PURPOSE

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.

DESIGN

Retrospective case series.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

中文翻译：

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颅内压升高儿童和青少年视神经鞘开窗术后视力恢复

目的

评估视神经鞘开窗术 (ONSF) 对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。

设计

回顾性案例系列。

方法

对 2009 年至 2020 年间在费城儿童医院接受 ONSF 的所有儿科患者的病历回顾。在术前和术后就诊时评估视觉功能。主要结果测量是通过光学相干断层扫描测量的视力、色觉、眼外运动、视野平均偏差、视网膜神经纤维层厚度。

结果

包括 14 名儿科患者（10 名女性；平均 ± SD 年龄为 14 ± 2.6 岁；范围为 8.5-17.5 岁）。5名患者接受了双侧手术。10名患者被诊断为特发性颅内高压。10 名特发性颅内高压患者中，3 名既往有体重增加史，2 名接受过全身性类固醇治疗；这些可以称为假性脑瘤。平均 ± SD 随访时间为 16.4 ± 12.3 个月。手术眼的 VA 从 20/138 提高到 20/68（P  = .0003），非手术眼的 VA 从 20/78 提高到 20/32（P  = .02）。手术眼的色觉得到改善（P  = .04），手术眼和非手术眼的眼外动力得到改善（P  = .002 和P = .04 分别）。手术眼（–23.4 dB 至 –11.5 dB， P < .0001）和非手术眼（–19.8 dB 至 –6.8 dB，P  = .02）的视野平均偏差有所改善。手术眼的视网膜神经纤维层厚度有所改善（349.1 至 66.2 µm；P < .0001）。早在术后第1天就观察到术后改善。

结论

ONSF 在手术眼和非手术眼中都能产生快速和持久的视力改善。在患有视乳头水肿和颅内压升高导致视力丧失的儿童和年轻人中，这些视力丧失在就诊时很严重或对标准医疗管理无效，应考虑 ONSF。