Recurrence in Pediatric IIH: An Ophthalmologist Perspective

Sir, Vision loss is a recognized complication in the Pediatric idiopathic intracranial hypertension (PIIH). Vitamin D deficiency (VDD) is a recognized aetiology of PIIH. The usual practice pattern is to evaluate the VDD during initial workup of PIIH. We would like to highlight few points regarding Vitamin D evaluation in PIIH patients who develop recurrence. Guven et al.[1] evaluated the aetiology and outcome of PIIH in 16 patients. Eleven patients had VDD. With appropriate treatment all patients had full recovery. None of the children in this cohort had visual loss or disease recurrence. Disease recurrence is a predictive factor for poor visual outcome in PIIH.[2] Current perspective is, VDD is no more considered as an aetiology of PIIH.[3] Our assumption is vitamin D level has to be evaluated in recurrent PIIH and deterioration of vision. Sleep disturbance and depression are observed in PIIH.[3] Probably these factors might restrict outdoor activities resulting in VDD and PIIH recurrence. Ince[4] evaluated the aetiologias in a cohort of 45 PIIH patients. Sixteen patients had VDD and 15 patients had low vitamin D level. None of the patients in this cohort had permanent visual loss following appropriate treatment. The therapeutic dose of vitamin D for VDD is different from VDD-prevention dose. Probably PIIH patients with low Vitamin D (vitamin D insufficiency) were periodically evaluated for dose modulation resulting in good visual outcome in this cohort.[4] To conclude, vitamin D level has to be evaluated in recurrent PIIH. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.