holleschau, Anne; Fissgus, Jody; Walski, Jamie; Harrison, Andrew R.; Falardeau, Julie; Hills, William L.; Bryant, Cristi; Kim, Donna; Armour, Rebecca; Higginbotham, Lori; Newman, Steven A.; Holbrook, Kristina; Cook, Laura D.; Bacon, Holly; Beall, Janis; Goddard, Thomas; Hall, William H.; Hamilton, Debbie; Lyon, Alan F.; Fletcher, William A.; Subramaniam, Suresh; Reimer, Jeannie; Nickerson, Jeri; Costello, Fiona; Rismondo-Stankovich, Vivian; Flanagan, Maureen; Jensen, Allison; Sibony, Patrick A.; Lavorna, Ann Marie; Mladek, Mary; Tenzler, Ruth; Honkanen, Robert; Miller-Horn, Jill; Krupp, Lauren; Rizzo, Joseph F.; Cestari, Dean M.; Snebold, Neal G.; Vatcher, Brian; Matera, Christine; Miretsky, Edward; Oakley, Judith; Dumser, Josyane; Alperen, Tim; Baptista-Pires, Sandra; Bator, Ursula Lord; Barrett, Barbara; Callahan, Charlene; Brett, Sarah; Zimmerman, K; Grillo, Marcia; Capaccioli, Karen; Bhatti, M. Tariq; Greene, La Toya; Santiago-Turla, Maria Cecilia; McClain, Noreen; El-Dairi, Mays; Schatz, Martha; Carter, John E.; O’Connor, Patrick S.; Mojica, Daniel; Smith, Joan M.; Trigo, Y.; Kellogg, Sherry Slayman; Martinez, Alejandra; Comeau, Paul; A, Sánchez; McCarthy, Nathan; Pérez, E. García; Bazán, Carlos; Maitland, Charles G.; Brooks, H. Logan; Gorsica, Ronda; Sherman, B.; Kramer, J D; Frohman, Larry; Ribeiro, Amanda Aparecida; Boschert, Kathryn; Tu, Yu Fei; Rivera, Susan M.; Turbin, Roger E.; Hove, Martin ten; Breen, Adriana; Simms, Craig; Kemp, Mary; Farmer, J. Doyne; Granadier, Robert; Osentoski, Tammy; Cumming, Kristi; Lewis, Bobbie; Stec, Lori; Kattah, Jorge C.; Pula, John H.; Buttice, Mary Rose; Page, Kimberly Du; Cooley, Kimberly L.; Beck, Judith; Bannon, Lynn; Guede, Cynthia I.; Mejico, Luis J.; Ko, Melissa W.; Jubelt, Burk; Grosso, Megan; Chilton, Mark; Watson, Mary Lou; Moore, Jennifer A.; Martin, Tim; Everhart, Cara; Fish, Joan; Cooke, Lori; Dickinson, JL; Acierno, Marie D; Watts, Rachelle; Thomassie, Amy; Rao, Aravinda; Chiasson, Trisha Mary; Rucker, Janet C.; Hannigan, Christine; Katz-Sand, Ilana; Rajguru, D.S.; Kedar, Sachin; Vega, Nubia; Morris, Stephanie A.; Pearson, Andrew; Hanson, Mike; Kovacs, Betty; Weil, Richard; Pi‐Sunyer, Xavier; Feldon, Steven E.; Fisher, William E.; Castillo, Dorothea; Davis, Valerie; Fagan, Lourdes; Hollar, Rachel; Keenan, T.; MacDowell, Peter; Keltner, John L.; Plumb, Kim; Leming, Laura; Werner, John S.; Harvey, Danielle; Johnson, Chris A.; Bausch, Jan; Gao, Shan; Tu, Xin; He, Hua; Watts, Arthur; Baker, Debbie; Constantinescu, Radu; Helles, Karen; McMullen, Nichole; Olsen, Bev; Preston, Larry; Snively, Victoria; Stoutenburg, Ann; Friedman, Deborah I.; Ayanru, O. Iyore; Moss, Elizabeth Ann; Patel, Pravin K.; Mills, Richard P.; Maguire, Maureen G.; Hart, William M.; Katz, Joanne; Kaufman, David I.; McCarthy, Cynthia; Selhorst, John B.; Corbett, James J.

doi:10.1136/bjophthalmol-2016-309852

Cited by 25 publications

(16 citation statements)

References 16 publications

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“…Our study supports the finding in that Frisén grade at presentation was associated with worse final VA and also adds an additional poor prognostic factor of severe CWS at presentation. It was suggested that ODH may be a marker of poor visual prognosis by the IIHTT, 11 but this was not found to be the case in our previous study of adults 9 and in this cohort of pediatric IIH patients when controlling for the severity of papilledema. In the IIHTT, ODH as a predictor of worse visual outcome was not assessed independent of Frisén grade, which is likely the reason for the differences in our studies.…”

Section: Discussioncontrasting

confidence: 77%

“…[8][9][10] The Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) proposed that optic disc hemorrhages (ODH) may be a risk factor for poor visual outcome in adults since this was a more frequent finding in the treatment failure group. 11 We performed a study of 708 eyes of 360 adult IIH patients and found that ODH and peripapillary cotton wool spots (CWS) were not an independent risk factor for a poor visual outcome in IIH when controlling for the severity of the papilledema. 9 The goal of this study was to determine whether optic nerve appearance, particularly ODH and CWS, were an independent risk factor for visual outcome in pediatric IIH.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Optic Nerve Appearance on Visual Outcome in Pediatric Idiopathic Intracranial Hypertension

Micieli

Vasseneix

Berezovsky

et al. 2020

Can. J. Neurol. Sci.

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Objectives: To determine whether optic disc hemorrhages (ODH) and cotton wool spots (CWS) at presentation are associated with worse visual outcomes in pediatric patients with idiopathic intracranial hypertension (IIH). Methods: Retrospective institutional review of 100 eyes of 50 consecutive pediatric IIH patients (aged 16 years or less) who had baseline optic disc photographs before or within 30 days of their diagnostic lumbar puncture and initiation of medical treatment. Optic disc photographs were independently graded by three ophthalmologists in a standardized manner. Visual function was assessed using visual acuity (VA) and visual field grade (VFG). Results: At least one ODH was found in 41% of eyes, at least one CWS was found in 27% of eyes, and 20% of eyes had both ODH and CWS. At presentation, Frisén grade was associated with the presence of CWS (p = 0.013) and showed no association with ODH (p = 0.060). When controlling for Frisén grade, ODH and CWS were not associated with worse VA or VFG at final follow-up. Severe ODH were associated with worse VA and VFG at presentation (p < 0.03), but not at final follow-up. Severe CWS at presentation was strongly associated with a worse Humphrey mean deviation of 5.0 dB (95% confidence interval 1.6–8.3) at final follow-up (p = 0.002). Conclusion: When controlling for the severity of papilledema, ODH do not provide any additional prognostic value in pediatric IIH patients. Frisén grade and severe CWS at presentation were independently associated with worse visual outcomes at the final follow-up.

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Section: Discussioncontrasting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Influence of Optic Nerve Appearance on Visual Outcome in Pediatric Idiopathic Intracranial Hypertension

Micieli

Vasseneix

Berezovsky

et al. 2020

Can. J. Neurol. Sci.

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“…Permanent visual loss is the most feared complication of this disease. Risk factors associated with irreversible visual loss include recent weight gain, papilledema severity, optic disc hemorrhages, decreased visual acuity and visual field loss at the time of presentation, early optic nerve atrophy, and hypertension. Symptom duration, transient visual obscurations, pulsatile tinnitus, headache severity, and the actual number of the OP have not been shown to influence long‐term prognosis.…”

Section: Secondary Causesmentioning

confidence: 99%

Idiopathic Intracranial Hypertension in Children and Adolescents: An Update

Cleves-Bayon

2017

Headache

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“…For example, the severity of the papilledema and loss of visual acuity correlate with the incidence of therapy failure [35]. The same is true for evidence of hemorrhages in the area of the papilla, which can already be present with mild visual impairment [36].…”

Section: Visual Disordersmentioning

confidence: 97%

Update on Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)

Hoffmann

May

2017

Neurology International Open

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Idiopathic intracranial hypertension is characterized by an increase of intracranial pressure of unknown etiology. The clinical presentation is dominated by progressive visual disturbances, which are commonly the result of a papilledema, headache and cranial nerve palsies. Clinical studies have revealed over the past years that the syndrome may also be associated with olfactory disturbances, cognitive deficits and a pulsatile tinnitus.The underlying pathomechanism is probably based on a disturbance of venous outflow, which causes a reduced absorption of cerebrospinal fluid that results in an increase of cerebrospinal fluid pressure. It remains unclear if the venous outflow disturbance results from the overweight-induced increase of intrathoracic pressure, the presence of sinus vein stenoses or both conditions. Recently hormonal factors have also been discussed, but the mechanisms behind a potential influence on intracranial pressure remain unclear.Treatment of idiopathic intracranial hypertension relies mainly on an effective body weight reduction and medication with carboanhydrase inhibitors, which can reduce the production of cerebrospinal fluid and body weight. Results of the first randomized, placebo-controlled trial as well as a 12-month follow-up show that acetazolamide effectively reduces papilledema, visual disturbances and headache in idiopathic intracranial hypertension. In contrast, the evidence for the carboanhydrase inhibitors topiramate and furosemide still relies on open-label trials, because double-blind, placebo-controlled trials for their efficacy in idiopathic intracranial hypertension do not exist. In addition to the treatment with carboanhydrase inhibitors, increasing evidence suggests that the somatostatin analog octreotide may be effective in the treatment of idiopathic intracranial hypertension, but to date no randomized, double-blind, placebo-controlled trials exist to confirm this observation.

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Optic disc haemorrhages at baseline as a risk factor for poor outcome in the Idiopathic Intracranial Hypertension Treatment Trial

Abstract: NCT01003639, Post-results.

Cited by 25 publications

References 16 publications

Influence of Optic Nerve Appearance on Visual Outcome in Pediatric Idiopathic Intracranial Hypertension

Influence of Optic Nerve Appearance on Visual Outcome in Pediatric Idiopathic Intracranial Hypertension

Idiopathic Intracranial Hypertension in Children and Adolescents: An Update

Update on Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)

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