Operative Complications of Optic Nerve Sheath Decompression

Abstract

Optic nerve sheath decompression (ONSD) is a procedure that is advocated for the treatment of certain types of optic nerve dysfunction associated with progressive decline in visual function. The reported postoperative complications attributed to ONSD surgery are relatively few and predominantly transient and benign. Few postoperative vascular complications are reported. The authors performed a retrospective review of the operative and postoperative course of 31 consecutive patients (38 eyes) undergoing ONSD surgery for various types of optic nerve dysfunction associated with progressive decline in visual acuity, visual fields, or both. The authors evaluated the reports of other investigators to ascertain the spectrum and diversity of postoperative complications associated with ONSD. Fifteen (40%) of the 38 eyes undergoing ONSD had postoperative complications, including temporary motility disorders (29%) and pupillary dysfunction (11%). Additionally, four eyes (11%) had postoperative vascular complications, including two central retinal artery occlusions (CRAOs), one superotemporal branch retinal artery occlusion (BRAO), and one episode of transient outer retinal ischemia. Both eyes with postoperative CRAOs had poor visual outcome. Eyes that had undergone prior ONSD were significantly more likely to have vascular complications than those without a previous operation (Fisher's exact test, P = 0.025). Optic nerve sheath decompression can be associated with a variety of postoperative complications, the majority of which are minor and resolve without sequelae. Other complications, such as a CRAO, can be associated with significant visual loss. The physician and patients should be aware of the potential risks of ONSD, including significant visual morbidity, when considering this form of treatment.