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Related Experiment Video

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Superonasal Transconjunctival Optic Nerve Sheath Decompression: A Simplified Technique for Safe and Efficient

Andrew T Melson1, Jacob D Warmath, Annie Moreau

  • 1Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma.

Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society
|March 7, 2020
PubMed
Summary

A modified transconjunctival optic nerve sheath decompression (ONSD) is safe and effective for treating vision loss in idiopathic intracranial hypertension (IIH). This surgical technique improved visual fields and reduced papilledema with minimal complications.

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Area of Science:

  • Ophthalmology
  • Neurosurgery

Background:

  • Idiopathic intracranial hypertension (IIH) can cause severe, permanent vision loss.
  • Optic nerve sheath decompression (ONSD) is an effective treatment for progressive vision loss in IIH patients unresponsive to medical management.

Purpose of the Study:

  • To introduce a modified transconjunctival technique for ONSD.
  • To evaluate the safety, efficacy, and efficiency of this modified ONSD in IIH patients.

Main Methods:

  • Retrospective case series of 66 IIH patients undergoing superonasal transconjunctival ONSD (stOND).
  • Data collected from January 2013 to February 2017.
  • Primary outcomes included visual field mean deviation, papilledema grading (Frisen scale), and visual acuity.

Main Results:

  • No operative complications or postoperative diplopia were reported.
  • Median papilledema grading decreased by 3 points (P < 0.0001).
  • Humphrey Visual Field mean deviation improved significantly (+1.91, P = 0.0052).

Conclusions:

  • The superonasal transconjunctival ONSD (stOND) is a safe, efficient, and effective surgical option for IIH-related vision loss.
  • This technique demonstrates reduced complication rates and significant efficacy.
  • Further research is needed to define optimal timing and indications for stOND in refractory IIH.