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Imtiaz A Chaudhry, Waleed Al-Rashed, Yonca O Arat, Farrukh A Shamsi; Sutureless Optic Nerve Sheath Fenestration for Papilledema due to Intracranial Hypertension. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4551.
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© ARVO (1962-2015); The Authors (2016-present)
All of the current techniques for accessing retrobulbar space for performing optic nerve sheath fenestration (ONSF) for papilledema due to intracranial hypertension are lengthy requiring considerable efforts associated with morbidity and requiring lengthy recovery period after the procedure. The purpose of this report is to describe our simplified method for obtaining access to the retrobulbar space for ONSF.
In our technique a simplified method of accessing the retrobulbar space includes medial peritomy and holding the medial rectus muscle by a muscle hook and rotating the eye outward and inferiorely making optic nerve directly accessible and visible to perform ONSF. After the procedure, the eye is allowed to return to its natural position. No suture is used to close the peritomy.
Retrospective review of our 12 patients undergoing medial peritomy and access to retrobulbar space without taking medial rectus muscle disinsertion having undergone ONSF for papilledema due to intracranial hypertension was carried out. The procedure was considered successful in all patients by having CSF emerging from the fenestration site. Visual acuity and visual fields improved after ONSF procedure in all patients with severe vision loss from papilledema. There were no short term or long term major complications over the average study period of 7.5 months. Minor complication included one episode of pyogenic granuloma in one patient requiring excision.
Optic nerve sheath fenestration can be performed by medial peritomy without medial rectus muscle dis-insertion while holding it and rotating the eye outward and down. The technique described is very simple, safe and relatively fast without causing any complications.References:Pelton RW, Patel BC. Superomedial lid crease approach to the medial intraconal space: a new technique for access to the optic nerve and central space. Ophthal Plast Reconstr Surg. 2001;17:241-53.Gupta AK, Gupta K, Sunku SK, Modi M, Gupta A. Endoscopic optic nerve fenestration amongst pediatric idiopathic intracranial hypertension: a new surgical option. Int J Pediatr Otorhinolaryngol..2014;78:1686-91.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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