Abstract In Reply. —First, we believe that optic nerve sheath decompression does improve the visual function of approximately 75% of patients with the progressive form of nonarteritic ischemic optic neuropathy. At present, we believe that optic nerve sheath decompression in some way improves the hemodynamic perfusion of the optic nerve, and possibly the optic disc.We agree that the issue of axoplasmic transport is complex and confusing. Although axoplasmic transport may not be directly responsible for visual function and neural conduction, we doubt that the physiologic processes of axoplasmic transport and impulse conduction can be segregated irrevocably in specific pathologic situations. For example, the experiments of McLeod et al1 dividing the posterior ciliary arteries of monkey eyes to produce ischemic optic neuropathy demonstrated an obstruction of axoplasmic transport at the lamina cribrosa.Finally, the need for a multicenter clinical trial depends on the acceptance or rejection by the neuro-ophthalmic References 1. McLeod D, Marshall J, Kohner EM. Role of axoplasmic transport in the pathophysiology of ischaemic disc swelling . Br J Ophthalmol . 1980;64:247-261.Crossref 2. Boghen DR, Glaser JS. Ischaemic optic neuropathy: the clinical profile and natural history . Brain . 1975;98:689-708.Crossref 3. Repka MX, Savino PJ, Schatz NJ, Sergott RC. Clinical profile and longterm implications of anterior ischemic optic neuropathy . Am J Ophthalmol . 1983;96:478-483.
Archives of Ophthalmology – American Medical Association
Published: Jul 1, 1991
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