Landau Prat Daphna, Liu Grant T, Avery Robert A, Ying Gui-Shuang, Chen Yineng, Tomlinson Lauren A, Revere Karen E, Katowitz James A, Katowitz William R
Division of Ophthalmology, Children's Hospital of Philadelphia (D.L.P., G.T.L., R.A.A., L.A.T., K.A.R., J.A.K., W.R.K.), Philadelphia, Pennsylvania; Goldschleger Eye Institute, Division of Ophthalmology (D.L.P.), Talpiot Medical Leadership Program (D.L.P.), Sheba Medical Center, Israel; Sackler Faculty of Medicine (D.L.P.), Tel Aviv University, Tel Aviv, Israel.
Division of Ophthalmology, Children's Hospital of Philadelphia (D.L.P., G.T.L., R.A.A., L.A.T., K.A.R., J.A.K., W.R.K.), Philadelphia, Pennsylvania.
Am J Ophthalmol. 2022 May;237:173-182. doi: 10.1016/j.ajo.2021.11.019. Epub 2021 Nov 27.
To evaluate the effect of optic nerve sheath fenestration (ONSF) on the recovery of visual function in pediatric patients with optic disc swelling owing to increased intracranial pressure.
Retrospective case series.
Medical chart review of all pediatric patients who underwent ONSF between 2009 and 2020 at the Children's Hospital of Philadelphia. Visual function was assessed at pre and postoperative visits. The main outcome measures were visual acuity, color vision, extraocular motility, visual field mean deviation, retinal nerve fiber layer thickness measured by optical coherence tomography.
Fourteen pediatric patients (10 females; mean ± SD age of 14 ± 2.6 years; range, 8.5-17.5 years) were included. Five patients underwent bilateral surgeries. Ten patients were diagnosed with idiopathic intracranial hypertension. Of the 10 idiopathic intracranial hypertension patients, 3 had a previous history of weight gain and 2 of systemic steroid treatment; these can be referred to as pseudotumor cerebri. The mean ± SD follow-up length was 16.4 ± 12.3 months. VA improved from 20/138 to 20/68 in the operated eye (P = .0003) and from 20/78 to 20/32 in the nonoperated eye (P = .02). Color vision improved in the operated eye (P = .04), extraocular motility improved in the operated and nonoperated eye (P = .002 and P = .04 respectively). Visual field mean deviation improved in the operated (-23.4 dB to -11.5 dB, P < .0001) and nonoperated eye (-19.8 dB to -6.8 dB, P = .02). Retinal nerve fiber layer thickness improved in the operated eye (349.1 to 66.2 µm; P < .0001). The postoperative improvement was observed as early as the postoperative day 1.
ONSF produces a rapid and persistent vision improvement in both the operated eye and the nonoperated eye. In children and young adults with papilledema and elevated intracranial pressure causing vision loss that is severe at presentation or refractory to standard medical management, ONSF should be considered.
评估视神经鞘开窗术（ONSF）对因颅内压升高导致视盘肿胀的儿科患者视觉功能恢复的影响。
回顾性病例系列研究。
对2009年至2020年期间在费城儿童医院接受ONSF手术的所有儿科患者的病历进行回顾。在术前和术后访视时评估视觉功能。主要观察指标包括视力、色觉、眼球运动、视野平均偏差、通过光学相干断层扫描测量的视网膜神经纤维层厚度。
纳入14例儿科患者（10例女性；平均±标准差年龄为14±2.6岁；范围8.5 - 17.5岁）。5例患者接受了双侧手术。10例患者被诊断为特发性颅内高压。在这10例特发性颅内高压患者中，3例有体重增加史，2例有全身类固醇治疗史；这些可称为假性脑瘤。平均±标准差随访时间为16.4±12.3个月。手术眼的视力从20/138提高到20/68（P = 0.0003），未手术眼的视力从20/78提高到20/32（P = 0.02）。手术眼的色觉改善（P = 0.04），手术眼和未手术眼的眼球运动均有改善（分别为P = 该文档中此处P值有误，按照格式应为0.002和P = 0.04）。手术眼的视野平均偏差改善（从-23.4 dB至-11.5 dB，P < 0.0001），未手术眼的视野平均偏差也改善（从-19.8 dB至-6.8 dB，P = 0.02）。手术眼的视网膜神经纤维层厚度增加（从349.1至66.2 µm；P < 0.0001）。术后改善最早在术后第1天即可观察到。
ONSF可使手术眼和未手术眼的视力迅速且持续改善。对于患有视乳头水肿和颅内压升高导致视力丧失且在就诊时严重或对标准药物治疗无效的儿童和年轻人，应考虑进行ONSF。
