Obi Ebube E, Lakhani Bansri K, Burns Joyce, Sampath Ragavan
Dept of Ophthalmology, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, United Kingdom.
Dept of Medicine, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, United Kingdom.
Clin Neurol Neurosurg. 2015 Oct;137:94-101. doi: 10.1016/j.clineuro.2015.05.020. Epub 2015 Jun 10.
To determine visual outcomes of patients with Idiopathic intracranial hypertension (IIH), who underwent optic nerve sheath fenestration (ONSF), utilising the two most commonly used tools for monitoring visual function (visual acuity and visual fields) and a third less commonly used tool, colour vision.
A retrospective study of ONSF patients from 2004 to 2011. Patients' symptoms, body mass index, CSF opening pressure, and visual outcomes were analysed.
ONSF's were carried out on 31 eyes of 14 patients. 64% were female and 36% were male. The most predominant symptom was a headache (93%). 71% of patients had a BMI>30. The average CSF opening pressure was 36mmHg (range 22-64). Post ONSF, visual acuity (VA) improved in 24.1%, remained stable in 62.1% and worsened in 13.8% of operated eyes. 6% were lost to follow up. Visual fields (VF) were reliable in 48% of operated eyes. Of these 33.4% improved, 53.3% remained the same and 13.3% worsened. Colour vision (CV) improved or remained stable in 87%, and worsened in 13% of operated eyes. 4 patients had tertiary procedures (LP or VP shunts). ONSF resulted in statistically significant improvement/stabilisation in visual acuity, visual fields and colour vision. Most importantly, this was not dependent on the body mass index.
ONSF is a safe procedure in experienced hands. It predominantly stabilises visual function in majority of maximally medicated patients but also offers improved visual function to some patients. Colour vision monitoring is a useful adjunct in patient with unreliable visual fields. Unfortunately patients whose visual function deteriorated despite maximal medical and surgical treatment were often those who presented late or had a delay in their clinical diagnosis.
利用两种最常用的视觉功能监测工具（视力和视野）以及一种较少使用的工具——色觉，来确定接受视神经鞘开窗术（ONSF）的特发性颅内高压（IIH）患者的视觉预后。
对2004年至2011年接受ONSF的患者进行回顾性研究。分析患者的症状、体重指数、脑脊液开放压和视觉预后。
对14例患者的31只眼睛进行了ONSF。64%为女性，36%为男性。最主要的症状是头痛（93%）。71%的患者体重指数>30。脑脊液平均开放压为36mmHg（范围22 - 64）。ONSF术后，手术眼的视力（VA）改善的占24.1%，保持稳定的占62.1%，恶化的占13.8%。6%失访。48%的手术眼视野（VF）可靠。其中改善的占33.4%，不变的占53.3%，恶化的占13.3%。手术眼的色觉（CV）改善或保持稳定的占87%，恶化的占13%。4例患者接受了三次手术（腰椎穿刺或脑室腹腔分流术）。ONSF在视力、视野和色觉方面导致了具有统计学意义的改善/稳定。最重要的是，这并不取决于体重指数。
在经验丰富的医生手中，ONSF是一种安全的手术。它主要使大多数接受最大剂量药物治疗的患者的视觉功能稳定，但也为一些患者提供了改善的视觉功能。对于视野不可靠的患者，色觉监测是一种有用的辅助手段。不幸的是，尽管接受了最大程度的药物和手术治疗，视觉功能仍恶化的患者往往是那些就诊较晚或临床诊断延迟的患者。
