Clinical Manifestations and Prognosis of Patient with Traumatic Optic Neuropathy

PURPOSE: To investigate the clinical manifestations, management, ophthalmologic complications, and prognosis of traumatic optic neuropathy. METHODS: A retrospective survey of 55 patients who visited Chosun Hospital from April 2009 to February 2016 was performed. The sex, age, causes, fracture characteristics, neurologic injury, and combined craniofacial bone fractures of patients who were diagnosed with traumatic optic neuropathy were statistically analyzed. Also, we investigated the rate of visual impairment in the patients with intracranial hemorrhaging and craniofacial fracture on radiologic examination and development of sensory strabismus. RESULTS: Traffic accidents were the most common cause of traumatic optic neuropathy. Among the patients, more than 60% showed severe visual impairment of less than 0.1 that lasted until the final observation. Altitudinal visual defects were the most common visual field defect and presented as marginal atrophy and central scotoma. While intracranial hemorrhaging was showed in 52.4% of the patients, craniofacial fracture was observed in 90.5% of the patients. The initial visual acuity was decreased when the patient presented with orbital fracture located in the retrobulbar area. Intravenous high-dose steroid injection did not affect visual prognosis. Sensory strabismus occurred more commonly under conditions of poor initial vision (p = 0.007) or young age (p < 0.001). CONCLUSIONS: Traumatic optic neuropathy in Korea has a high rate of initial visual impairment with poor prognosis of vision. In addition, high-dose intravenous steroid injection did not result in visual improvement.

Evans Syndrome following T Cell-repleted Unrelated Bone Marrow Transplantation for Myelodysplastic Syndrome: Successful Response to High-dose Corticosteroid

Evans syndrome after hematopoietic stem cell transplantation rarely occurs and this condition is refractory to treatment, particularly in childhood. We experienced a case of Evans syndrome following unmanipulated unrelated bone marrow transplantation. Evans syndrome developed at early post-transplantation period (day +42) and it responded very well to high-dose corticosteroid. Autoimmune cytopenia should be considered for post-engraftment cytopenias and high-dose corticosteroid therapy might be considered as a treatment of the early onset type of autoimmune cytopenia that can occur after hematopoietic stem cell transplantation.

Clinical Evaluation of the Traumatic Optic Neuropathy

Traumatic optic neuropathy is one of true ophthalmic emergencies and there is no proven form of treatment for traumatic optic neuropathy. 82 cases of traumatic optic neuropathy were investigated to evaluate the effectiveness of high dose corticosteroid for the visual improvement. Age, sex, initial visual acuity, final visual acuity, interval to treatment, the type of trauma and the affected region were studied retrospectively.250 mg of Methylprednisolone was administered intravenously every 6 hours for 3 days, and then followed by tapering using oral prednisone The vision was improved in 36 of 82 cases[43.9%]. It was difficult to interpret the relation-ships between the affected region and visual improvement, the interval for each treatment and final visual acuity. However, the vision was improved in 45 of 50 cases who had an initial visual acuity of above light perception, but in the two of 32 cases with no light perception. If indicated, fifteen cases were treated with a combination of high dose corticosteroid and optic nerve decompression. In initial treatment of traumatic optic neuropathy, high dose corticosteroid was effecive. Whether or not initial visual acuity was better than light perception was a key risk factor in the outcome.

Clinical Evaluation of the Traumatic Optic Neuropathy

The nineteen patients(20 eyes) of traumatic optic neuropathy were investigated to evaluate the effectiveness of high dose corticosteroid for the visual improvernent in the early treatment of this disease. The relationships between the affected region and visual improvement, the interval to treatment and final visual acuity, the initial visual acuity and final visual acuity were studied. 250mg of methylprednisolone was administered intravenously every 6 hours followed by tapering using oral prednisone. The optic canal decompression was performed in five patients suspected swelling of optic nerve or optic canal fracture revealed by orbital CT. It is difficult to know the relationships between the affected region and visual improvement, the interval to treatment and final visual acuity. The vision was improved in nine of eleven patients who had an initial visual acuity of above light perception, but in the two of nine patients who had an initial visual acuity of no light perception. The two of five patients treated with a combina tion of high dose corticosteroid and optic canal decompression showed improved visual function. In initial treatment of traumatic optic neuropathy, high dose corticosteroid was effective and combined optic canal decompression was helpful, if indicated.