Expert Diagnosis and Surgical Procedure Saves Young Girl from Blindness

The remarkable case began when Roni, a 14-year old girl from Jerusalem began complaining of severe pain in her neck. Roni’s mother attributed the pain to stress as a result of her upcoming exams. But when the pains failed to subside, she decided to take her daughter to their family doctor who similarly attributed the issue to stress from the intense exam schedule. However, the pains then radiated into her shoulders and began to affect Roni’s vision.

After continued follow-up, a community eye doctor referred her to the Emergency Department at the Shaare Zedek Medical Center in Jerusalem. Roni was quickly diagnosed with an edema in her ocular nerve and intracranial pressure had built up, bringing with it a growing risk of complete blindness.

Dr. Daniel Rappoport, Director of the Neuro-Ophthalmology Unit in the Eye Care Institute at Shaare Zedek Medical Center was the one who identified Roni’s condition. He says that it is a phenomenon which is being increasingly witnessed in Israel and across the world. “It very rare that patients will require surgery for this condition and in most cases pharmaceutical care and weight loss is the best treatment and reduces the risk of loss of vision. In certain cases, the cause is essentially the buildup of pressure in the skull leading to headaches and danger to the patient’s sight. In the most severe cases, it can cause such extensive vision complications that, if ignored and remains untreated, it can lead to irreversible blindness. Over the past year, we’ve seen an increase in such cases including three such cases that required surgical intervention as compared to just two that I had seen in all my years in this field.”

Recent medical research has indicated a correlation between COVID-19 and the resulting lockdowns as a factor that has contributed to the increase in juvenile obesity, which could lead to more cases of Idiopathic Intracranial Hypertension, increased pressure in the skull. Dr. Rappoport explained that “community doctors aren’t well aware of this phenomenon which allows these cases to go improperly treated. The chance of this occurring is about 1 in 100,000 but the chances multiply by as much as 19 times when we are dealing with overweight patients.”

After the doctors were able to determine the absence of a tumor, additional testing confirmed the presence of the edema. Based on the fact that Roni had already experienced some vision loss, the decision was made for immediate surgery to prevent further deterioration of her sight.

Dr. Udi Reich, Director of Ocular Oncology at Shaare Zedek, and Dr. Ortal Zachs, performed the emergency procedure, which required a complex approach to drain the edema from the ocular nerve.

Dr. Reich summed up the surgery saying, “Roni presented with an expanding edema with only six percent remaining in her field of vision with considerable risk to the ocular nerve and significant concern that she would be blind for life. The surgery saw us perform a very precise incision in the area around the nerve to drain the built-up fluid with the cut only millimeters away from key nerves that if harmed during surgery would result in permanent blindness. Surgeries of this type are extremely complex because we know that they bring with them the risk of a young woman losing her sight for life. We were extremely happy to see that she quickly regained her vision and is improving nicely by the day.”

He added, “Excess bodyweight is a known health issue and in girls and younger women it can be associated with loss of vision. In cases of headaches which don’t go away after a couple of days, the case should be quickly referred to an eye specialist. Roni’s case was particularly complicated because it wasn’t accompanied by headaches which is something which would have been a more clear indicator that something was wrong and allowed for earlier intervention.

Roni’s mother added, “This is truly miraculous. I have so much gratitude for the doctors who were able to so quickly save her sight. Roni has become herself again and she has been given back the gift of vision.”

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