Macular changes in pseudotumor cerebri before and after optic nerve sheath fenestration

Macular abnormalities such as chorioretinal striae, pigmentary disturbances, exudates, and subretinal hemorrhage or scar can occur in patients with pseudotumor cerebri. The purpose of this study is to determine the potential resolution of the macular abnormalities after optic nerve sheath fenestration, as well as the visual significance of these changes.

The authors retrospectively compared the preoperative and postoperative examinations of seven patients with pseudotumor cerebri-associated macular changes who underwent unilateral optic nerve sheath fenestration.

Preoperatively, visual acuity was worse than 20/25 in two patients with macular exudates and in one with a subretinal scar. Chorioretinal striae and pigment mottling did not appear to decrease visual acuity. With a mean postoperative follow-up of 14 months, the patients with exudates had improvement in visual acuity and clearing of the exudates, unlike the patient with the subretinal scar. Chorioretinal striae, pigment mottling, and the subretinal scar did not resolve with surgery.

This study suggests that chorioretinal striae and pigment mottling in the setting of pseudotumor cerebri, unlike exudates and subretinal scars, do not have a significant effect on visual acuity. After optic nerve sheath fenestration, only macular exudates decreased. Therefore, the persistence of striae, pigment mottling, and macular scars, in the face of resolved papilledema and improved visual fields, does not indicate failure of the optic nerve sheath fenestration.