The Relationship Between Optic Nerve Sheath Decompression Failure and Intracranial Pressure in Idiopathic Intracranial Hypertension

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Title The Relationship Between Optic Nerve Sheath Decompression Failure and Intracranial Pressure in Idiopathic Intracranial Hypertension
Creator Mark E. Robinson, MD, MPH; Annie Moreau, MD; Ryan O'Meilia, BS; John Pagteilan, BS; Kai Ding, PhD; Raymond Michael Siatkowski, MD; Bradley K. Farris, MD
Affiliation Department of Ophthalmology (MR, AM, RMS, BKF), Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; University of Oklahoma College of Medicine (RO, JP), Oklahoma City, Oklahoma; and University of Oklahoma Health Sciences Center (KD), College of Public Health, Oklahoma City, Oklahoma
Abstract Ocular neuromyotonia (ONM) is a rare motility disorder in which paroxysms of tonic extraocular muscle contraction from abnormal ocular motor nerve firing result in episodic diplopia and strabismus. Medical therapy with membrane-stabilizing agents has varied success. A surgical approach to treatment has not yet been described. We report the outcomes of strabismus surgery in patients with ONM.; ; We describe 3 patients with sixth nerve paresis and ONM of the affected lateral rectus muscle who underwent strabismus surgery. All patients had a history of radiation therapy for intracranial tumors. Ophthalmologic and orthoptic examinations were performed with appropriate medical and neuroradiologic evaluation. Preoperative and postoperative data are presented and analyzed.; ; Two patients were noted to have ONM after their first strabismus surgery for a sixth nerve palsy. Patients 1 and 2 had 3 surgeries, whereas Patient 3 had 1 operation. Extraocular muscles operated on included the medial rectus and lateral rectus. Preoperative primary gaze baseline esotropia ranged from 35 to 75 prism diopters (Δ). All patients achieved improvement in ocular alignment and motility. Postoperative primary gaze deviations ranged from orthotropia to 20Δ of esotropia. Abduction deficits were unchanged or improved. The follow-up period ranged from 15 months to 2 years.; ; Patients with ONM of a paretic rectus muscle can achieve binocular fusion with strabismus surgery. ONM may manifest postoperatively in patients with a sixth nerve palsy and a contractured medial rectus who, preoperatively, were not noted to have ONM.
Subject Adolescent; Adult; Older people; Blindness, Cortical; Female; Follow-Up Studies; Humans; Hypoxia-Ischemia, Brain; Magnetic Resonance Imaging; Male; Middle Older people; Occipital Lobe; Retrospective Studies; Time Factors; Tomography, X-Ray Computed; Visual Acuity; Young Adult
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Date 2016-09
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, September 2016, Volume 36, Issue 3
Collection Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s6jq4vh9
Setname ehsl_novel_jno
ID 1276518
Reference URL https://collections.lib.utah.edu/ark:/87278/s6jq4vh9
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