Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA.
Deparment of Ophthalmology, The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, USA.
Orbit. 2022 Aug;41(4):413-421. doi: 10.1080/01676830.2021.1880444. Epub 2021 Feb 15.
The purpose of this study is to report the safety and outcomes of optic nerve sheath fenestration (ONSF) performed via superomedial eyelid crease approach.
A retrospective chart review was performed on patients undergoing superomedial eyelid crease ONSF at a single institution between 2014-2019. Data obtained included preoperative visual acuity (VA), mean deviation (MD) on visual field (VF), papilledema grade, intraoperative time, estimated blood loss, intraoperative complications and optic nerve sheath biopsy results. Postoperative month 6 (POM6) data collected included VA, MD, papilledema grade, and lid contour. Outcome measures included overall change in VA, MD, and papilledema grade at POM6. Statistical analysis was performed using STATA version 16 statistical software. Data analysis was done comparing all patients pre- and postoperatively. Additional subgroup analysis was performed on patients undergoing ONSF for IIH vs other indications, and on the contralateral unoperated eye.
A total of 31 eyes of 24 patients were identified, four of whom were excluded due to being lost to follow-up. At POM6, improvement was seen in VA (p<0.001) across all groups. There was improvement in POM6 median papilledema grade and MD, but these did not reach statistical significance. Additional subgroup analysis on patients with IIH showed statistically significant improvement in POM 6 VA (p=0.009), papilledema (p=0.009) and MD (p<0.001), as well as VA improvement in the contralateral unoperated eye (p<0.001).
Superomedial eyelid crease approach for ONSF is a safe and effective surgery in IIH and other conditions of excess pressure within the optic nerve sheath.
本研究旨在报告经内上睑皱襞入路行视神经鞘开窗术（ONSF）的安全性和结果。
对 2014 年至 2019 年间在一家单中心行内上睑皱襞入路 ONSF 的患者进行回顾性病历审查。获得的数据包括术前视力（VA）、视野（VF）平均偏差（MD）、视乳头水肿分级、术中时间、估计失血量、术中并发症和视神经鞘活检结果。术后 6 个月（POM6）收集的数据包括 VA、MD、视乳头水肿分级和眼睑轮廓。主要观察指标为 POM6 时 VA、MD 和视乳头水肿分级的总体变化。使用 STATA 版本 16 统计软件进行统计分析。数据分析比较了所有患者术前和术后的数据。对行 ONSF 治疗 IIH 与其他适应证的患者以及对侧未手术眼进行了亚组分析。
共确定了 24 例患者的 31 只眼，其中 4 例因失访而被排除。在 POM6，所有组的 VA 均有改善（p<0.001）。POM6 中位数视乳头水肿分级和 MD 有所改善，但无统计学意义。对 IIH 患者的亚组分析显示，POM6 的 VA（p=0.009）、视乳头水肿（p=0.009）和 MD（p<0.001）以及对侧未手术眼的 VA 改善均有统计学意义。
经内上睑皱襞入路行 ONSF 是治疗 IIH 和其他视神经鞘内压增高疾病的一种安全有效的手术方法。
