OPTIC-NERVE SHEATH DECOMPRESSION FOR VISUAL-LOSS IN PATIENTS WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME AND CRYPTOCOCCAL MENINGITIS WITH PAPILLEDEMA

Visual dysfunction developing in association with acquired immunodefic iency syndrome (AIDS) can be multifactorial. Two patients with this sy ndrome and cryptococcal meningitis had papilledema and visual loss. Bo th were treated by optic nerve sheath fenestration. One patient had bi lateral nonsimultaneous optic nerve sheath fenestrations; visual funct ion improved in one eye. The other patient had bilateral visual improv ement after a unilateral optic nerve sheath fenestration. Cryptococcal organisms were present in the dural sheath specimens of both patients despite ongoing therapy with antifungal medication. Postoperative orb ital infectious complications did not occur. Autopsy examination of on e patient showed that the sites of fenestration were patent. Medical t reatment of cryptococcal meningitis associated with AIDS has a guarded prognosis. Optic nerve sheath fenestration offers a treatment alterna tive for papilledema and visual loss that occur with cryptococcal meni ngitis.