July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Neuro-ophthalmic Manifestation after Repair of Cerebrospinal Fluid Leak
Author Affiliations & Notes
  • Aishwarya Pastapur
    College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States
  • Omar Solyman
    Ophthalmology & Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States
  • Burce Ozgen
    Department of Radiology, University of Illinois at Chicago, Chicago, Illinois, United States
  • Stephanie Joe
    Department of Otolaryngology and Head and Neck Surgery,, University of Illinois at Chicago, Chicago, Illinois, United States
  • Peter MacIntosh
    Ophthalmology & Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States
  • Footnotes
    Commercial Relationships   Aishwarya Pastapur, None; Omar Solyman, None; Burce Ozgen, None; Stephanie Joe, None; Peter MacIntosh, None
  • Footnotes
    Support  Unrestricted Grant from Research to Prevent Blindness, EY01792 from the National Eye Institute, Craig Fellowship at the University of Illinois College of Medicine at Chicago
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 2307. doi:
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      Aishwarya Pastapur, Omar Solyman, Burce Ozgen, Stephanie Joe, Peter MacIntosh; Neuro-ophthalmic Manifestation after Repair of Cerebrospinal Fluid Leak. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2307.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Cerebrospinal fluid (CSF) leak has recently been linked with idiopathic intracranial hypertension (IIH). Neuro-ophthalmic manifestations after repairing CSF leak in patients with IIH have not been adequately explored, and most of the evidence comes from the otolaryngology and neurosurgery literature. The primary objective of this study was to explore the neuro-ophthalmologic manifestations in patients who underwent surgical CSF leak repair through a retrospective chart review.

Methods : This was a retrospective chart review of individuals diagnosed with spontaneous CSF leak. Data regarding patient’s age, sex, ethnicity, CSF leak site, duration of CSF leak, symptoms, ophthalmic examination including visual acuity, and CSF opening pressure on lumbar puncture were all collected pre- and post-operatively whenever possible. Due to a large variation in data documented in patients’ charts, this information was analyzed qualitatively.

Results : Thirty-three patients with spontaneous CSF leaks were identified. Average age at symptom onset was 50 years old. Most patients (84.8%) were female, and the average BMI was 39.3. Most patients (56%) were African American. Most commonly, defects were found in the ethmoid sinus on radiography. Most patients presented with rhinorrhea. Most patients were not referred to neuro-ophthalmology for follow-up. Eye exams were not standardized in those who did have neuro-ophthalmology follow-up. Eye exams were mostly within normal limits, though 2 patients showed both pre- and post-operative Frisen grade 1 papilledema. Three patients had CSF opening pressures measured pre-operatively, and two different patients had CSF opening pressures measured post-operatively, with post-operative LPs showing higher opening pressures.

Conclusions : This retrospective review of patient medical records shows a need for further studies to characterize the neuro-ophthalmic changes that may occur in patients after repair of a CSF leak as well as standardization and coordination of care. This is especially true of patients with symptoms concerning for IIH and of patients with multiple recurrences after leak repairs.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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