Idiopathic Intracranial Hypertension with Secondary Choroidal Neovascular Membrane

A patient with no past ocular history presented to the emergency department complaining of floaters in the left eye for 4 days. Exam was notable for visual acuity of 20/20 in the right eye and 20/25 in the left eye. Intraocular pressures were 22 and 21. Anterior segment exam was unremarkable in both eyes. Posterior segment exam revealed grade 1 optic nerve head edema in the right eye and grade 3 optic nerve head edema in the left eye with peripapillary subretinal hemorrhage and subretinal fluid extending from the optic nerve to the inferior macula. Optical coherence tomography demonstrated a peripapillary CNVM with associated subretinal fluid and hemorrhage. Fluorescein angiography demonstrated peripapillary leakage with surrounding hypofluorescence. Optical coherence tomography angiography of the macula demonstrated choroidal neovascularization between Bruch’s membrane and the retinal pigment epithelial layer. Humphrey visual field demonstrated an enlarged blind spot in the left eye. She received intravitreal bevacizumab in the left eye. Lumbar puncture was performed and cerebrospinal fluid opening pressure was 28. The patient was diagnosed with idiopathic intracranial hypertension and was started on acetazolamide 500 mg twice daily. She received another dose of intravitreal bevacizumab one month after initial diagnosis. At 2 months her optic nerve head edema had resolved in both eyes and her choroidal neovascular membrane had regressed.

Presentation Date: 08/04/2022

Issue Date: 08/19/2022