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Presentation type	E-poster
Title	Visual Threatening Papilledema Resistant to Endoscopic Third Ventriculostomy

Purpose	This abstract presents a case study of a patient with visual-threatening papilledema that remained refractory to endoscopic third ventriculostomy (ETV). Papilledema, resulting from increased intracranial pressure, is a serious condition that can lead to irreversible vision loss and therefore, needs prompt intervention.
Methods	We report the case of a 21-years old woman, with a history of headache and emesis for the previous 5 weeks. Clinical examination showed marked papilledema and further investigation unveiled a tri-ventricular hydrocephaly, for which ETV was performed to ease intracranial pressure. However, despite a technically successful procedure and reduction in intracranial pressure, the patient's papilledema persisted, with progressive visual deterioration.
Results	MRI imaging confirmed a patent ventriculostomy, adequate cerebrospinal fluid diversion and intracranial pressure reduction. However, the patient's visual acuity and color vision worsened rapidly. Optic nerve swelling persisted and even worsened to bilateral grade V papilledema, which urged us to escalate with the dose of medication and demand for urgent ventriculoperitoneal (VP) shunt surgery. Visual acuity and color vision improved rapidly following the VP shunt.
Conclusion	This case highlights the challenging scenario of visual-threatening papilledema that remains unresponsive to ETV, a generally effective treatment for elevated intracranial pressure. It underscores the importance of a multidisciplinary approach and the role of ophthalmologists to explore alternative management strategies for such cases, ensuring timely intervention to prevent irreversible visual impairment. Further research is needed to better understand the underlying mechanisms and alternative treatment options for cases of intractable papilledema.
Conflict of interest	No

Authors 1

Last name	SADEGHI
Initials	N