Management of IIH Patients Who Present With Grade V Papilledema

Frisén grade III-V papilledema predicts worse visual outcomes in patients with idiopathic intracranial hypertension (IIH). High-grade papilledema is associated with subretinal fluid, chorioretinal folds, and reduced acuity, but good prognosis. Surgical therapy is recommended for fulminant IIH (significant visual field constriction or acuity reduction within 4 weeks of symptom onset), but this recommendation is sometimes applied loosely to severe papilledema. We studied a retrospective series of IIH patients who presented with grade V papilledema and compared medical and surgical management.