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Case Reports
. 2021 Oct;49(10):3000605211048362.
doi: 10.1177/03000605211048362.

Endoscopic transconjunctival optic nerve sheath fenestration for progressive idiopathic visual field deficit: a case report

Tomasz Lyson  1 , Andrzej Sieskiewicz  2 , Robert Chrzanowski  1 , Joanna Konopinska  3 , Marek Rogowski  2 , Zenon Mariak  1
Affiliations
Case Reports

Endoscopic transconjunctival optic nerve sheath fenestration for progressive idiopathic visual field deficit: a case report

Tomasz Lyson et al. J Int Med Res. 2021 Oct.

Abstract

Intra-orbital optic nerve sheath fenestration (ONSF) is an effective option in patients with progressive vision loss due to idiopathic intracranial hypertension. Most proposed techniques involve surgical trauma and require disinsertion of the medial rectus muscle; thus, less invasive surgical procedures are needed. Here, a feasible and effective technique of endoscopic intra-orbital ONSF through a conjunctival incision is presented, in a patient with a progressively compromised visual field, papilloedema, and distended subarachnoid space around the optic nerves. The retrobulbar segment of the optic nerve was exposed for incision, avoiding manipulation of the lateral orbital rim bones and irritation of the ciliary microvessels and nerves. The patient regained the entire visual field. ONSF was safely and effectively performed endoscopically through a narrow corridor gained by brushing away the orbital fat with minimal traction on the medial rectus muscle. The small postoperative wound was associated with faster and easier convalescence, and less tissue trauma versus conventional open approaches.

Keywords: Optic nerve sheath fenestration; endoscopic surgery; endoscopy; intra-orbital; ocular surgery; vision loss.

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Conflict of interest statement

Declaration of conflicting interest: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Transverse plane magnetic resonance image showing bilateral widening of the fluid space around the optic nerves in an adult male patient with progressive visual field deficit and deteriorating vision in both eyes.
Figure 2.
Figure 2.
Preoperative left eye visual field test results in an adult male patient, showing enlarged blind spots and peripheral field defects.
Figure 3.
Figure 3.
Preoperative right eye visual field test results in an adult male patient, showing enlarged blind spots and peripheral field defects.
Figure 4.
Figure 4.
Preoperative optical coherence tomography (OCT) revealing optic nerve oedema with no signs of retinal vasculitis or uveitis in an adult male patient with progressive visual field deficit and deteriorating vision in both eyes. OD, right eye; OS, left eye; RNFL, retinal nerve fibre layer; TMP, temporal; SUP, superior; NAS, nasal; INF, inferior.
Figure 5.
Figure 5.
Postoperative optical coherence tomography (OCT) revealing increase in optical nerve thickness. OD, right eye; OS, left eye; RNFL, retinal nerve fibre layer; TMP, temporal; SUP, superior; NAS, nasal; INF, inferior.
Figure 6.
Figure 6.
Postoperative right eye visual field test results in an adult male patient, showing improved visual field.
See this image and copyright information in PMC

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