Unilateral Optic Nerve Sheath Fenestration in Idiopathic Intracranial Hypertension: A 6-Month Follow-Up Study on Visual Outcome and Prognostic Markers

Life

Rigmor Højland Jensen¹  Kåre Fugleholm²  Steffen Hamann³  Marianne Wegener³  Peter Bjerre Toft³  Snorre Malm Hagen³ 

[1] Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, 2600 Glostrup, Denmark;Department of Neurosurgery, Rigshospitalet, University of Copenhagen, 2100 Copenhagen Ø, Denmark;Department of Ophthalmology, Rigshospitalet, University of Copenhagen, 2600 Glostrup, Denmark;

关键词: optic nerve sheath fenestration;    idiopathic intracranial hypertension;    papilledema;    optic nerve head;    automated perimetry;    optical coherence tomography;   

DOI  :  10.3390/life11080778

来源: DOAJ

【 摘 要 】

Loss of vision is a feared consequence of idiopathic intracranial hypertension (IIH). Optic nerve sheath fenestration (ONSF) may be an effective surgical approach to protect visual function in medically refractory IIH. In this study, we evaluate the impact of unilateral superomedial transconjunctival ONSF on bilateral visual outcome using a comprehensive follow-up program. A retrospective chart review of IIH patients who underwent unilateral ONSF between January 2016 and March 2021 was conducted. Patients fulfilling the revised Friedman criteria for IIH and who had exclusively received ONSF as a surgical treatment were included. Main outcomes were visual acuity (VA); perimetric mean deviation (PMD); papilledema grade; and optic nerve head elevation (maxONHE) 1 week, 2 weeks, and 1, 3, and 6 months after surgery. VA (p < 0.05), PMD (p < 0.05), papilledema grade (p < 0.01), and maxOHNE (p < 0.001) were improved after 6 months on both the operated and non-operated eye. Prolonged surgical delay impedes PMD improvement (r = −0.78, p < 0.01), and an increasing opening pressure initiates a greater ganglion cell loss (r = −0.79, p < 0.01). In this small case series, we demonstrate that unilateral superonasal transconjunctival ONSF is a safe procedure with an effect on both eyes. Optic nerve head elevation and PMD are feasible biomarkers for assessing early treatment efficacy after ONSF.

【 授权许可】

Unknown