Abstract
Purpose :
Idiopathic Intracranial Hypertension (IIH) is vision threatening disease mainly affecting females of a reproductive age. Fulminant IIH is a rapidly progressive form of IIH causing severe vision loss and or blindness. Tetracyclines and retinoids can cause secondary IIH, also known as medication induced IIH. We aimed to determine the frequency of medication induced IIH among patients diagnosed with IIH in a large referral center.
Methods :
For this retrospective study, data was collected from the electronic medical records of patients diagnosed with IIH (ICD-9: 348.2; ICD-10: G93.2) from 6/2012-6/2022. Medication induced IIH patients were compared to IIH patients confirmed through the Dandy criteria. Data was collected regarding demographic features, disease characteristics (papilledema, neuroimaging, lumbar puncture, visual field testing), treatments, and follow-up data.
Results :
775 patients with IIH were identified, of which 74 (8.8%) were medication induced IIH with exposure to tetracyclines (66.2%), retinoids (23%), or both (10.8%). The mean age was 23 (SD 18, 31), mean body mass index (BMI) was 32 (SD 25, 38), and 88% were female. Four patients (4.9%, 3 female) had a fulminant course of disease, including two taking retinoids and two taking both retinoids and tetracyclines. Acne was the reason for medication use in 83.7% of cases. The average length of treatment was 9 weeks (SD 5, 22) in tetracycline group, 23 weeks (SD 8, 42) in retinoid use, and 12 weeks (SD 10, 21) with both. Patients exposed to retinoids had 4.85 (95% CI 1.55-15.24) times increased odds of having a fulminant presentation of disease compared to patients not exposed to retinoids.
Conclusions :
Medication-induced IIH constitutes approximately 9% of all IIH diagnoses. Tetracyclines were a more prevalent exposure although retinoids were associated with a fulminant disease course. Further studies are needed to assess appropriate screening measures for these patients.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.