Optic Nerve Sheath Decompression

Moreau, Annie; Lao, Kenneth C.; Farris, Bradley K.

doi:10.1097/wno.0000000000000065

Cited by 45 publications

(13 citation statements)

References 16 publications

(28 reference statements)

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“…Surgical treatment of visual field defects due to optic disc drusen with optic nerve sheath fenestration or radial optic neurotomy is controversial and not considered standard of care, but success has been reported by a few authors. 85; 86; 129; 146 …”

Section: Treatmentmentioning

confidence: 99%

Optic disk drusen in children

Chang

Pineles

2016

Survey of Ophthalmology

111

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Optic disc drusen occur in 0.4% of children and consist of acellular intracellular and extracellular deposits that often become calcified over time. They are typically buried early in life and generally become superficial, and therefore visible, later in childhood, at the average age of 12 years. Their main clinical significance lies in the ability of optic disc drusen, particularly when buried, to simulate true optic disc edema. Misdiagnosing drusen as true disc edema may lead to an invasive and unnecessary workup for elevated intracranial pressure. Ancillary testing, including ultrasonography, fluorescein angiography, fundus autofluorescence, and optical coherence tomography, may aid in the correct diagnosis of optic disc drusen. Complications of optic disc drusen in children include visual field defects, hemorrhages, choroidal neovascular membrane, non-arteritic anterior ischemic optic neuropathy, and retinal vascular occlusions. Treatment options for these complications include ocular hypotensive agents for visual field defects and intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents for choroidal neovascular membranes. In most cases, however, children with optic disc drusen can be managed by observation with serial examinations and visual field testing, once true optic disc edema has been excluded.

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Section: Treatmentmentioning

confidence: 99%

Optic disk drusen in children

Chang

Pineles

2016

Survey of Ophthalmology

111

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“…Major complications were rarely reported, including central retinal artery occlusion, acute angle-closure glaucoma, iatrogenic traumatic optic neuropathy, and infectious optic neuropathy. 99 – 102 In the early postoperative period, fluid collection adjacent to the dural window site occurs in majority of the patients, but this disappears in the late period. 96 , 103 Protracted postsurgical blindness can occur after ONSF, and patients subsequently recover in some cases.…”

Section: Current Managementmentioning

confidence: 99%

Idiopathic intracranial hypertension: ongoing clinical challenges and future prospects

Julayanont¹,

Ruthirago²,

Panikkath³

et al. 2016

JPR

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Idiopathic intracranial hypertension (IIH) is an uncommon disorder characterized by increased intracranial pressure without radiological or laboratory evidence of intracranial pathology except empty sella turcica, optic nerve sheath with filled out cerebrospinal fluid spaces, and smooth-walled nonflow-related venous sinus stenosis or collapse. This condition typically affects obese women. The incidence of IIH is increasing with the rising prevalence of obesity. Persistent headache is the most common symptom. Visual impairment is a serious complication that may not be recognized by the patients. This paper reviews clinical manifestations, diagnostic challenges, and current treatments of IIH in adults. Various imaging modalities have been studied on their validity for detection of IIH and papilledema. This review also includes new studies on medical, surgical, and interventional management of this condition. Acetazolamide and topiramate are the only two medications that have been studied in randomized controlled trials about their efficacy in treatment of IIH. In patients who have severe visual impairment or progressive visual deterioration despite medical management, surgical or interventional treatment may be considered. The efficacy and complications of cerebrospinal fluid diversion, optic nerve sheath fenestration, and endovascular venous stenting reported in the last 3 decades have been summarized in this review. Finally, the prospective aspects of biomarkers and treatments are proposed for future research.

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“…Complications like retrobulbar hemorrhage and sixth nerve palsy have been reported in the literature 24. Other less frequently observed complications were transient blindness, choroidal infarction, diplopia and orbital infections 12,25. Shorter follow up time and no comparison of VF defects between pre and post-operative eyes are few limitations of the study.…”

Section: Discussionmentioning

confidence: 94%

“…Since raised ICP has multiple etiologies, the ONSF has been also been used less frequently for management of other conditions adversely affecting the vision. It has been used in treatment of progressive non-arteritic ischemic optic neuropathy, and optic disc drusen 12. It has also been used in case of cryptococcal meningitis secondary to acquired immunodeficiency syndrome successfully 13.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Optic Nerve Sheath Fenestration in Patients with Raised Intracranial Pressure

Yaqub

Mehboob²,

Islam³

2017

Pak J Med Sci

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Objective:To evaluate the efficacy and safety of Optic Nerve Sheath Fenestration (ONSF) in patients with raised intracranial pressure (ICP).Methods:This Quasi Experimental Study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi from July 2013 to July 2015. Thirty one eyes of 18 patients who underwent ONSF for raised ICP were followed up for one year to ascertain efficacy and safety of ONSF procedure.Results:Thirteen (72.22%) patients underwent ONSF bilaterally, while five (27.78%) underwent unilateral ONSF. Best corrected visual acuity (BCVA) improved in 24 (77.4%), remained stable in four (12.9%) and deteriorated in three (9.7%) patients. Papilledema improved in 27 (87.1%) while remained stable in four (12.9%) according to Frisénscale of Papilledema. Change in BCVA and papilledema from pre-operative values was statistically significant (p<0.001). There was significant negative correlation (r= -0.434, p=.017) between duration of symptoms before presentation and improvement in BCVA. Common complications were a tonic pupil, subconjunctival haemorrhage, chemosis, weakness of recti and diplopia.Conclusion:ONSF is an effective procedure with statistically significant improvement in BCVA and reduction in severity of papilledema.

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Optic Nerve Sheath Decompression

Cited by 45 publications

References 16 publications

Optic disk drusen in children

Optic disk drusen in children

Idiopathic intracranial hypertension: ongoing clinical challenges and future prospects

Efficacy and Safety of Optic Nerve Sheath Fenestration in Patients with Raised Intracranial Pressure

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