Danger to vision fades away after experimental surgery

November 05, 1990|By Sue Miller | Sue Miller,Evening Sun Staff

Luzanne Lichtfuss received terrifying news from a neuro-ophthalmologist at the University of Maryland Medical Center.

Lichtfuss, who wore glasses only when she drove, was told she was going blind in both eyes -- quickly. Her peripheral or side vision was slipping away; her central vision could begin to erode at any time; she had episodes of darkness in both eyes and excruciating headaches.

The culprit was an excess amount of spinal fluid circulating in the brain, Dr. Shalom E. Kelman informed her. This leads to a high level of pressure in the brain and swelling of all its structures, especially the optic nerve, which causes the visual loss.

This created a dilemma for Lichtfuss, who lives in Towson and is the mother of two children. She could opt for traditional surgery, which involves a shunt or tube to drain the spinal fluid but does not always arrest the deteriorating vision. Or, she could be one of the pioneers in a more experimental type surgery that could possibly reverse her vision loss.

Lichtfuss gambled on the experimental surgery -- and won. Today, a year after surgery, the vision in her left eye is a better-than-normal, 20/15, and she wears glasses to correct a slight blurriness in her right eye.

The surgical technique which reverses the blinding eye disorder that masquerades as a brain tumor last week was hailed as "the procedure of choice" by experts attending the American Academy of Ophthalmology meeting in Atlanta.

The disorder is known as pseudotumor cerebri and it strikes young women of child-bearing age, particularly as they near 30. For some unknown reason, black women are hit the hardest. Each year 5,000 new cases are diagnosed in the United States, (( experts conservatively estimate.

The procedure was cited as "the procedure of choice" by Dr. Michael Wall of Tulane University in Louisiana, following a collaborative study between the University of Maryland Medical Center and Wills Eye Hospital in Philadelphia.

Dr. Robert C. Sergott, of Philadelphia, and Kelman performed the delicate surgery on 12 patients who had had no success with traditional shunt surgery. The ophthalmologists cut several tiny holes in the sheath that covers the optic nerve, permitting the excess high pressure fluid inside to escape into the eye socket where it was absorbed.

"Not only did their vision stop deteriorating, it became much better in all 12 patients within a few weeks of surgery," Kelman said in an interview. "This procedure, called optic nerve sheath decompression, offers new hope to patients for whom no other therapy is effective to prevent blindness from this disorder."

Kelman, who studied with Sergott at Wills Eye Hospital, has treated 30 patients over the last 18 months using the new procedure which requires general anesthesia and takes about 1 1/2 hours.

"Of that group, 29 patients had their vision restored to normal or saw a vast improvement," he said. "One patient had a post-surgical complication that resulted in blindness in one eye, but the other eye regained normal vision.

The procedure is now being done at other medical centers throughout the country, said Kelman. But the Wilmer Eye Institute in Baltimore is not among them, he said.

Over the years, the initial treatment has been medications, such as diuretics or steroids, to reduce the production of the fluid in the brain. Beginning in the late 1960s, shunt procedures were introduced as a therapy for patients who could not be helped by drugs. A tube or shunt that would go from the lower spine to the belly, was used to drain the fluid out of the brain.

"But in the last 20 years people have recognized that these shunts had a lot of complications," Kelman said. "They would be blocked and even if they were not blocked, they still would not drain the fluid completely and people would still lose vision."

Sergott began work on the new technique six years ago. Two years ago, he reported on it in the Archives of Ophthalmology. In the same issue, there were two other corroborating reports and an editorial saying the new technique appeared to work.

"I was anxious to start doing the procedure because I had patients in my practice at the University of Maryland who just didn't seem to be responding to the conventional surgery and I felt we had to offer them something else," Kelman said.

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