Effect of optic nerve sheath fenestration on visual function, neurological status, and oct metrics in idiopathic intracranial hypertension

Title : Effect of optic nerve sheath fenestration on visual function, neurological status, and oct metrics in idiopathic intracranial hypertension

Abstract:

IIH is defined as increased intracranial pressure (ICP) without an identifiable cause, which results in optic nerve damage and potential vision impairment. The purpose of this study was to evaluate the efficacy of optic nerve sheath fenestration (ONSF) in improving visual outcomes for patients with IIH. In this study, 35 patients (70 eyes) with IIH who received ONSF were followed for an average of 16.8 months.  Optical coherence tomography (OCT) and visual function parameters were assessed at pre-operation, and 6, 12, and 24- weeks post-ONSF.  In addition to traditional visual acuity (VA) testing, OCT was used to measure the thickness of the retinal nerve fiber layer (RNFL) and the macular ganglion cell layer (mGCL). The correlations between OCT parameters and visual function were evaluated using Pearson correlation coefficients. ONH parameters (total thickness, rim area, and disc area) significantly reduced (p < 0.001), indicating decreased papilledema and ICP. Macular GCL++ thinning by 24 weeks (p < 0.001) reflected retinal sensitivity to pressure changes, with visual function gains in Mean Deviation (MD) and VA paralleling these structural improvements. The increasing correlations between ONH total and VFI, macular volume, and GCL++ over time revealed an association between structural repair and visual function, although steady cup volume suggested it is less influenced by ICP. Persistent problems in certain patients noted the importance of close monitoring after ONSF, especially for long-term or severe IIH. 
In IIH patients, ONSF exhibits positive effects in improving visual outcomes, and OCT measurements are reliable predictors of visual prognosis.

Biography:

Professor Reza Nabie is an accomplished ophthalmologist and ocular surgeon, serving as a Professor of Clinical Ophthalmology at Tabriz University of Medical Sciences, Tabriz, Iran, since 2002. A consistent honor student with a 4.0 GPA, he completed his MD and ophthalmology residency at Tabriz University, earning national recognition as the second-ranked ophthalmologist in 1999. He pursued clinical fellowships in strabismus and oculoplastics at Tehran University. Professor Nabie leads the Strabismus and Oculoplastic Service at Nikookari Hospital, Tabriz, where he teaches and performs surgeries. He published more than 60 article in this area.