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Eye Care 2018 & Public Health Congress 2018 Archives of General Internal Medicine | ISSN: 2591-7951 | Volume 2
S e p t e m b e r 0 3 - 0 4 , 2 0 1 8 | L i s b o n , P o r t u g a l
alliedacademies Joint Event on
PUBLIC HEALTH, EPIDEMIOLOGY AND NUTRITION
OCULAR PHARMACOLOGY AND EYE CARE
&
World Congress on
19th International Conference on
Maha A Badr, Arch Gen Intern Med 2018, Volume 2 | DOI: 10.4066/2591-7951-C4-011
OPTIC NERVE SHEATH DECOMPRESSION
MEDIAL APPROACH EXPERIENCE OF
PRINCE SULTAN MILITARY MEDICAL CITY
Maha A Badr
Prince Sultan Military Medical City, Saudi Arabia
Introduction: Idiopathic intracranial hypertension (IIH), also known as prima-
ry pseudo tumor cerebri, is a disorder of increased intracranial pressure (ICP)
with normal Neuroimaging and CSF composition and no underlying etiolo-
gy .The incidence of IIH in many Middle East countries has been estimated at
2.02–2.2/100,000 in the general population, which is higher than the Western
rate. When vision impartment in a patient with papilledema is persistent, prompt
treatment is required in hopes of preventing permanent loss of vision. If medical
treatment is not effective, we can have surgical option like venrticulo -peritoneal
shunt, lumbo- peritoneal shunt or optic nerve sheath decompression.
Methods: Retrospective, non comparative, interventional case series.
Thirty cases underwent by using ONSD medial approach in Ophthalmology
Department in Prince Sultan Military Medical City from 1995 to 2017. All these
patient was referred from the Neurology Department. 26 patient was diagnosed
as increase idiopathic intracranial pressure and 4 patient with secondary
increase intracranial pressure. All patients underwent full Neuro ophthalmic
assessment including visual acuity, visual field pre-operative and post
operative. The treatment of IIH patients depends on their symptoms and vision
status. The indications for ONSD Progressive visual loss who fail maximum
medical therapy, severe bilateral disc swelling or visual loss in patients who
do not comply with medical therapy. Secondary increase in ICP due to non-
respectable tumor and Presence of additional risk factors like Renal failure,
Hypertension, SLE and others.
Results: Main outcome measures the visual acuity, visual fields, and surgical
complications will be discussed. Thirty patient underwent ONSD, in one eye
with the worst visual field, 26 patients out of 30 (86%) cases due to idiopathic
increase intracranial pressure, four patient (13%) cases due to secondary
increase ICP. After ONSD 22 patient 73% improved visual field in both eyes. Six
patient 20% stabilized visual field in both eyes, one patient 3% deteriorated post
operative vision secondary to operative complication.
Conclussion: Optic Nerve Sheath Decompression effectively stabilizes or
improves visual function in the majority of patients with PTC and visual loss.
However, it may fail at any time after surgery; patients with PTC need to be
followed-up routinely with visual field assessment to detect deterioration of
visualfunction.Bilateraldiscedemaresolvedandvisualfiledimprovementseen
most cases when only one eye underwent optic nerve sheath decompressed.
Key words: Optic Nerve Sheath Fenestration, Decompression, Pseudo Tumor
Cerebri.
Maha A Badr is a Consultant of Neuro Ophthalmology
at Prince Sultan Military Medical in Saudi Arabia.
BIOGRAPHY