Management of visual loss after optic nerve sheath decompression in patients with pseudotumor cerebri.
OBJECTIVE
To determine the appropriate management of patients with pseudotumor cerebri with early, progressive visual loss after optic nerve sheath decompression (ONSD).


METHODS
The records of all patients with pseudotumor cerebri who underwent ONSD were reviewed retrospectively. Patients who showed visual loss within 1 month of surgery were studied.


RESULTS
Five patients with pseudotumor cerebri, including two with renal failure and hypertension, had visual loss within 1 month of ONSD. The first patient had an abrupt decrease in vision 6 days after ONSD. In this patient, a vessel on the nerve sheath bled into the surgical site. At the time of ONSD, this patient had a visual acuity of 20/20 1 day after surgery. Six days later, visual acuity decreased to 20/200. After high-dose intravenous corticosteroids failed to improve vision, emergency lumboperitoneal shunt resulted in full visual recovery. An apparent infectious optic neuropathy developed in the second patient 3 days after surgery. After 72 hours of intravenous antibiotics, visual acuity improved from 20/600 to 20/15. The other three patients had gradual visual loss after ONSD, which stabilized after lumboperitoneal shunts.


CONCLUSIONS
Avoidance of bleeding during ONSD may prevent fibrous occlusion of the surgical site. Patients with no identifiable cause for visual loss after ONSD, who do not respond to intravenous corticosteroids, should be evaluated for emergency lumboperitoneal shunting. Postoperative infectious optic neuropathy should be considered in the differential diagnosis of abrupt visual loss after ONSD.
Mauriello
J A
JA
Department of Ophthalmology, UMD--New Jersey Medical School, Newark 07103-2499.
Shaderowfsky
P
P
Gizzi
M
M
Frohman
L
L
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D009186:Myelin Sheath; D009900:Optic Nerve / Q000601:surgery*; D011183:Postoperative Complications; D011559:Pseudotumor Cerebri / Q000601:surgery*; D012189:Retrospective Studies; D017287:Ventriculoperitoneal Shunt; D014786:Vision Disorders / Q000209:etiology / Q000628:therapy*; D014792:Visual Acuity; D014794:Visual Fields
D000900:Anti-Bacterial Agents