Weight reduction for a better visual outcome in idiopathic intracranial hypertension.

PURPOSE: To evaluate the correlation between weight reduction and visual outcome in overweight patients with idiopathic intracranial hypertension. METHODS: Thirty-nine newly diagnosed, overweight (body mass index >25 kg/m2) patients with idiopathic intracranial hypertension were studied retrospectively. All patients underwent medical treatment with acetazolamide, and a weight reduction program was also offered. Patients were grouped according to their compliance with this weight reduction program into the diet-success (Group 1) and diet-failure groups (Group 2). Body mass index, papilledema, visual acuity, and perimetric mean deviation were compared at the end of the 6-month study period. RESULTS: Groups 1 and 2 did not differ regarding the baseline mean body mass index (32.63 ± 5.61, 32.35 ± 5.06 kg/m2), visual acuity (0.080 ± 0.13, 0.130 ± 0.24 logMAR), perimetric mean deviation (-9.978 ± 0.68, -12.86 ± 8.91), or papilledema grade (2.94 ± 0.22, 2.90 ± 0.30), respectively (p>0.05). During the 6 months' follow-up, Group 1 patients, who complied with both medical and diet therapy, improved significantly in all parameters, including body mass index (p<0.001), visual acuity (p=0.001), perimetric mean deviation (p=0.016), and papilledema grade (p<0.001). Conversely, Group 2 patients, who only underwent medical therapy, improved only in papilledema grade (p<0.001). However, coincident development of optic disc pallor was observed in three patients. Further, they also had significant loss in visual acuity (p=0.047) during the study period. CONCLUSION: Weight reduction combined with medical treatment is associated with significantly better improvement in visual acuity, visual field, and papilledema in idiopathic intracranial hypertension patients. Compliance with an efficient diet program should be encouraged in overweight patients with idiopathic intracranial hypertension.

Weight reduction for a better visual outcome in idiopathic intracranial hypertension / Redução de peso para a melhora do resultado visual na hipertensão intracraniana idiopática

ABSTRACT Purpose: To evaluate the correlation between weight reduction and visual outcome in overweight patients with idiopathic intracranial hypertension. Methods: Thirty-nine newly diagnosed, overweight (body mass index >25 kg/m2) patients with idiopathic intracranial hypertension were studied retrospectively. All patients underwent medical treatment with acetazolamide, and a weight reduction program was also offered. Patients were grouped according to their compliance with this weight reduction program into the diet-success (Group 1) and diet-failure groups (Group 2). Body mass index, papilledema, visual acuity, and perimetric mean deviation were compared at the end of the 6-month study period. Results: Groups 1 and 2 did not differ regarding the baseline mean body mass index (32.63 ± 5.61, 32.35 ± 5.06 kg/m2), visual acuity (0.080 ± 0.13, 0.130 ± 0.24 logMAR), perimetric mean deviation (-9.978 ± 0.68, -12.86 ± 8.91), or papilledema grade (2.94 ± 0.22, 2.90 ± 0.30), respectively (p>0.05). During the 6 months' follow-up, Group 1 patients, who complied with both medical and diet therapy, improved significantly in all parameters, including body mass index (p<0.001), visual acuity (p=0.001), perimetric mean deviation (p=0.016), and papilledema grade (p<0.001). Conversely, Group 2 patients, who only underwent medical therapy, improved only in papilledema grade (p<0.001). However, coincident development of optic disc pallor was observed in three patients. Further, they also had significant loss in visual acuity (p=0.047) during the study period. Conclusion: Weight reduction combined with medical treatment is associated with significantly better improvement in visual acuity, visual field, and papilledema in idiopathic intracranial hypertension patients. Compliance with an efficient diet program should be encouraged in overweight patients with idiopathic intracranial hypertension.

RESUMO Objetivo: Avaliar a correlação entre a redução de peso e o resultado visual em pacientes com hipertensão intracraniana idiopática e sobrepeso. Métodos: Trinta e nove pacientes, recém-diagnosticados com hipertensão intracraniana idiopática e sobrepeso (índice de massa corporal >25 kg/m2), foram estudados retrospectivamente. Todos os pacientes foram submetidos a tratamento médico com acetazolamida e receberam um programa para redução de peso. Os pacientes foram classificados de acordo com o cumprimento do programa de redução de peso em: sucesso da dieta (Grupo 1) e falha da dieta (Grupo 2). Os índices de massa corporal, a papiledema, a acuidade visual e desvios médios perimétricos foram comparados no final de 6 meses. Resultados: Os grupos não apresentaram diferenças em relação às médias da linha de base de índice de massa corporal (32,63 ± 5,61/32,35 ± 5,06 kg/m2), acuidade visual (0,080 ± 0,13/0,130 ± 0,24 logMAR), desvios médios perimétricos (-9,978 ± 0,68/-12,86 ± 8,91) e níveis de papiledema (2,94 ± 0,22/2,90 ± 0,30) (p>0,05). Durante o período de acompanhamento de 6 meses, os pacientes do grupo 1, que obedeceram as terapias médicas e dietéticas, melhoraram significativamente em todos os parâmetros, incluindo o índice de massa corporal (p<0,001), a acuidade visual (p=0,001), o desvio médio perimétrico (p=0,016) e o nível de papiledema (p<0,001). Por outro lado, os pacientes do grupo 2, que receberam apenas terapia médica, apresentaram melhoras somente no nível de papiledema (p<0,001). No entanto, observou-se o desenvolvimento coincidente de palidez de disco óptico em três pacientes. Além disso, esses pacientes também apresentaram perda significativa de acuidade visual (p=0,047) durante o período de estudo. Conclusão: A redução de peso combinada ao tratamento médico está associada à melhora significativa das acuidades visuais, dos campos visuais e de papiledema em pacientes com hipertensão intracraniana idiopática. O cumprimento de programas de dietas eficientes deve ser encorajado em pacientes obesos com hipertensão intracraniana idiopática.

Disc swelling in abetalipoproteinemia: a novel feature of Bassen-Kornzweig syndrome.

PURPOSE: Abetalipoproteinemia is a very rare disease with multisystemic manifestations. METHODS: Retrospective, case report. RESULTS: We report a 9-year-old girl with a history of Bassen-Kornzweig syndrome diagnosed at the age of 3. The patient was referred to us by the pediatricians for ocular assessment. During the examination, an atypical pigmentary retinopathy and bilateral swelling of the optic discs were observed, with no consequences to her visual acuity. CONCLUSIONS: Ophthalmic manifestations in Bassen-Kornzweig syndrome are not uncommon. We describe, for the first time, bilateral swelling of the optic discs, a sign that appears directly associated with abetalipoproteinemia.

Low energy diet and intracranial pressure in women with idiopathic intracranial hypertension: prospective cohort study.

OBJECTIVE: To observe intracranial pressure in women with idiopathic intracranial hypertension who follow a low energy diet. DESIGN: Prospective cohort study. SETTING: Outpatient department and the clinical research facility based at two separate hospitals within the United Kingdom. PARTICIPANTS: 25 women with body mass index (BMI) >25, with active (papilloedema and intracranial pressure >25 cm H(2)O), chronic (over three months) idiopathic intracranial hypertension. Women who had undergone surgery to treat idiopathic intracranial hypertension were excluded. INTERVENTION: Stage 1: no new intervention; stage 2: nutritionally complete low energy (calorie) diet (1777 kJ/day (425 kcal/day)); stage 3: follow-up period after the diet. Each stage lasted three months. MAIN OUTCOME MEASURE: The primary outcome was reduction in intracranial pressure after the diet. Secondary measures included score on headache impact test-6, papilloedema (as measured by ultrasonography of the elevation of the optic disc and diameter of the nerve sheath, together with thickness of the peripapillary retina measured by optical coherence tomography), mean deviation of Humphrey visual field, LogMAR visual acuity, and symptoms. Outcome measures were assessed at baseline and three, six, and nine months. Lumbar puncture, to quantify intracranial pressure, was measured at baseline and three and six months. RESULTS: All variables remained stable over stage 1. During stage 2, there were significant reductions in weight (mean 15.7 (SD 8.0) kg, P<0.001), intracranial pressure (mean 8.0 (SD 4.2) cm H(2)O, P<0.001), score on headache impact test (7.6 (SD 10.1), P=0.004), and papilloedema (optic disc elevation (mean 0.15 (SD 0.23) mm, P=0.002), diameter of the nerve sheath (mean 0.7 (SD 0.8) mm, P=0.004), and thickness of the peripapillary retina (mean 25.7 (SD 36.1) micro, P=0.001)). Mean deviation of the Humphrey visual field remained stable, and in only five patients, the LogMAR visual acuity improved by one line. Fewer women reported symptoms including tinnitus, diplopia, and obscurations (10 v 4, P=0.004; 7 v 0, P=0.008; and 4 v 0, P=0.025, respectively). Re-evaluation at three months after the diet showed no significant change in weight (0.21 (SD 6.8) kg), and all outcome measures were maintained. CONCLUSION: Women with idiopathic intracranial hypertension who followed a low energy diet for three months had significantly reduced intracranial pressure compared with pressure measured in the three months before the diet, as well as improved symptoms and reduced papilloedema. These reductions persisted for three months after they stopped the diet.