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Progressive and static nonarteritic ischemic optic neuropathy treated by optic nerve sheath decompression
T C Spoor1, J G McHenry, L Lau-Sickon
1Wayne State University, School of Medicine, Detroit, Michigan.
Ophthalmology
|March 1, 1993
Summary
Optic nerve sheath decompression improved visual acuity in progressive nonarteritic ischemic optic neuropathy (NAION) but not visual fields. Surgery did not benefit static NAION patients. Echography can identify candidates for NAION treatment.
Area of Science:
- Ophthalmology
- Neuroscience
- Surgical Innovation
Background:
- Nonarteritic ischemic optic neuropathy (NAION) is a leading cause of vision loss.
- Optic nerve sheath fenestration is a proposed treatment for NAION.
- The efficacy of optic nerve sheath decompression in NAION remains debated, particularly for progressive vs. static cases.
Purpose of the Study:
- To evaluate the effectiveness of optic nerve sheath decompression for progressive NAION.
- To assess the benefit of optic nerve sheath decompression for static NAION.
- To identify objective measures for predicting treatment response in NAION.
Main Methods:
- Retrospective review of 38 patients with NAION (23 progressive, 15 static) who underwent optic nerve sheath decompression.
- Assessment of visual acuity and visual field mean deviation pre- and post-surgery.
- Standardized echography to measure optic nerve sheath diameter and compressibility.
Main Results:
- Progressive NAION patients showed significant visual acuity improvement (P=0.0005) but not visual field improvement (P=0.11).
- Static NAION patients had no significant improvement in visual acuity (P=0.90) or visual fields (P=0.87).
- Echography revealed significant compressibility differences between progressive and static NAION (P=0.001), with fluid accumulation noted in some progressive cases.
Conclusions:
- Optic nerve sheath decompression enhances visual acuity in progressive NAION but offers limited benefit for overall visual function.
- Optic nerve sheath decompression is ineffective for static NAION.
- Standardized echography detecting intrasheath fluid can objectively differentiate NAION patients who may benefit from optic nerve sheath decompression.