Retrospective investigation of the results of medical and surgical treatment in patients with idiopathic intracranial hypertension

Idiopathic intracranial hypertension (IIH) is a clinical picture characterized by normal cerebrospinal fluid content and increased intracranial pressure without intracranial space-occupying lesions. In this study, we aimed to retrospectively evaluate the follow-up processes of patients with IIH who underwent oral carbonic anhydrase inhibitor therapy and/or optic nerve sheath fenestration (ONSF). In Tekirdağ Namık Kemal University, Faculty of Medicine, Department of Ophthalmology, 20 patients diagnosed with IIH between January 2010 and October 2021, who were given medical treatment during the diagnosis and follow-up, were analyzed as Group 1, and 14 patients who underwent surgical treatment as Group 2. In the retrospective study, demographic characteristics of the patients, clinical examination signs and symptoms, treatments and MR scans were evaluated. Headache was the most common symptom in Group 1 and Group 2 patients. All patients in Group 1 were started on acetazolamide treatment. ONSF surgery was performed on Group 2 patients. While the most common indication was narrowing of the visual field (92,9%) in patients who underwent ONSF, the most common complication after surgery was diplopia (21,4%). In the follow-up of Group 2 cases, an increase in mean best corrected visual acuity was observed in both the right and left eyes. Blind spot enlargement was the most common vision loss pattern at the time of diagnosis in patients in Group 1, while severe narrowing was observed in Group 2. The mean deviation (MD) results of the first and last examinations of the patients in Group 1 and Group 2 were statistically significant (p=0,001). When the standard deviation (PSD) first examination averages were compared, no statistically significant difference was found, while the last examination averages were statistically significant (p<0,05). The mean retinal nerve fiber layer thickness values of the right and left eyes of Group 1 and Group 2 cases decreased compared to the first examination. The most common finding on MR was empty sella. In conclusion, significant losses in visual functions can be prevented with correct patient management in IIH patients. ONSF in surgical treatment and acetazolamide in medical treatment are reliable options. Key words: Idiopathic intracranial hypertension, papilledema, optic nerve sheath fenestration.