Optic canal decompression in severe therapy refractory optic neuritis: a case report

To describe a unique case of successful optic canal decompression in radiologically confirmed severe optic neuritis involving the optic canal.

A 24-year-old woman experienced severe visual loss in the right eye due to retrobulbar optic neuritis (ON), as an initial symptom of multiple sclerosis. High-dose corticosteroids and subsequent plasmapheresis yielded no improvement. Thus, visual prognosis was considered poor. Since MRI demonstrated ON within the optic canal with only minimal contrast enhancement, findings were compatible with a canalicular compartment syndrome. As a result, an unconventional treatment approach with optic canal decompression (OCD) was pursued. Immediately after the intervention, the patient noticed improved color vision and continued visual improvement, with vision almost restored to 20/30 one month after the intervention.

This case report demonstrates that OCD can be performed safely in severe ON and that it might represent a valuable treatment option in selected cases of ON.