1. How can we preserve the visual function in idiopathic intracranial hypertension?
Hlavacova P., Vlkova E., Doskova H.
FN Brno, Department of Ophthalmology

2. Case report 1 34-year old obese woman
Headaches, pulsatile tinnitus, visual obscurations of the right eye
Neurological status and MRI scan: no patology
Opening pressure of cerebrospinal fluid (CSF) 400 mm H2O; CSF: no pathology
Visual acuity (VA): OD 0,9; OS 1,0
Perimetry: OD blind spot enlargment, OS physiological

3. 18 months after the surgery VA is 1,0 and VF is physiological
Therapy:
Acetazolamide 1,5g/day
Optic nerve sheaths decompression (ONSD) of the right eye
18 months after the surgery VA is 1,0 and VF is physiological

4. Case report 2 51-year old healthy man
Headaches, pulsatile tinnitus, visual obscurations of the right eye
Neurological status and MRI scan: no pathology,
Opening pressure 700 mm H2O; CSF: no pathology
VA OD 0,9; OS 1,25
Perimetry OD blind spot enlargement, OS physiological

5. Therapy:
ONSD
Acetazolamide 3g/day failed and ventriculoperitoneal shunt input
18 months after the surgeries VA is 1,0 and perimetry showed enlargement of blind spot

6. Case report 3 54-year old woman
Idiopathic intracranial hypertension for 4 years, therapy: Acetazolamide 250 mg/day
Progressive visual loss of both eyes, esp. left eye
Intermittent headaches, pulsatile tinnitus
Opening pressure 500 mm H2O; CSF: no pathology
Neurological status: no pathology, MRI scan: the slit ventricles
VA OD 0,9, OS light perception
Perimetry OD tapered nasally to 30˚, OS concetric tapering of VF to 20˚

7. Valve and programmer of LP shunt

8. 12 months after the surgeries VA and perimetry remain unchanged.
Therapy :
ONSD of the right eye
Acetazolamide 3 g/day failed and LP shunt input
12 months after the surgeries VA and perimetry remain unchanged.

9. Conclusion:
ONSD appears to be an efficient method in early treatment of papilloedema in IIH
There are different ways how can we preserve visual function in IIH. Patient´s compliance and neurosurgical cooperation is very important.