Improved Ophthalmic Outcomes Following Venous Sinus Stenting in Idiopathic Intracranial Hypertension

Background Ophthalmic outcomes following venous sinus stenting (VSS) in patients with idiopathic intracranial hypertension (IIH) are not well characterized. Materials and Methods A retrospective chart review was conducted on 86 consecutive IIH who underwent at Mayo Clinic, Rochester, Minnesota Stanford Medical Center, Palo Alto, California between May 2015 October 2021. Patients raised pressure from a non-IIH etiology were excluded. Clinical symptoms neuro-ophthalmological data, including best corrected visual acuity (BCVA), field mean deviation, papilledema, optical coherence tomography (OCT) peripapillary retinal nerve fiber layer (pRNFL) ganglion cell inner plexiform (GC-IPL), analyzed. Baseline measurements before VSS 3 months or more postoperatively compared. Results Eighty-six subjects (82 female) included this study, median age of 33 (16–68) years body mass index 36.69 (22.30–62.00) kg/m 2 . 85/86 (98.8%) had attempted prior management medication, 12/86 (14%) surgical optic sheath fenestration, ventriculoperitoneal shunt, bariatric surgery. Prior to VSS, 67/86 (77.9%) headaches, 68/86 (79.1%) pulsatile tinnitus. For both pre- post-VSS data available, the average papilledema grade 1.76 (0–5) (n = 74) OCT pRNFL 186.34 (52.00–588.00) µm 70), VSS. 4.0 (interquartile range 3.3–5.4) after improved 0.39 (0–2), p <0.001, 96.86 (47.00–168.00) µm, <0.001. 28/86 (32.6%) no longer required medication for high pressure. 14/85 (16.5%) reported complete resolution their headache 55/71 (77.5%) improvement quality. 40/68 (66.7%) GC-IPL, BCVA, deviation did significantly change vs post-VSS. Conclusions Our large case series corroborates smaller studies demonstrating overall efficacy IIH. We found ophthalmic improvements, as demonstrated by reduced pRNFL, clinical symptom improvement.