View 2019 Abstracts

Title Does Redo Optic nerve sheath fenestration have a role in preventing optic nerve function deterioration
Submitted by Reena Kumari
Abstract Number 121
Review Result rapid fire presentation
Purpose

Optic nerve sheath fenestration is one of the surgical options in treating patient with sight threatening papilledema secondary to raised intracranial pressure. But what is its role in patients with refractile papilledema. We intend to look into the surgical success of this procedure in redo patients.

Methods

Patient were identified by the coding system in the hospital database.
Retrospective case notes review and data analysis of patients undergoing redo optic nerve sheath fenestration in refractile papilledema was done.

Results

• 3 patients identified by the database were excluded due to lack of enough follow up data due to a combination of factors .
• 9 eyes of 5 patients were included for the purpose of this study. 8 of these patients had idiopathic intracranial hypertension. I patient had sinus venous thrombosis.
• Indication for redo surgery was worsening of visual fields in 5 eyes, worsening of vision in 2 eyes and persistent disc oedema in 2 eyes. 1 patient had 3 ONSF as the shunt had to be removed due to complications.
• 3 patients had a shunt inserted for uncontrolled raise of ICP. 5 patients were on medical treatment with furosemide. 2 on acetazolamide and 1 on warfarin.
• In 6 eyes mitomycin was used at optic nerve sheath fenestration
• Vision improvement was noted in 1 eye. 4 patients had slight worsening in visual acuity
• Visual field improvement was noted in 5 eyes while there was a slight visual field worsening in 4 eye
• Colour vision improvement was noted in 1 eye only

Conclusion

Refractile papillaedema is difficult to treat. Doing a redo ONSF does not change the Visual acuity and the visual field in these patient. In these cases we need to look at other modalities of treatment.


Additional Authors
Last name Initials City / Hospital Department
Kumari Reena Leicester Royal Infirmary Oculoplastics
Deol Sunny Leicester Royal Infirmary Ophthalmology
Tsaousis Konstantinos Leicester Royal Infirmary Ophthalmology
Sampath Raghavan Leicester Royal Infirmary Oculoplastics