University of California, Davis, Eye Center, Sacramento, California 95817, USA.
J Neuroophthalmol. 2011 Dec;31(4):310-5. doi: 10.1097/WNO.0b013e3182269910.
Idiopathic intracranial hypertension (IIH) is a rare condition that can lead to significant morbidity from visual loss. The cause of IIH is unknown, but IIH is known to be associated with obesity. Obese patients may be at particularly high risk for suffering vision loss from IIH. The purpose of the present study is to determine the prevalence of undiagnosed or asymptomatic papilledema in a population of morbidly obese individuals and to determine if these patients should undergo routine screening for papilledema.
Patients presenting to the UC Davis Bariatric Surgery Clinic between February 2008 and January 2011 who met the National Institutes of Health criteria for bariatric surgery were invited to participate in the study. Those patients who met the inclusion criteria and consented to the study were included. Participants were screened for IIH by nonmydriatic fundus photographs and by concerning symptoms prompting direct referral for neuro-ophthalmologic evaluation. Images were reviewed by a neuro-ophthalmologist, and patients with suspicious optic discs underwent neuro-ophthalmologic evaluation. Patients with findings consistent with IIH were sent for neurological evaluation.
A total of 606 patients with an average body mass index of 47 kg/m2 were included in the study. Seventeen of these patients had photographic optic disc findings or symptoms suspicious for IIH. Seven of these patients did not have disc edema on clinical examination. Six patients were not evaluated in the clinic. Four of the 17 patients had subtle optic disc edema confirmed by clinical evaluation and were referred for full neurological workup. These 4 patients had normal neuroimaging, 3 of whom underwent lumbar punctures with borderline high opening pressures. All 4 patients had unremarkable visual field examinations. Fundus abnormalities other than optic disc edema were discovered in 33 patients.
Our study suggests that in a morbidly obese patient population, papilledema with significant visual loss is rare. Routine screening with fundus photography of morbidly obese patients likely is not warranted.
特发性颅内高压（IIH）是一种罕见的疾病，可导致视力丧失而产生重大的发病率。IIH 的病因尚不清楚，但已知 IIH 与肥胖有关。肥胖患者可能特别容易因 IIH 而遭受视力丧失。本研究的目的是确定肥胖人群中未确诊或无症状性视乳头水肿的患病率，并确定这些患者是否应进行常规的视乳头水肿筛查。
邀请 2008 年 2 月至 2011 年 1 月期间在加利福尼亚大学戴维斯分校减重手术诊所就诊的符合国立卫生研究院减重手术标准的患者参加本研究。符合纳入标准并同意参加本研究的患者被纳入研究。通过非散瞳眼底照片和提示直接转诊进行神经眼科评估的相关症状筛查 IIH。由神经眼科医生对图像进行审查，对可疑视盘的患者进行神经眼科评估。对符合 IIH 发现的患者进行神经科评估。
共有 606 名平均体重指数为 47 kg/m2 的患者纳入本研究。其中 17 名患者的眼底照片显示视神经盘有病变或存在疑似 IIH 的症状。在临床检查中，这 7 名患者均未发现视盘水肿。6 名患者未在诊所进行评估。17 名患者中的 4 名患者经临床评估证实存在轻微视神经盘水肿，因此被转介进行全面的神经科评估。这 4 名患者的神经影像学检查正常，其中 3 名进行了腰椎穿刺，发现压力略高。这 4 名患者的视野检查均无异常。33 名患者除视神经盘水肿外还发现了其他眼底异常。
我们的研究表明，在肥胖患者人群中，伴有严重视力丧失的视乳头水肿较为罕见。对肥胖患者进行眼底摄影常规筛查可能没有必要。
