Optic nerve sheath decompression for glaucomatous optic neuropathy with normal intraocular pressure
M. B. Wax, D. A. Barrett, W. M. Hart Jr and P. L. Custer
Department of Ophthalmology and Visual Sciences, Washington University, School of Medicine, St Louis, Mo.
OBJECTIVE: To report our therapeutic experience with optic nerve sheath
decompression in patients with normal-pressure glaucoma. DESIGN: A case
series of seven eyes from six patients with glaucoma and normal intraocular
pressures who continued to have progressive visual field loss despite
conventional therapy. SETTING: A hospital-based, referral glaucoma service.
PATIENTS: Three men (67, 67, and 72 years of age) and three women (58, 61,
and 70 years of age). INTERVENTIONS: Optic nerve sheath decompression. MAIN
OUTCOME MEASURES: Visual field data and visual acuity measurements were
obtained at regular intervals during the postoperative periods (range, 3 to
18 months). RESULTS: Two of seven eyes from six patients appear to have
enjoyed an initial significant improvement in their visual fields with
improved visual acuity in one eye of one patient. The visual fields,
however, appear to have deteriorated 18 months after the initial procedure
in these two patients. In the remaining four patients, no further
improvement or deterioration was observed within a limited follow-up
period. CONCLUSIONS: The transient improvement in the visual fields of one
eye from each of two patients documents an initial successful use of optic
nerve sheath decompression in patients with nerve fiber bundle damage in
the absence of optic nerve head swelling. However, the long-term potential
of optic nerve sheath decompression in these patients may be of limited
value.
