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Osamah J. Saeedi, Grant Gilliland; Predictive Factors For Optic Nerve Sheath Decompression Surgery In Idiopathic Intracranial Hypertension. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3900.
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To determine predictors of the need for and outcome of optic nerve sheath decompression (ONSD) in pseudotumor cerebri patients using demographic, clinical, and ancillary testing data (OCT Retina Nerve Fiber Layer, VEP).
We performed a retrospective chart review of all pseudotumor cerebri patients referred to an ophthalmology practice in Dallas, Texas, from 2004 to 2009. In particular, OCT RNFL data, visual field, and VEP data was evaluated. Demographic and clinical variables such as age, race, sex, visual acuity, lumbar puncture opening pressure, disc edema, intraocular pressure, cup to disc ratio, height, weight, and history of psychiatric illness. Failure of ONSD was defined as loss of greater than 2 lines of vision, loss of 5dB or more in mean deviation on visual field, or need for repeat ONSD.
In total, 94 patients, or 188 eyes, had a diagnosis of pseudotumor cerebri, of which approximately 24 right eyes and 23 left eyes (47 total, 25%) underwent ONSD. 83% of patients evaluated were white and 86% were female. 21 patients (22%) had undergone a prior neurosurgical shunting procedure. Average BMI was 32.57. 89% of ONSD were deemed successful based on criteria and 17% of patients had an improvement in visual acuity or visual field. There was one complication. Need for ONSD was predicted by prior neurosurgical shunting procedure (P=0.00). OCT and VEP data did not show a statistically significant predictive value or association with indication for ONSD or success rate of ONSD.
ONSD is an effective treatment for Visual Field loss due to Pseudotumor Cerebri with a high success rate. Prior neurosurgical shunting procedure is predictive for the need for optic nerve sheath decompression. OCT RNFL and VEP data are not predictive of the need for ONSD, nor are they predictive of surgical success.
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