Original article
Puberty as a Risk Factor for Less Favorable Visual Outcome in Idiopathic Intracranial Hypertension

https://doi.org/10.1016/j.ajo.2006.03.043Get rights and content

Purpose

To test the hypothesis that puberty is a risk factor for poorer visual outcome in idiopathic intracranial hypertension (IIH).

Design

Retrospective chart review case series.

Methods

setting: Tertiary referral center, neuro-ophthalmology unit. patient population: Ninety-six patients with IIH followed for a minimum of one year. observation: Age (grouped into prepubertal, pubertal, teenage, or adult), obesity, initial intracranial pressure (ICP), measurements and presence of hypertension, anemia, or renal failure were correlated with final visual outcome using χ2, stepwise logistic regression, and model-selection log linear analyses. main outcome measures: Visual outcome was graded into “excellent” —no evidence of an optic neuropathy or any permanent visual field defect in either eye, “moderate”—evidence of an optic neuropathy and/or a mild (nasal constriction) visual field defect, or “poor outcome” (peripheral constriction)— permanent visual field defect.

Results

Outcome data were complete for 96 patients. Moderate to poor visual outcome, as opposed to excellent, was significantly associated with puberty (P = .007 using the gender-specific definition of puberty, .0002 using the broad definition). Moderate-poor visual outcome occurred in none of seven IIH patients of prepubertal age (<9 years), in 15 of 26 patients presenting between nine to 16 years, in two of six patients aged 17 to 22 years, and in seven of 57 adult patients over the age of 23 years.

Conclusions

In this series of 96 patients with IIH, visual outcome was less favorable in pubertal patients than in prepubertal, teenage, and adult patients. We recommend that clinicians maintain a high index of awareness when caring for pubescent children with IIH.

Section snippets

Methods

We included all 102 patients with the diagnosis of IIH who presented to the Neuro-Ophthalmology Unit at Rabin Medical Center between January 2001 and June 2003. The study was presented to the institutional review board (IRB). IRB approval was not needed as no intervention was applied, nor was follow-up of patients any different than that of all IIH patients.

Inclusion criteria were normal brain magnetic resonance imaging (MRI) and magnetic resonance venography (MRV), or computed tomographic

Results

Data of final visual outcome was available for 96 of 102 patients with IIH. Follow-up range was 12 months (minimum) to 2.5 years, mean 20 months. The age distribution of final visual outcomes is detailed in Table 1. Excellent visual outcome was recorded in 11 (42%) of 26 patients of pubertal age, in seveb four (58%) of seven prepubertal children, four (67%) of six teenagers, and 50 (88%) of 57 adults. Table 2 reports the frequency distribution of puberty as an age group, anemia, obesity,

Discussion

While a relatively small number of respondents in the younger age group posed some difficulties in analysis, converging results for the series of analyses reveals a novel observation that less favorable visual outcome in IIH is associated with a critical period around puberty. It further suggests a nonlinear relationship between outcome and age, which may explain why other studies have not found such a relationship. Cinciripini, Donahue, and Borchert2 have already demonstrated that prepubertal

Hadas Stiebel-Kalish, MD, is the chief of the Neuro-ophthalmology division at Rabin Medical Center, Israel. Dr Stiebel-Kalish is engaged in clinical service and in research focused on endovascular neuro-ophthalmology, increased intracranial hypertension, neurosarcoidosis, and the measurement of ACE activity in the cerebrospinal fluid and in gene expression of pituitary adenomas.

References (16)

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Hadas Stiebel-Kalish, MD, is the chief of the Neuro-ophthalmology division at Rabin Medical Center, Israel. Dr Stiebel-Kalish is engaged in clinical service and in research focused on endovascular neuro-ophthalmology, increased intracranial hypertension, neurosarcoidosis, and the measurement of ACE activity in the cerebrospinal fluid and in gene expression of pituitary adenomas.

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