Optic nerve sheath decompression: a surgical technique with minimal operative complications

Area of Science:

• Ophthalmology
• Neurosurgery
• Neuro-ophthalmology

Background:

• Optic nerve sheath decompression (ONSD) is a surgical procedure aimed at relieving pressure on the optic nerve.
• Previous studies have reported on the safety and efficacy of ONSD, but larger patient populations are needed for comprehensive analysis.
• Various conditions can lead to progressive vision loss, necessitating effective treatment options.

Purpose of the Study:

• To evaluate the safety and efficacy of optic nerve sheath decompression (ONSD) using a medial transconjunctival approach.
• To assess ONSD outcomes in a large patient cohort across diverse indications for progressive vision loss.
• To analyze visual acuity, visual fields, and surgical complications following ONSD.

Main Methods:

• Retrospective chart review of 331 patients (578 eyes) who underwent ONSD between January 1992 and December 2010.
• Inclusion criteria: documented progressive loss of visual acuity or visual field.
• Follow-up included assessments at 1 week, 1 month, and every 3-6 months; outcomes measured were visual acuity, visual fields, and complications.

Main Results:

• Visual acuity remained stable or improved in 94.4% of eyes (536/568) and worsened in 5.6% (32/568).
• Visual fields remained stable or improved in 95.9% of eyes (257/268) with progressive loss in 4.1% (11/268).
• No intraoperative complications were reported; the most common postoperative complication was diplopia (6.0%).

Conclusions:

• This study represents the largest series of ONSD patients to date, confirming its safety and efficacy.
• ONSD is effective for idiopathic intracranial hypertension (IIH); further research is warranted for indications like optic nerve drusen (OND).
• Complications associated with this ONSD technique are infrequent across various indications.