Acquired bilateral myelinated retinal nerve fibers after unilateral optic nerve sheath fenestration in a child with idiopathic intracranial hypertension.

Journal Article (Journal Article)

PURPOSE: To report the unusual development of bilateral myelinated retinal nerve fibers (MRNF) adjacent to the optic nerve in a child after treatment of idiopathic intracranial hypertension (IIH) with unilateral optic nerve sheath fenestration (ONSF) and to discuss the etiology of acquired MRNF. METHODS: The patient's clinical history, including visual acuity, refractive error, ocular alignment, fundus examination, and optic nerve photographs, was retrospectively reviewed. A literature review was performed for acquired MRNF in children using PubMed. The results of the demographic and clinical findings of our patient were compared with those of previously reported cases. RESULTS: The child developed bilateral MRNF adjacent to the optic nerve 5 months after unilateral ONSF. In reviewing the literature, 8 of 10 cases of acquired MRNF in children had previous abnormalities of the optic nerve, 4 of 10 had associated bilateral optic nerve head drusen, 3 of 10 had associated optic nerve glioma, and 3 of 10 had a history of significant increased intracranial pressure requiring surgical intervention. CONCLUSIONS: Although the etiology of acquired MRNF is uncertain, this case plus a review of the literature suggest that it may be related to changes in the lamina cribosa combined with possible optic nerve injury caused by optic nerve head drusen, optic nerve glioma, or increased intracranial pressure and that it can occur months to years after intervention.

Full Text

Duke Authors

Cited Authors

  • Prakalapakorn, SG; Buckley, EG

Published Date

  • December 2012

Published In

Volume / Issue

  • 16 / 6

Start / End Page

  • 534 - 538

PubMed ID

  • 23237749

Pubmed Central ID

  • PMC3535484

Electronic International Standard Serial Number (EISSN)

  • 1528-3933

Digital Object Identifier (DOI)

  • 10.1016/j.jaapos.2012.08.006


  • eng

Conference Location

  • United States