Optic nerve sheath decompression for glaucomatous optic neuropathy with normal intraocular pressure

Abstract

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.