Pseudotumor cerebri and optic nerve sheath decompression

Objective: To determine the efficacy and safety of optic nerve sheath decom pression in a large population of patients with pseudotumor cerebri with vi sual loss despite medical treatment and to suggest a treatment algorithm on the basis of these data. Design: Retrospective, noncomparative, interventional case series. Participants: One hundred fifty-eight eyes in 86 patients with pseudotumor cerebri. Intervention: Optic nerve sheath decompression. Main Outcome Measures: Visual acuity, visual fields, and surgical complicat ions. Results: After optic nerve sheath decompression for pseudotumor cerebri, vi sual acuity stabilized or improved in 148 of 158 (94%) eyes, and visual fie lds stabilized or improved in 71 of 81 (88%) eyes. Surgical complications, most of which were transient and benign, were seen in 39 of 86 patients. On ly one eye in one patient had permanent severe visual loss secondary to an operative complication. Conclusions: in patients with pseudotumor cerebri with progressive visual l oss despite maximum medical therapy, optic nerve sheath decompression is a safe and effective means of stabilizing visual acuity and the visual fields of those tested. Ophthalmology 2000;107:1907-1912 (C) 2000 by the American Academy of Ophthalmology.