Sclerectomy Reverses Nanophthalmic Optic Neuropathy.

Area of Science:

• Ophthalmology
• Surgical Innovation

Background:

• Nanophthalmos, a rare condition, presents challenges in diagnosing and treating unilateral disc swelling due to short axial length and thickened sclera.
• Optic nerve head edema in nanophthalmos can lead to significant vision loss and requires innovative therapeutic approaches.

Observation:

• A 59-year-old male experienced sudden vision reduction in one eye, diagnosed as nanophthalmos with optic disc swelling.
• Optical coherence tomography revealed a crowded optic nerve head and significant choroidal thickening.
• Standard neuro-ophthalmology workups were inconclusive, and no treatment was initially suggested.

Findings:

• A novel surgical approach involving circumferential and radial posterior sclerotomy was performed to decompress choroidal pressure.
• Post-operatively, the patient experienced rapid vision recovery and sustained improvement over six months.
• Optical coherence tomography confirmed normalization of the optic nerve head contour and nerve fiber layer thickness.

Implications:

• Sclerectomy demonstrates efficacy in treating compressive optic neuropathy associated with nanophthalmos.
• This surgical technique may offer a potential treatment for other optic neuropathies linked to peripapillary pachychoroid conditions.
• Further research into sclerectomy's role in managing various optic neuropathies is warranted.