Orbit (Amsterdam, Netherlands) · 2026
Safety and efficacy of bilateral same-day optic nerve sheath fenestration.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Shah Ayushi S, Hughes Kendall L, Adesina Ore-Ofe O, Nguyen John, Spadaro Jane, Kahana Alon, Tooley Andrea A
Аннотация
PURPOSE: To evaluate the safety and efficacy of bilateral same-day optic nerve sheath fenestration (ONSF) in patients with vision-threatening papilledema.
METHODS: This multi-institutional study included 119 patients with bilateral papilledema who underwent same-day bilateral ONSF. Clinical data collected included: visual acuity (VA), visual field mean deviation (MD) and index (VFI), retinal nerve fiber layer (RNFL) thickness, and intraocular pressure (IOP). Pre- and postoperative outcomes and complications were evaluated with a Generalized Estimating Equation (GEE) using Statistical Analysis System (SAS) for analysis.
RESULTS: This cohort included 119 patients (87% female, mean age 43 years), with idiopathic intracranial hypertension (75%) as the most common cause of papilledema. The median follow-up was 12.5 months. Approximately 20% (40/198) of eyes had improvements in visual acuity >2 Snellen lines, 58% (114/198) had no change in vision, and 22% (44/198) had a decrease in vision >2 lines following ONSF. Visual field MD improved from -17.2 dB to -14.3 dB (p = 0.09). RNFL thickness decreased from 224.7 µm to 146.9 µm (p < 0.001). Two planned bilateral procedures were aborted intraoperatively due to safety concerns; no intraoperative complications occurred among completed bilateral procedures. Additional cerebrospinal fluid diversion procedures were required in 7% of patients.
CONCLUSIONS: Same-day bilateral ONSF is a safe and effective option for patients with bilateral vision-threatening papilledema, demonstrating improvement in RNFL thickness while minimizing surgical risk and treatment delays.
METHODS: This multi-institutional study included 119 patients with bilateral papilledema who underwent same-day bilateral ONSF. Clinical data collected included: visual acuity (VA), visual field mean deviation (MD) and index (VFI), retinal nerve fiber layer (RNFL) thickness, and intraocular pressure (IOP). Pre- and postoperative outcomes and complications were evaluated with a Generalized Estimating Equation (GEE) using Statistical Analysis System (SAS) for analysis.
RESULTS: This cohort included 119 patients (87% female, mean age 43 years), with idiopathic intracranial hypertension (75%) as the most common cause of papilledema. The median follow-up was 12.5 months. Approximately 20% (40/198) of eyes had improvements in visual acuity >2 Snellen lines, 58% (114/198) had no change in vision, and 22% (44/198) had a decrease in vision >2 lines following ONSF. Visual field MD improved from -17.2 dB to -14.3 dB (p = 0.09). RNFL thickness decreased from 224.7 µm to 146.9 µm (p < 0.001). Two planned bilateral procedures were aborted intraoperatively due to safety concerns; no intraoperative complications occurred among completed bilateral procedures. Additional cerebrospinal fluid diversion procedures were required in 7% of patients.
CONCLUSIONS: Same-day bilateral ONSF is a safe and effective option for patients with bilateral vision-threatening papilledema, demonstrating improvement in RNFL thickness while minimizing surgical risk and treatment delays.
Предметные рубрики MeSH
HumansFemalePapilledemaVisual AcuityAdultOptic NerveVisual FieldsMaleMiddle AgedTreatment OutcomeIntraocular PressureRetrospective StudiesOphthalmologic Surgical ProceduresYoung AdultAgedDecompression, SurgicalAdolescentNerve FibersTomography, Optical CoherenceRetinal Ganglion CellsPseudotumor CerebriPostoperative Complications