Unilateral optic nerve sheath fenestration in idiopathic intracranial hypertension: A 6-month follow-up study on visual outcome and prognostic markers

Snorre Malm Hagen*, Marianne Wegener, Peter Bjerre Toft, Kåre Fugleholm, Rigmor Højland Jensen, Steffen Hamann

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

Loss of vision is a feared consequence of idiopathic intracranial hypertension (IIH). Optic nerve sheath fenestration (ONSF) may be an effective surgical approach to protect visual function in medically refractory IIH. In this study, we evaluate the impact of unilateral superomedial transconjunctival ONSF on bilateral visual outcome using a comprehensive follow-up program. A retrospective chart review of IIH patients who underwent unilateral ONSF between January 2016 and March 2021 was conducted. Patients fulfilling the revised Friedman criteria for IIH and who had exclusively received ONSF as a surgical treatment were included. Main outcomes were visual acuity (VA); perimetric mean deviation (PMD); papilledema grade; and optic nerve head elevation (max-ONHE) 1 week, 2 weeks, and 1, 3, and 6 months after surgery. VA (p < 0.05), PMD (p < 0.05), papilledema grade (p < 0.01), and maxOHNE (p < 0.001) were improved after 6 months on both the operated and non-operated eye. Prolonged surgical delay impedes PMD improvement (r = −0.78, p < 0.01), and an increasing opening pressure initiates a greater ganglion cell loss (r = −0.79, p < 0.01). In this small case series, we demonstrate that unilateral superonasal transconjunctival ONSF is a safe procedure with an effect on both eyes. Optic nerve head elevation and PMD are feasible biomarkers for assessing early treatment efficacy after ONSF.

Original languageEnglish
Article number778
JournalLife
Volume11
Issue number8
ISSN2075-1729
DOIs
Publication statusPublished - Aug 2021

Bibliographical note

Funding Information:
Funding: This research was funded by Fight for Sight, Denmark, and the Synoptik Foundation.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Keywords

  • Automated perimetry
  • Idiopathic intracranial hypertension
  • Optic nerve head
  • Optic nerve sheath fenestration
  • Optical coherence tomography
  • Papilledema

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