Visual outcomes for optic nerve sheath fenestration in pseudotumour cerebri and related conditions.
BACKGROUND
To determine the efficacy and safety of optic nerve sheath fenestration, and to identify factors predicting visual field (VF) and visual acuity (VA) in patients with progressive pseudotumour cerebri syndrome.


METHODS
This retrospective observational case series studied 51 eyes of 32 patients with pseudotumour cerebri syndrome, by chart review and comparison of preoperative and postoperative examinations. Main outcome measures included VF, VA and complications.


RESULTS
Postoperative VF mean deviation scores improved (P = 0.03) within 6 months when compared with preoperative VF. Multiple regression analysis demonstrated that eyes with mean deviation > or = -20 dB were associated with improved or stabilized VA at 6 months, odds ratio 7.5 and confidence interval (1.2, 46.1), P = 0.03. Eyes with VF defects outside 10 degrees of fixation were associated with improved or stabilized VF at 6 months odds ratio 9.7, 95% confidence interval 1.1, 85.9, P = 0.04. Five patients developed self-limiting complications from surgery.


CONCLUSIONS
Optic nerve sheath fenestration is safe and effective in stabilizing or improving VF and VA in the short to medium term. Patients with mild VF loss improved following surgery, and patients with severe VF loss stabilized following surgery.
Chandrasekaran
Sujatha
S
Department of Ophthalmology, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia.
McCluskey
Peter
P
Minassian
Darwin
D
Assaad
Nazih
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D009900:Optic Nerve / Q000601:surgery*; D010211:Papilledema / Q000503:physiopathology / Q000601:surgery*; D011559:Pseudotumor Cerebri / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013577:Syndrome; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*; D014794:Visual Fields / Q000502:physiology