THE CONTRIBUTION OF MACULAR CHANGES TO VISUAL-LOSS IN BENIGN INTRACRANIAL HYPERTENSION

Purpose To describe the significance of macular changes to visual outc ome in benign intracranial hypertension (BIH). Method The clinical and photographic records of 24 patients with Bill who required optic nerv e sheath fenestration were analysed. Results Macular changes were foun d in 21 of 48 (44%) eyes. These were: choroidal folds 9; circumferenti al lines (Paton's lines) 4; nerve fibre layer haemorrhage 3; macular s tars 5; macular oedema 6; retinal pigment epithelial changes 4;subreti nal haemorrhage leading to a macular scar 1. Significant visual loss a ttributable to the macular changes was found in 5 eyes in the short te rm and 3 in the long term. The 2 eyes that improved had macular stars, Of the 3 eyes that did not improve, 2 eyes had retinal pigment epithe lial changes and 1 a large subretinal haemorrhage that led to a macula r scar. These 3 cases had long-standing BIH. Conclusions The majority of macular changes resolve and do not add to visual loss from optic ne rve damage. Patients with marked macular oedema are at most risk of pe rmanent visual loss and should be considered for early treatment such as optic nerve sheath fenestration.