Visual Field Mean Deviation at Diagnosis of Idiopathic Intracranial Hypertension Predicts Visual Outcome.
Visual Field Mean Deviation at Diagnosis of Idiopathic Intracranial Hypertension Predicts Visual Outcome.
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DOI：
10.1097/wno.0000000000000709
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发表时间：
2019-06
期刊：
影响因子：
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通讯作者：
De Lott L
中科院分区：
文献类型：
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作者：
Mikkilineni S;Trobe JD;Cornblath WT;De Lott L
特发性颅内高压症（IIH）的视觉结果的一个强大的预测将是有用的管理，但在这一点上的信息有限。本研究的目的是确定在一个大型患者队列中，诊断时进行的标准静态视野检查的视野平均偏差是否是视觉结果的可靠预测因素。我们回顾性分析了1999年至2015年在一个学术医疗中心的神经眼科诊所检查的79例IIH患者在诊断和最终就诊时的自动视野平均偏差。在79名研究患者中，66名（84%）进入时视野平均偏差为-7 dB或更好。在这66例患者中，59例（89%）的最终平均偏差为-4 dB或更好，33例（56%）的最终平均偏差为-2 dB或更好。初始平均偏差为-7 dB或更好且最终平均偏差较差（-32 dB）的单个患者不依从处方药物。在13名（21%）平均偏差低于-7 dB的患者中，11名（85%）最终视力结果较差，其最终平均偏差范围为-5 dB至-32 dB。在这13名患者中，超过一半的患者需要手术治疗IIH，通常在诊断后3周内，由于诊断时严重的视神经乳头水肿和视觉功能障碍。根据这项回顾性研究，诊断时有相对轻度视觉功能障碍的IIH患者如果坚持推荐的治疗，可能会有良好的视觉结局。许多诊断时视觉功能差的患者，尽管进行了积极的治疗，仍会有不利的视觉结果。
A robust predictor of visual outcome in idiopathic intracranial hypertension (IIH) would be useful in management, but there is limited information on this point. The purpose of this study was to ascertain whether visual field mean deviation on standard static perimetry performed at diagnosis in a large patient cohort is a reliable predictor of visual outcome. We retrospectively reviewed the automated visual field mean deviations at diagnosis and at final encounter in 79 patients with IIH examined in the neuro-ophthalmology clinics at a single academic medical center from 1999 to 2015. Of the 79 study patients, 66 (84%) entered with visual field mean deviations of −7 dB or better. Of those 66 patients, 59 (89%) had final mean deviations of −4 dB or better and 33 (56%) had final mean deviations of −2 dB or better. The single patient who had an initial mean deviation of −7 dB or better and a poor final mean deviation (−32 dB) was non-adherent to prescribed medication. Of the 13 (21%) patients who entered with mean deviations worse than −7 dB, 11 (85%) ended up with poor visual outcomes, their final mean deviations ranging from −5 dB to −32dB. Over half of those 13 patients had required surgery for IIH, often within 3 weeks of diagnosis, owing to severe papilledema and visual dysfunction at time of diagnosis. Based on this retrospective study, patients with IIH who have relatively mild visual dysfunction at diagnosis are likely to have a favorable visual outcome provided they are adherent to recommended treatment. Many of those with poor visual function at diagnosis will have unfavorable visual outcomes despite aggressive treatment.