This retrospective multicentre study reviewed 72 patients who underwent optic nerve or optic nerve sheath biopsy at 3 sites over a 24-year period. The authors aimed to evaluate the indications, diagnostic yield and complications associated with these procedures, which are generally reserved for cases of unexplained and progressive optic neuropathy when less invasive investigations have failed to provide a diagnosis. The study reported that a biopsy provided a definitive diagnosis in 67% of cases, with a higher diagnostic yield for optic nerve biopsies (81%) than optic nerve sheath biopsies (55%). The most common diagnoses were meningioma, glioma and sarcoidosis. Importantly, biopsy results altered subsequent clinical management in 89% of cases, highlighting their potential value in guiding treatment decisions. Complications were reported in 18% of cases, including strabismus (7%) and visual acuity loss (6%). The authors therefore emphasise the need to balance diagnostic benefit against the risk of permanent morbidity. This study is one of the largest reported cohorts undergoing optic nerve and optic nerve sheath biopsy. The study provides useful data to support risk-benefit discussions with patients. The reported diagnostic yield demonstrates that biopsy can meaningfully contribute to diagnosis and management planning. The authors do acknowledge several limitations including the retrospective methodology, missing data, variable surgical approaches varied and potential selection bias. It is likely cases represented a highly specialised tertiary referral population, which may limit generalisability. The study reinforces that optic nerve biopsies should remain a carefully selected last-resort investigation, but one that can provide important diagnostic information when vision is already severely compromised or when establishing a diagnosis is critical for managing potentially serious disease.
What are the indications and outcomes of optic nerve and optic nerve sheath biopsies?
Reviewed by Anitha Priya Arun Shankar
Optic nerve and optic nerve sheath biopsy indications and outcomes.
CONTRIBUTOR
Lauren R Hepworth
University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.
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