Abstract
Purpose :
Venous sinus stenting (VSS) is an emerging surgical intervention for treatment of idiopathic intracranial hypertension (IIH). We determine the impact of stenting on vision.
Methods :
A retrospective chart review of IIH patients with papilledema who underwent VSS of the transverse sinus sigmoid sinus junction at Weill Cornell Medicine - New York Presbyterian Hospital from 2012 to 2017 was conducted. Measures of vision in individual eyes were compared pre-stent (within one month prior to stent date) and post-stent (within 4 months of stent date) using paired t-tests.
Results :
Of a total of 30 patients, 18 had intrinsic venous sinus stenosis on MRV and 13 had extrinsic stenosis. The majority of patients were female (99.9%) with a mean age of 29.2 (SD 8.2). Patients were on an average of 1187.5mg (SD 710.0mg) acetazolamide per day pre-stent and 359.4mg (SD 532.0mg) post-stent. Mean body mass index was 39.4 (SD 8.1) pre-stent and 40.4 (SD 7.9) post-stent. At baseline, mean Frisen grade was 2.5, visual field mean deviation (VF MD) was -10.1 dB, retinal nerve fiber layer (RNFL) thickness was 247.7 um, ganglion cell layer (GCL) thickness was 75.5, and visual acuity was 0.14 logMAR. Post-stent, there was on average an improvement in Frisen grade of 1.7 to 0.77 (p<0.01), corresponding with a decrease in RNFL thickness by 109.5 um (p<0.01). No difference in GCL thickness was observed post-stent (73.2 um post-stent, p=0.12). Visual field mean deviation improved by 5.6 dB (p<0.01). Visual acuity improved by 0.08 logMAR to 0.07 logMAR (p=0.03) post-stent.
Conclusions :
In IIH patients with both intrinsic and extrinsic venous sinus stenosis, VSS improves papilledema and RNFL thickness, whereas GCL thickness remains unchanged. This is associated with improvement in visual fields and visual acuity. VSS is an effective treatment to improve vision in IIH patients with papilledema.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.