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Pediatric and adult vision restoration after optic nerve sheath decompression for idiopathic intracranial hypertension. | LitMetric

AI Article Synopsis

  • A retrospective study was conducted to compare the presentation and surgical outcomes of idiopathic intracranial hypertension in adult and pediatric patients who underwent optic nerve sheath decompression from 1991 to 2012.
  • Both groups showed significant improvements in visual fields and acuity after surgery, but children had worse pre-operative visual measures compared to adults.
  • Despite a higher prevalence of severe visual impairment prior to surgery in children, the surgery was found to be equally safe and effective for both groups, highlighting the need for earlier diagnosis and treatment in pediatric cases.

Article Abstract

To compare presentations of idiopathic intracranial hypertension and efficacy of optic nerve sheath decompression between adult and pediatric patients, a retrospective cohort study was completed All idiopathic intracranial hypertension patients undergoing optic nerve sheath decompression by one surgeon between 1991 and 2012 were included. Pre-operative and post-operative visual fields, visual acuity, color vision, and optic nerve appearance were compared between adult and pediatric (<18 years) populations. Outcome measures included percentage of patients with complications or requiring subsequent interventions. Thirty-one adults (46 eyes) and eleven pediatric patients (18 eyes) underwent optic nerve sheath decompression for vision loss from idiopathic intracranial hypertension. Mean deviation on visual field, visual acuity, color vision, and optic nerve appearance significantly improved across all subjects. Pre-operative mean deviation was significantly worse in children compared to adults (p=0.043); there was no difference in mean deviation post-operatively (p=0.838). Significantly more pediatric eyes (6) presented with light perception only or no light perception than adult eyes (0) (p=0.001). Pre-operative color vision performance in children (19%) was significantly worse than in adults (46%) (p=0.026). Percentage of patients with complications or requiring subsequent interventions did not differ between groups. The consistent improvement after surgery and low rate of complications suggest optic nerve sheath decompression is safe and effective in managing vision loss due to adult and pediatric idiopathic intracranial hypertension. Given the advanced pre-operative visual deficits seen in children, one might consider a higher index of suspicion in diagnosing, and earlier surgical intervention in treating pediatric idiopathic intracranial hypertension.

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Source
http://dx.doi.org/10.1080/01676830.2016.1176051DOI Listing

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