Safety and efficacy of bilateral same-day optic nerve sheath fenestration

PURPOSE: To evaluate the safety and efficacy of bilateral same-day optic nerve sheath fenestration (ONSF) in patients with vision-threatening papilledema. METHODS: This multi-institutional study included 119 patients with bilateral papilledema who underwent same-day bilateral ONSF. Clinical data collected included: visual acuity (VA), visual field mean deviation (MD) and index (VFI), retinal nerve fiber layer (RNFL) thickness, and intraocular pressure (IOP). Pre- and postoperative outcomes and complications were evaluated with a Generalized Estimating Equation (GEE) using Statistical Analysis System (SAS) for analysis. Two planned bilateral procedures were aborted intraoperatively due to safety concerns; no intraoperative complications occurred among completed bilateral procedures. Additional cerebrospinal fluid diversion procedures were required in 7% of patients. CONCLUSIONS: Same-day bilateral ONSF is a safe and effective option for patients with bilateral vision-threatening papilledema, demonstrating improvement in RNFL thickness while minimizing surgical risk and treatment delays.