The Role of Optic Nerve Sheath Fenestration in Management of Anterior Ischemic Optic Neuropathy

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Abstract
To the Editor. —I was very interested to read the expedited publication in the December 1989 issue of theArchivesby Sergott et al1claiming that surgical optic nerve sheath decompression improved visual function in patients with "progressive" nonarteritic anterior ischemic optic neuropathy (NA-AION). They hypothesized that in NA-AION, "progressive visual loss after the initial ischemic event could be due to interference with rapid axoplasmic transport produced by [cerebrospinal fluid] CSF pressure within the anatomically restricted confines of the perineural optic nerve space. Drainage of the CSF might allow recovery of fast axoplasmic transport with subsequent improvement in vision." This theory raises some very important issues that need comment before they are accepted as scientifically valid concepts. My comments are based on the following: (1) my prospective studies on NA-AION in more than 600 patients; (2) my studies of the blood supply of the optic nerve head for the