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Management of Peripapillary Choroidal Neovascular Membrane in Patients With Idiopathic Intracranial Hypertension

Ozgonul, Cem MD; Moinuddin, Omar MD; Munie, Metasebia MD; Lee, Michael S. MD; Bhatti, M. Tariq MD; Landau, Klara MD; Van Stavern, Gregory P. MD; Mackay, Devin D. MD; Lebas, Maud MD; DeLott, Lindsey B. MD; Cornblath, Wayne T. MD; Besirli, Cagri G. MD, PhD

doi: 10.1097/WNO.0000000000000781
Original Contribution
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Objective: To report the clinical features and treatment outcomes of patients with peripapillary choroidal neovascular membrane (CNVM) secondary to idiopathic intracranial hypertension (IIH).

Methods: Retrospective, multicenter chart review of patients diagnosed with peripapillary CNVM in the course of the treatment and follow-up of IIH.

Results: Records were reviewed from 7 different institutions between 2006 and 2016. Ten patients (13 eyes) with a diagnosis of IIH and at least 3 months of follow-up developed CNVM. Three of the total 10 patients developed bilateral CNVM. The mean time from the diagnosis of IIH to CNVM diagnosis was 41 months. Mean follow-up period was 8 months after diagnosis of CNVM. All patients were treated with acetazolamide for IIH. Seven eyes were observed, and 6 eyes were given anti–vascular endothelial growth factor (anti-VEGF) injections, including bevacizumab, ranibizumab, and aflibercept. All CNVMs regressed with subretinal fibrosis, and visual acuity improved in most patients. Papilledema resolved in only 1 eye, while the other 12 eyes had persistent papilledema at last follow-up.

Conclusions: Peripapillary CNVM, a rare complication of IIH, often resolves spontaneously with treatment of IIH. In vision-threatening and/or persistent cases, intravitreal anti-VEGF treatment may be a safe and effective therapeutic option.

Department of Ophthalmology (CO), Gulhane Training and Research Hospital, Ankara, Turkey; Department of Ophthalmology and Visual Sciences (OM, LBD, WTC, CGB), W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Department of Ophthalmology (MM), Mid-Atlantic Permanente Medical Group, Rockville, Maryland; Department of Ophthalmology and Visual Neurosciences (MSL), University of Minnesota, Minneapolis, Minnesota; Department of Ophthalmology and Neurology Mayo Clinic (MTB), Rochester, Minnesota; Department of Ophthalmology (KL), University Hospital Zurich and University of Zurich, Zurich, Switzerland; Department of Ophthalmology (GPVS), Washington University in St. Louis, St. Louis, Missouri; Department of Ophthalmology (DDM), Indiana University School of Medicine, Indianapolis, Indiana; Department of Ophthalmology (ML), Hôpital Delafontaine, Saint-Denis, France; and Department of Neurology (LBD, WTC), University of Michigan, Ann Arbor, Michigan.

Address correspondence to Cagri G. Besirli, MD, PhD, Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105; E-mail: cbesirli@med.umich.edu

The authors report no conflicts of interest.

© 2019 by North American Neuro-Ophthalmology Society