PURPOSE: To determine the natural history and visual outcomes of papilledema in cerebral venous sinus thrombosis (CVST).
DESIGN: Retrospective observational case series.
METHODS: This multicenter study included 7 tertiary care neuro-ophthalmology clinics. Sixty-five patients with CVST were identified who received serial eye examinations with documented papilledema from 2008-2016. Outcome measures included time from diagnosis to papilledema documentation, papilledema progression, time to papilledema resolution, treatment interventions and final visual outcomes.
RESULTS: Papilledema was present on initial presentation in 54% of patients or detected later during the course of the disease in 46% of patients. The average time from CVST diagnosis to papilledema documentation was 29 days with a mean (SD) initial Frisén grade of 2.7 (1.3). In 21.5% of cases, papilledema progressed over an average of 55.6 (56.6) days. Time to papilledema resolution was approximately 6 months. Final visual acuity ranged from 20/20 to light perception, with 40% of patients having residual visual field defects on standard automated perimetry. Frisén grade ≥3 (odds ratio [OR] 10.21, P < .0053) and cases with worsening papilledema (3.5, P < .043) were associated with permanent visual field deficits.
CONCLUSIONS: Our study indicates the importance of serial ophthalmic evaluation in all cases of CVST. Follow-up fundoscopy is critical given that a subset of cases can show delayed onset and/or worsening of papilledema with time. Specifically, we recommend an ophthalmic examination at the time of initial diagnosis, with repeat examination within a few weeks and further follow-up depending on the level of papilledema or vision changes.
Bibliographical noteFunding Information:
Funding/Support: This research was supported in part by an unrestricted grant from Research to Prevent Blindness to the University of Rochester Medical Center. All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest and the following were reported. Financial Disclosures: Collin M. McClelland is a consultant for ophthoquestions.com (Pukalani, Hawaii). Michael S. Lee received research support from Quark Pharmaceuticals (Newark, CA), received royalties from Springer Publishing (New York, NY) and Uptodate (Waltham, MA), received honoraria from Vindico medical education (Thorofare, NJ) and Projects in Knowledge (Livingston, NJ), and had stock in Horizon Therapeutics. Prem Subramanian is a consultant and received research support from GenSight Biologics (Paris, France) and Quark Pharmaceuticals, received research support from Santhera Pharmaceuticals (Pratteln, Switzerland), was a consultant for Horizon Therapeutics (Dublin, Ireland), was an expert witness for various legal firms, and received royalties from Wolters Kluwer (Alphen aan den Rijn, Netherlands) and Springer. All authors attest that they meet the current ICMJE requirements to qualify as authors.
Funding/Support: This research was supported in part by an unrestricted grant from Research to Prevent Blindness to the University of Rochester Medical Center .
© 2020 Elsevier Inc.
Copyright 2020 Elsevier B.V., All rights reserved.
- Disease Progression
- Middle Aged
- Retrospective Studies
- Risk Factors
- Sinus Thrombosis, Intracranial/diagnosis
- Time Factors
- Vision Disorders/diagnosis
- Visual Acuity/physiology
- Visual Field Tests
- Visual Fields/physiology
- Young Adult
PubMed: MeSH publication types
- Research Support, Non-U.S. Gov't
- Multicenter Study
- Journal Article