Título

POLYPOIDAL CHOROIDAL VASCULOPATHY ASSOCIATED WITH IDIOPATHIC INTRACRANIAL HYPERTENSION: A MULTIMODAL ANALYSIS

Objetivo

In this paper we present a multimodal imaging analysis of a peripapillary polypoidal choroidal vasculopathy (PCV) in a patient with idiopathic intracranial hypertension (IIH), a very unusual ocular manifestation of the disease.

Relato do Caso

A 61-year-old female patient was seen as a follow-up examination of a 5-year history of IIH. Past medical history was significant for grade II obesity. Treatment was accomplished with significant weight loss and oral acetazolamide leading to complete resolution of papilledema over the following two years.
On examination, VA was 20/20 in OU, with normal pupillary examination, extraocular movements, intraocular pressure, and anterior segment biomicroscopy. Fundoscopy revealed a pale grayish optic disc with peripapillary atrophy of the retinal pigment epithelium (RPE) in OU and a yellowish white peripapillary subretinal nodular lesion temporally in OD (Fig.1, A-B). Fluorescein angiography showed a peripapillary nodular hyperfluorescence (Fig.1, C-D) and indocyanine green angiography (ICGA) disclosed polypoidal lesions in OD (Fig.1, E-F). OCT scan demonstrated a dome shaped RPE detachment (PED) with moderate internal reflectivity (Fig.1 G,) and OCT-A showed RPE elevation OD (Fig.1 H). Visual field examination revealed an enlarged blind spot in OU. Imaging studies were unremarkable in the OS and CSF opening pressure was 18 cmH2O.
Neurologic examination and extensive laboratory investigation were normal. A diagnosis of a peripapillary PCV associated with IIH was made. A closer follow up was adopted without further treatment since no signs of active PCV or IIH were detected

Conclusão

Papilledema, retinal nerve fiber layer and retinal ganglion cell loss are the most common structural complications of IIH, but chorioretinal complications are important findings and should be carefully evaluated in such patients. Awareness of such occurrence and the use of appropriated clinical and multimodal imaging studies are of great importance for its early detection, leading to proper treatment and prevention of further visual loss.