title: Visual outcomes following optic nerve sheath fenestration via the medial transconjunctival approach.
abstract: This article determines the safety of optic nerve sheath fenestration (ONSF) for the treatment of patients with intracranial hypertension in the immediate 6-month post-operative period and its efficacy in reducing optic disk edema. Retrospective, non-comparative interventional case series. 207 eyes in 104 patients undergoing ONSF between the years 2005 and 2014. Papilledema grade based on modified Frisen scale and mean deviation of Humphrey visual field. 207 eyes of 104 patients (102 IIH, 2 IH due to dural sinus thrombosis) were included in the study. The patients were 96.1% female (N = 100) and 3.9% male (N = 4). The average patient age was 28.8 years (SD ± 9.5 years) and had a mean opening pressure of 39.85 cmH2O (SD ± 8.4 cmH2O). Mean follow-up period was 6.0 months (SD ± 5.9 months). Papilledema resolved in 76.1% of eyes at 1 week (N = 102 eyes), 75% of eyes at 1 month (N = 90 eyes), and 71% of eyes at 6 months (N = 94 eyes). Visual field comparison had a mean of the paired differences in MD at 1 week, 1 month, and 6 months of 1.59dB (P = 0.006), 2.53dB (P < 0.001), and 1.30dB (P = 0.016), respectively. ONSF is effective in reducing optic disk edema and does not cause vision loss in the 6-month post-operative period regardless of severity of IIH (as judged by elevation of opening pressure measured at pre-operative assessment).
authors.affiliation: a The Ohio State University College of Medicine , Columbus , Ohio , USA.|b Department of Ophthalmology , Wexner Medical Center, The Ohio State University , Columbus , Ohio , USA.
authors.forename: Neel S
authors.initials: NS
authors.lastname: Vaidya
authors.affiliation: b Department of Ophthalmology , Wexner Medical Center, The Ohio State University , Columbus , Ohio , USA.|c Department of Biomedical Engineering , The Ohio State University, Wexner Medical Center , Columbus , Ohio , USA.
authors.forename: Ashraf M
authors.initials: AM
authors.lastname: Mahmoud
authors.affiliation: b Department of Ophthalmology , Wexner Medical Center, The Ohio State University , Columbus , Ohio , USA.
authors.forename: Dominic
authors.initials: D
authors.lastname: Buzzacco
authors.affiliation: b Department of Ophthalmology , Wexner Medical Center, The Ohio State University , Columbus , Ohio , USA.|c Department of Biomedical Engineering , The Ohio State University, Wexner Medical Center , Columbus , Ohio , USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Katz
mesh_terms: D000328:Adult; D003228:Conjunctiva / Q000601:surgery; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D013508:Ophthalmologic Surgical Procedures; D009900:Optic Nerve; D010211:Papilledema / Q000503:physiopathology / Q000601:surgery*; D011559:Pseudotumor Cerebri / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology*; D014794:Visual Fields / Q000502:physiology*; D055815:Young Adult
keywords: Visual fields; idiopathic intracranial hypertension; optic nerve sheath fenestration; pseudotumor cerebrii