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M. J. Kupersmith, N. Heran, J. Song, Y. Niimi, D. Langer, A. Berenstein; Ophthalmic Segment Aneurysms With Anterior Optic Pathway Compression: Anatomic and Vision Outcomes After Endosaccular Coiling. Invest. Ophthalmol. Vis. Sci. 2007;48(13):930.
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The optimal therapy for ophthalmic segment aneurysms with anterior optic pathway compression (AOPC) is undecided. To report results of endovascular coiling of AOPC.
We retrospectively reviewed all of our patients with unruptured ophthalmic segment aneurysms with AOPC treated with endovascular coils. The outcomes were vision function of affected eyes, using visual acuity expressed in logmar notation and visual field grade (1- 5, normal - blind), angiographic occlusion, additional interventions, neurological outcome, and treatment complications.
Seventeen patients (16 women), age 38-83 years, had 28 affected eyes. In affected worse eyes mean baseline visual acuity and visual field score were 0.8, sd 0.8 and 3.2, sd 1.4. For first procedures, 16/17 aneurysms had endosaccular coiling with ICA preservation; and 1 aneurysm was trapped with ICA occlusion. Afterwards, patients were followed for a mean of 2.9 years (range: 1 month - 11.2 years). One patient died from subarachnoid hemorrhage (SAH) after 1 month. Vision worsened in 6 patients, stabilized in 4, and improved in 6. 12 patients had 13 subsequent procedures including endovascular ICA occlusion in 7, recoiling in 5, and optic nerve decompression in 1. Vision improved in 83% after ICA occlusion. Another patient died of SAH 5 months after recoiling. The final vision improved in 8 patients (50%), stabilized in 4 (25%), and worsened in 4 (25%). In the eyes with worse vision at baseline, the mean final acuity and field score were 0.8, sd 1.2 and 2.8, sd 1.6.
Coil endosaccular treatment, with ICA preservation, of ophthalmic segment aneurysms with chronic AOPC may not benefit vision. Our results suggest that currently, endovascular trapping with ICA sacrifice appears to result in good vision, clinical, and anatomic outcomes.
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