Anzeljc Andrew J, Frias Patrick, Hayek Brent R, Canter Weiner Nancy, Wojno Ted H, Kim H Joon
a Department of Ophthalmology , Emory University School of Medicine , Atlanta , GA , USA.
b Piedmont Healthcare , Atlanta , GA , USA.
Orbit. 2018 Aug;37(4):266-272. doi: 10.1080/01676830.2017.1423337. Epub 2018 Jan 9.
Optic nerve sheath fenestration (ONSF) is a common surgical option for patients with idiopathic intracranial hypertension (IIH) with vision loss refractory to medical management. Little is known about the visual benefit of repeated ONSF. The authors aimed to assess the efficacy of secondary and tertiary ONSF in patients with IIH.
A retrospective chart review was performed on all patients with repeat ONSF for IIH at Emory University from 1999 to 2016. Primary outcome measures included visual acuity, optic nerve head findings, and visual field results.
A total of nine eyes in seven patients (five females and two males) with repeat ONSF were identified. Two of the seven patients had repeat ONSF in both eyes, while the remaining five patients had only one eye repeated. Five of seven patients (five eyes) improved or remained stable after the secondary ONSF. Two patients (three eyes) continued to worsen despite the secondary fenestration surgery and underwent tertiary ONSF at an average of 13.2 months (SD 5.5 months) after the failed secondary ONSF. Both patients that underwent the tertiary fenestration showed improvement. Six of the patients had either improvement or stability in their clinical findings at their last documented follow-up, but one continued to worsen despite intervention.
This study suggests that secondary and tertiary nerve sheath fenestration is a viable management option for patients with progressive vision loss from IIH. Repeat ONSFs do not appear to have increased complication or failure rates compared to prior documented studies regarding primary fenestrations.
视神经鞘开窗术（ONSF）是特发性颅内高压（IIH）且视力丧失对药物治疗无效的患者常用的手术选择。关于重复进行视神经鞘开窗术对视功能的益处知之甚少。作者旨在评估IIH患者二次和三次视神经鞘开窗术的疗效。
对1999年至2016年在埃默里大学接受重复视神经鞘开窗术治疗IIH的所有患者进行回顾性病历审查。主要观察指标包括视力、视神经乳头表现和视野结果。
共确定了7例患者（5例女性和2例男性）的9只眼睛接受了重复视神经鞘开窗术。7例患者中有2例双眼接受了重复视神经鞘开窗术，其余5例患者仅一只眼睛接受了重复手术。7例患者中有5例（5只眼睛）在二次视神经鞘开窗术后视力改善或保持稳定。2例患者（3只眼睛）尽管进行了二次开窗手术仍继续恶化，在二次视神经鞘开窗术失败后平均13.2个月（标准差5.5个月）接受了三次视神经鞘开窗术。接受三次开窗术的2例患者均有改善。6例患者在最后一次记录的随访中临床症状改善或稳定，但1例患者尽管接受了干预仍继续恶化。
本研究表明，二次和三次视神经鞘开窗术是IIH导致进行性视力丧失患者可行的治疗选择。与先前关于初次开窗术的文献研究相比，重复视神经鞘开窗术似乎并未增加并发症或失败率。
