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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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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.
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.
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.
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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