[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
March 1993

Save the Optic Nerve-Reply

Author Affiliations

Los Angeles, Calif

Arch Ophthalmol. 1993;111(3):300-301. doi:10.1001/archopht.1993.01090030018011

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.


In Reply.  —Kwitko argues in favor of routine optic nerve sheath fenestration for treatment of progressive AION. He bases his argument on hypothetical considerations put forward by Sergott et al.1 There is general agreement that the pathogenesis of both the progressive and nonprogressive forms of AION relate to vascular compromise, mechanical compression, or both, at the level of the lamina cribrosa within the scleral canal.2 Thus, it is not clear that relieving "pressure" on the retrolaminar optic nerve would be any more beneficial than lowering the prelaminar pressure with ocular hypotensive agents. We must accept that the use of optic nerve sheath fenestration for progressive AION is supported only by a few clinical reports and not by any rigorously supported scientific hypotheses.Kwitko suggests that the visual fields of the two patients presented in our letter3 might have been even less constricted had surgery been performed. However,

Sergott RC, Cohen MS, Bosley TM, Savino PJ.  Optic nerve decompression may improve the progressive form of nonarteritic ischemic optic neuropathy . Arch Ophthalmol . 1989;107:1743-1754.Article
Beck RW, Savino PJ, Repka MX, Schatz NJ, Sergott RC.  Optic disc structure in anterior ischemic optic neuropathy . Ophthalmology . 1984;91:1334-1337.Article
Aiello A, Sadun AA, Feldon SE.  Spontaneous improvement of progressive anterior ischemic optic neuropathy: report of two cases . Arch Ophthalmol . 1992;110:1197-1199.Article
Jablons MM, Glaser JS, Schatz NJ, Siatkowski RM, Tse DT, Kronish JW.  Optic nerve sheath fenestration for treatment of progressive ischemic optic neuropathy: results in 26 patients . Arch Ophthalmol . 1993;111:84-87.Article
Hayreh SS.  Anterior ischemic optic neuropathy . Arch Neurol . 1981;38:675-678.Article
Kelman SE, Elman MJ.  Optic nerve sheath decompression for nonarteritic ischemic optic neuropathy improves multiple visual function measurements . Arch Ophthalmol . 1991;109:667-671.Article