title: Optic disc haemorrhages at baseline as a risk factor for poor outcome in the Idiopathic Intracranial Hypertension Treatment Trial.
abstract: The risk of optic disc haemorrhages on visual outcome in idiopathic intracranial hypertension (IIH) is unknown. We report the type and frequency of optic disc haemorrhages and other funduscopic abnormalities at baseline in the study eye of the 133 subjects enrolled in the Idiopathic Intracranial Hypertension Treatment Trial completing 6 months of follow-up.
  
  
  
  We reviewed optic disc photographs to tabulate the frequency and type of optic disc haemorrhages, other funduscopic abnormalities and papilloedema grades of the study eye at baseline and analyse if their presence is associated with a poor visual outcome.
  
  
  
  27.2% of subjects had nerve fibre layer haemorrhages in at least one eye. Five of seven, 71% of subjects that met criteria for treatment failure, had nerve fibre layer haemorrhages in at least one eye (Fisher's exact test: p=0.02). There was a good correlation between presence of nerve fibre layer haemorrhages and Frisén grade (Spearman's correlation, p=0.002; r=0.271). Subjects with nerve fibre layer haemorrhages had a higher cerebrospinal fluid pressure (40.0 mm water, p=0.04). There was poor correlation between nerve fibre layer haemorrhages at baseline and the perimetric mean deviation change at 6 months. Cotton wool spots were present in 4% of subjects, exudates in 3% and pseudodrusen in 4%.
  
  
  
  Nerve fibre layer haemorrhages are common in patients with IIH with mild visual loss and correlate with the severity of the papilloedema. They occur more frequently in treatment failure subjects and therefore may be associated with poor visual outcomes.
  
  
  
  NCT01003639, Post-results.
authors.affiliation: Departments of Neurology and Ophthalmology, University of Iowa College of Medicine, Iowa City, Iowa, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Wall
authors.affiliation: Department of Ophthalmology, University of Iowa College of Medicine, Iowa City, Iowa, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Thurtell
mesh_terms: D000086:Acetazolamide / Q000627:therapeutic use*; D000328:Adult; D002257:Carbonic Anhydrase Inhibitors / Q000627:therapeutic use; D015170:Cerebrospinal Fluid Pressure; D003131:Combined Modality Therapy; D004039:Diet, Sodium-Restricted; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology*; D010211:Papilledema / Q000503:physiopathology / Q000628:therapy; D010781:Photography; D011559:Pseudotumor Cerebri / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012166:Retinal Hemorrhage / Q000175:diagnosis* / Q000503:physiopathology; D012307:Risk Factors; D040242:Risk Reduction Behavior; D017211:Treatment Failure; D016896:Treatment Outcome; D014786:Vision Disorders / Q000503:physiopathology / Q000628:therapy; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D015431:Weight Loss
chemical_list: D002257:Carbonic Anhydrase Inhibitors; D000086:Acetazolamide
keywords: Clinical Trial; Optic Nerve