Department of Ophthalmology, New England Eye Center/Tufts Medical Center, Boston, Massachusetts, USA.
Division of Ophthalmology, Department of Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA.
Orbit. 2023 Aug;42(4):397-403. doi: 10.1080/01676830.2022.2118791. Epub 2022 Sep 7.
To evaluate the effect of optic nerve sheath fenestration (ONSF) on the rate of visual function improvement in patients with pseudotumor cerebri syndrome (PTCS).
Retrospective chart review of patients with PTCS who underwent ONSF between 1998 and 2017. Visual function was evaluated by evaluating visual field (VF), mean deviation (MD), retinal nerve fiber layer (RNFL) thickness, papilledema grade, and visual acuity (VA) prior to and after ONSF.
Seventeen female patients aged 17 to 36 years underwent unilateral ONSF. Follow-up averaged 40.1 months. VF MD improved steadily in both eyes up to 12 months. Average RNFL thickness improved in the operated eye from 347 ± 166 mm to 92 ± 27 mm ( < .001) and the non-operated eyes from 306 ± 165 mm to 109 ± 46 mm ( < .001). The grade of papilledema improved in the operated eye from 3.3 ± 1.3 to 0.3 ± 0.7 and the non-operated eye from 3.0 ± 1.6 to 0.18 ± 0.4. There was an exponential rate of improvement in papilledema and RNFL thickness, with the greatest improvement occurring within the first 30 days. Average visual acuity remained intact in both eyes before and after surgery.
ONSF in appropriately selected patients leads to rapid improvement in papilledema and a steady recovery in VF.
评估视神经鞘开窗术（ONSF）对视神经鞘开窗术治疗假性脑瘤综合征（PTCS）患者视觉功能改善率的影响。
回顾性分析 1998 年至 2017 年间接受 ONSF 的 PTCS 患者的病历。通过评估视野（VF）、平均偏差（MD）、视网膜神经纤维层（RNFL）厚度、视乳头水肿程度和视力（VA），在 ONSF 前后评估视觉功能。
17 名 17 至 36 岁的女性患者接受了单侧 ONSF。平均随访时间为 40.1 个月。VF MD 在双眼中稳定改善，直至 12 个月。手术眼的平均 RNFL 厚度从 347 ± 166 mm 增加到 92 ± 27 mm（ < .001），非手术眼从 306 ± 165 mm 增加到 109 ± 46 mm（ < .001）。手术眼视乳头水肿程度从 3.3 ± 1.3 级改善到 0.3 ± 0.7 级，非手术眼从 3.0 ± 1.6 级改善到 0.18 ± 0.4 级。视乳头水肿和 RNFL 厚度的改善呈指数增长，最大改善发生在第 30 天内。手术前后双眼平均视力均保持完整。
在适当选择的患者中，ONSF 可导致视乳头水肿迅速改善，VF 稳定恢复。
