Optic nerve sheath decompression. Review of 17 cases

Area of Science:

• Ophthalmology
• Neurosurgery

Background:

• Progressive visual loss can be associated with retrobulbar optic nerve and/or sheath enlargement.
• Enlargement of the optic nerve sheath may be caused by the accumulation of compressible fluids.

Purpose of the Study:

• To evaluate the efficacy of surgical optic nerve sheath decompression in patients with progressive visual loss and optic nerve sheath enlargement.
• To assess the safety and potential complications of the medial orbital approach for optic nerve sheath decompression.

Main Methods:

• Seventeen patients (19 eyes) with progressive visual loss and optic nerve sheath enlargement underwent surgical nerve sheath decompression.
• Imaging techniques such as computed tomography, contrast orbitography, or orbital echography were used to determine optic nerve sheath enlargement.
• Follow-up ranged from three months to nine years.

Main Results:

• Visual function improvement was observed in 7 of 19 eyes within one month post-operation.
• The remaining 12 eyes showed no improvement or experienced further visual deterioration.
• Postoperative complications were infrequent, with motility disturbances being the most common.

Conclusions:

• Optic nerve sheath decompression via the medial orbital approach is associated with low operative morbidity.
• This surgical procedure may improve visual function in select patients with progressive visual loss due to retrobulbar optic nerve sheath enlargement.
• The approach may offer future utility for retrieving optic nerve tissue and fluid for analysis.