Bilateral peripapillary subretinal neovessel membrane associated with chronic papilledema: report of two cases.
BACKGROUND
Increased intracranial pressure (ICP) usually results in headaches and papilledema with infrequent loss of visual acuity. Peripapillary subretinal neovessel membranes (PSNVM) rarely complicate chronic papilledema.


METHODS
Case 1: A headache-free 9-year-old boy presented with a bilateral loss of vision due to chronic papilledema. Bilateral PSNVM was present. Cerebral imaging revealed a pilocytic astrocytoma and hydrocephaly. Case 2: A headache-free 39-year-old man presented with severe visual loss of the left eye due to an exudative macular star. Severe papilledema and PSNVM were present in both eyes due to idiopathic intracranial hypertension.


RESULTS
Lowering of ICP (tumor resection - Case 1 and lumboperitoneal shunt - Case 2) resulted in involution of the PSNVMs in both patients. No improvement of visual acuity occurred for Case 1 (optic atrophy) but Case 2 benefited from gradual visual recovery.


CONCLUSIONS
PSNVMs are rare complications of chronic papilledema, as only 10 patients have been reported so far in the literature. Absence of headaches in both of our patients was probably responsible for the late diagnosis, hence chronicity of papilledema. Laser therapy of PSNVM might not be necessary once the ICP is lowered.
Nguyen
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Hôpital Ophtalmique Jules Gonin, University of Lausanne, Lausanne, Switzerland.
Borruat
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FX
D000328:Adult; D001254:Astrocytoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D001932:Brain Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002648:Child; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D019586:Intracranial Hypertension / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008297:Male; D009898:Optic Disk / Q000098:blood supply* / Q000473:pathology; D010211:Papilledema / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D015861:Retinal Neovascularization / Q000150:complications* / Q000175:diagnosis; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D015354:Vision, Low / Q000175:diagnosis / Q000209:etiology; D014792:Visual Acuity / Q000502:physiology