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Optic Nerve Sheath Decompression: A Surgical Technique With Minimal Operative Complications

Moreau, Annie MD; Lao, Kenneth C. MD; Farris, Bradley K. MD

Journal of Neuro-Ophthalmology: March 2014 - Volume 34 - Issue 1 - p 34–38
doi: 10.1097/WNO.0000000000000065
Original Contribution

Background: The purpose of this study was to determine the safety and efficacy of optic nerve sheath decompression (ONSD) with a medial transconjunctival approach for a variety of indications in a larger population of patients than has previously been reported.

Methods: A retrospective chart review was performed on consecutive patients who underwent ONSD between January 1992 and December 2010. Before ONSD, all patients had documented evidence of progressive loss of visual acuity or visual field, or both. Postoperative follow-up visits were scheduled at 1 week, 1 month, and then every 3–6 months. Main outcome measures were visual acuity, visual fields, and surgical complications.

Results: Five hundred seventy-eight eyes of 331 patients underwent ONSD for progressive vision loss due to various indications, which included but were not limited to idiopathic intracranial hypertension (IIH), progressive nonarteritic ischemic optic neuropathy, and optic nerve drusen (OND). During a mean follow-up of 18.7 months (range, 1 week to 10 years), postoperative visual acuity remained stable or improved in 536 of 568 eyes (94.4%) and progressively worsened in 32 of 568 eyes (5.6%). Visual fields remained stable or improved in 257 of 268 eyes (95.9%) and progressive visual field loss occurred in 11 of 268 eyes (4.1%). There were no reported intraoperative complications. The most common postoperative complication was diplopia (6.0%).

Conclusions: To our knowledge, this review represents the largest series of patients who have undergone ONSD for any indication. Our data are consistent with current literature supporting ONSD as a safe and effective procedure for IIH. Other indications for ONSD, such as progressive visual field loss associated with OND, warrant further study. Regardless of the indication, complications following ONSD with the technique described in this report are infrequent.

Department of Ophthalmology (AM, BKF), Dean A. McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and Department of Ophthalmology (KCL), Scott & White Eye Institute, Texas A&M Health Science Center,Temple, Texas.

Address correspondence to Bradley K. Farris, MD, Department of Ophthalmology, Dean A. McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Boulevard, Oklahoma City, OK 73104; E-mail:

Supported in part by an unrestricted grant to the Department of Ophthalmology, University of Oklahoma, from Research to Prevent Blindness, Inc., New York, NY.

The authors report no conflicts of interest.

© 2014 by North American Neuro-Ophthalmology Society