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Purpose: To analyze the visual outcome in patients with traumatic optic neuropathy (TON) with respect to different treatment modalities, to study the correlation of initial visual loss with the final visual outcome, and to find out the predictor of final visual outcome in patients with indirect TON. Methods: A retrospective analysis of 36 eyes with TON was done. Data on clinical profile, including demographics, mode of trauma, best corrected visual acuity (BCVA), pupillary reflex examination, and anterior and posterior segment examination, was collected. Presence and location of orbital and cranial fractures were identified from computed tomography scan. Visual outcomes following steroid therapy, optic nerve (ON) decompression, and in untreated patients were analyzed. Pre? and post?treatment BCVA were divided into three groups based on logarithm of the minimum angle of resolution (logMAR) as follows: group A: 3, group B: 2.9–1.3, and group C<1.3. BCVA values at follow?up visits were taken as the primary outcome measure. Association between various risk factors and final visual outcome in patients with indirect TON was also analyzed. Results: Out of 34 patients whose 36 eyes were studied, three (8.8%) patients were females and 31 (91.2%) patients were males. Most common mode of trauma was road traffic accident (RTA; 91.2%), which was followed by fall (8.8%) and assault (2.9%). Pre? and post?treatment BCVA values of 36 eyes were compared, and improvement in BCVA after treatment was found to be statistically significant. Also, 28.6% of patients with presenting BCVA of no light perception showed improvement compared to 94.1% and 100% in groups B and C, respectively. Orbital wall fractures were seen in 80.5% (n = 29) of the patients, with lateral wall fracture being the most common (58.3%) followed by medial wall (33.3%), roof (27.7%), floor (27.7%), and optic strut (5%). Conclusion: Baseline BCVA had significant association with final vision improvement. Lateral wall fracture was the most common fracture associated with indirect TON. Patients treated with high?dose corticosteroids, irrespective of the time of presentation, had a better visual outcome
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Purpose: Our study aims to evaluate the effectiveness of intravenous erythropoietin (EPO) in patients with indirect traumatic optic neuropathy (TON), assess the side effects, and compare the visual function results among three groups of patients who had received different treatment options – EPO, steroids, and observation. Methods: Patients with indirect TON presenting to the neuro?ophthalmology clinic from August 2019 to March 2020, were assigned to three groups, with six patients in each group. In group 1, patients were recruited prospectively and received recombinant human erythropoietin, whereas, in groups 2 and 3, patients were recruited retrospectively and received intravenous methylprednisolone followed by oral steroids and multivitamins, respectively. Groups 1 and 2 included patients presenting within 2 weeks of trauma, whereas group 3 included those presenting beyond that. Best?corrected visual acuity, pupillary reaction, color vision, and visual fields following treatment were measured. Results: Initial visual acuity in the EPO group ranged from 20/80 to no perception of light (No PL). The mean initial BCVA (1.82 logMAR, standard deviation [SD] = 0.847) improved to 1.32, SD = 0.93 logMAR after treatment recorded at the third month (P = 0.0375), with no significant adverse effects. The initial BCVA of group 2 ranged from 20/120 to No PL. The mean initial BCVA (1.95, SD = 0.77 logMAR) improved to 1.45 logMAR, SD = 0.97 after treatment (P = 0.0435) but three patients had side effects of steroids. Initial visual acuity in Group 3 ranged from 20/40 to no PL. The mean initial BCVA (1.09 logMAR, SD = 1.10) worsened to 1.19 logMAR, SD = 1.06 after treatment after treatment (P = 0.0193). The improvement in BCVA when compared between the three groups was not significant. Conclusion: Both erythropoietin and steroids are effective in the management of traumatic optic neuropathy. However, erythropoietin shows lesser or no side effects when compared to steroids
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OBJECTIVE@#To investigate the therapeutic effect of Epothilone D on traumatic optic neuropathy (TON) in rats.@*METHODS@#Forty-two SD rats were randomized to receive intraperitoneal injection of 1.0 mg/kg Epothilone D or DMSO (control) every 3 days until day 28, and rat models of TON were established on the second day after the first administration. On days 3, 7, and 28, examination of flash visual evoked potentials (FVEP), immunofluorescence staining and Western blotting were performed to examine the visual pathway features, number of retinal ganglion cells (RGCs), GAP43 expression level in damaged axons, and changes of Tau and pTau-396/404 in the retina and optic nerve.@*RESULTS@#In Epothilone D treatment group, RGC loss rate was significantly decreased by 19.12% (P=0.032) on day 3 and by 22.67% (P=0.042) on day 28 as compared with the rats in the control group, but FVEP examination failed to show physiological improvement in the visual pathway on day 28 in terms of the relative latency of N2 wave (P=0.236) and relative amplitude attenuation of P2-N2 wave (P=0.441). The total Tau content in the retina of the treatment group was significantly increased compared with that in the control group on day 3 (P < 0.001), showing a consistent change with ptau-396/404 level. In the optic nerve axons, the total Tau level in the treatment group was significantly lower than that in the control group on day 7 (P=0.002), but the changes of the total Tau and pTau-396/404 level did not show an obvious correlation. Epothilone D induced persistent expression of GAP43 in the damaged axons, detectable even on day 28 of the experiment.@*CONCLUSION@#Epothilone D treatment can protect against TON in rats by promoting the survival of injured RGCs, enhancing Tau content in the surviving RGCs, reducing Tau accumulation in injured axons, and stimulating sustained regeneration of axons.
Subject(s)
Animals , Rats , Disease Models, Animal , Epothilones , Evoked Potentials, Visual , Nerve Regeneration/physiology , Optic Nerve Injuries/metabolism , Rats, Sprague-Dawley , Retinal Ganglion Cells/physiologyABSTRACT
@#AIM: To evaluate the efficacy and safety of traditional Chinese medicine combined with Western medicine(TCM-WM)in the treatment of traumatic optic neuropathy(TON).<p>METHODS:The computer searched PubMed, EMBASE, Cochrane Library, Chinese Biomedical Literature Database(CBM), Wan-Fang Database, China National Knowledge Infrastructure(CNKI)database and Weipu database. Search time was limited from their inception to May 2020. A comprehensive search strategy was designed to identify all randomized controlled trials(RCTs)comparing TCM-WM therapy versus WM therapy alone. The methodological quality of the included trials was assessed by the quality grade evaluation used in Cochrane handbook. Data extraction and Meta-analysis were performed by RevMan5.3 statistical software.<p>RESULTS: Twelve RCTs were included. The Meta-analysis showed that compared with the WM therapy alone in treating TON, TCM-WM therapy was better in improving the effective rate \〖<i>RR</i>=1.33, 95% <i>CI</i>(1.23-1.45), <i>P</i><0.001\〗, visual acuity \〖<i>MD</i>=0.18,95% <i>CI</i>(0.14-0.23), <i>P</i><0.001\〗, visual field mean defect \〖<i>MD</i>=-3.08, 95% <i>CI</i>(-5.20-0.96), <i>P</i>=0.004\〗, P<sub>100</sub> lantency \〖<i>MD</i>=-9.47, 95% <i>CI</i>(-16.37-2.57), <i>P</i>=0.007\〗 as well as P<sub>100</sub> amplitude \〖<i>MD</i>=1.44, 95% <i>CI </i>(0.22-2.66), <i>P</i>=0.02\〗. Two researches reported the occurrence and treatment of adverse reactions, and the remaining included researches did not report the adverse reactions.<p>CONCLUSION:The TCM-WM therapy in treating TON is more effective compared with the WM therapy alone.
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Objective:To retrospectively analyze the effect of hormone combined with cerebral glycoside carnosine and dehydration drugs in traumatic optic neuropathy (TON) patients.Methods:The enrolled 215 TON patients in our hospital from February 2014 to September 2021 were randomly divided into the combination group ( n=143) and routine group ( n=142). The baseline data, visual acuity recovery before and after treatment and adverse reactions of each group were compared. Univariate analysis was conducted to analyze the differences in indicators of good prognosis and visual acuity improvement between the two groups. Results:The effective rate of vision recovery in the combination group was significantly increased than that in the routine group ( P<0.05). After treatment, the intraocular pressure and visual field defect in the combination group were significantly decreased than those in the routine group ( P<0.05). Univariate subgroup analysis showed that there were statistically significant differences between TON patients with age ≤40 years, residual light sensation after injury, visit time ≤24 h, and VEP not extinguished with combined treatment of hormone, brain glycoside carnotin and dehydrating drugs and the routine group ( P<0.05). Univariate subgroup analysis showed that TON patients with optic canal fracture without optic nerve swelling and tortuosity had a good prognosis after treatment with combined hormone, cerebral glucoside carnosine and dehydration, which was statistically different from that in the routine group ( P<0.05). Conclusions:Brain glycosides carnosine and dehydration therapy on the basis of combined hormone a prednisolone sodium succinate treatment can improve vision in TON patients, lighten the optic nerve injury, will not increase the occurrence risk of adverse reactions, and have higher security. It is necessary to focus on high-risk patient over 40 years old, more than 24 h of treatment time, VEP extinction, optic nerve swelling poor efficacy. It is worthy of clinical promotion.
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@#AIM:To evaluate the clinical efficacy of different interventions of traditional Chinese medicine in the treatment of traumatic optic neuropathy by means of mesh Meta-analysis.<p>METHODS:The Computer searched of Chinese databases(CNKI, VIP, WanFang, SinoMed)and English databases(PubMed, Embase, Cochrane Library). Search time was limited from their inception to March 2020. Randomized controlled clinical trials of traditional Chinese medicine for treatment of traumatic optic neuropathy were subjected to Meta-analysis. Cochrane evaluation tool was used to evaluate the quality of the included studies and Stata 14.2 software was used to conduct network Meta-analysis.<p>RESULTS: Twenty-one RCT studies involving 1 297 patients were included and 7 interventions were involved. Among them, Chinese medicine, Chinese medicine+hormone drugs, acupuncture+Chinese medicine+neurotrophic drugs were better than those with neurotrophic drugs alone. Chinese medicine+hormone drugs, acupuncture+Chinese medicine+neurotrophic drugs, acupuncture+Chinese medicine+hormone drugs were better than that of hormone drugs alone(<i>P</i><0.05), and the intervention measures ranked first in terms of effective treatment rate is acupuncture+Chinese medicine+neurotrophic drugs.<p>CONCLUSION: Chinese medicine has advantages in the treatment of traumatic optic neuropathy. Among them, acupuncture+ Chinese medicine+neurotrophic drugs is most likely to be the best choice.
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@#AIM: To detect the visual dysfunction, and investigate the changes of Tau and its phosphorylated Ser396/Ser404 forms in retinas and optic nerves in traumatic optic neuropathy(TON)model rats by using FVEP technique.<p>METHODS: Totally 30 SD rats were conducted FVEP electrode implantation. One week later, all rates were implemented TON operation with the optic nerve of left eye crushed and the optic nerve of right eye exposed(sham-operated). FVEP detections were performed respectively in these TON model rats at 1, 3, 7, 14, and 28d post crush, with 5 rats tested at each time point. After FVEP tests were taken, rats were sacrificed and then retinas and optic nerves of left eyes were separated for detecting the expression levels of Tau and pTau-Ser396/404 by Western Blot.<p>RESULTS: Typical FVEP waves were observed in the sham-operated eyes. Compared to the sham group, the N2 waves were significantly delayed and the amplitude of N2-P2 were greatly reduced at each time point in the operation eyes. However, the differences of N2 wave and the amplitude reduction of N2-P2 were not significant at each time point after crush. The contents of total Tau protein in retinas of TON rats sharply decreased at 1d post crush, briefly recovered at 7d post crush, and remained a slightly lower level than normal condition till 28d. The changes of pTau-Ser396/404 were consistent with the changes of total Tau in retains and the Ser396 was the main phosphorylation site. However, the total Tau contents in optic nerves of TON rats increased gradually, and peaked at the 14d post crush and remained till 28d. The changes of pTau-Ser396/404 were similar to the changes of total Tau in optic nerves, which peaked at 7d post crush. However, Ser404 was the main phosphorylation site of Tau in optic nerves.<p>CONCLUSION: The related indexes of N2 and P2 waves in FVEP can be used to detect the visual dysfunction in TON rats. After TON, the content changes of total Tau in retinas and optic nerves were much different while the changes of pTau-Ser396/404 followed the alterations of total Tau in the two locations. However, the main phosphorylation site of Tau was differnet according to the locations.
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Introduction: Traumatic Optic Neuropathy (TON) is a devastating potential complication of closed head injury. Indirect traumatic optic neuropathy is seen in up to 5% of closed head trauma in Indian population. The diagnosis of TON is often missed in emergency room unless viewed with a high index of suspicion in patients with unilateral/bilateral Periorbital Ecchymosis. Visual evoked Potential (VEP) can be helpful to document the presence of TON in unresponsive patients or in cases with concomitant ocular injuries. Patients can also be followed with serial VEP examinations to document recovery of function when clinical parameters are equivocal. Aim: To evaluate the usefulness of VEP in prognostigating the outcome in Traumatic Optic Neuropathy and to analyze the clinical parameters useful in predicting the final visual outcome. Methodology: This study was conducted at the Institute of Neurology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai over a 3 year period. 65 patients of closed head injury with indirect traumatic optic neuropathy were enrolled in the study. Patients were subjected to complete physical examination including tests for visual acuity and Swinging torch light test to detect Relative Afferent Pupillary Defect (RAPD). CT scan of the ain and orbits were done. Visual Evoked Potentials were recorded using the Checker–Board pattern Full–field stimulation method. All patients received intravenous methylprednisolone 1gm daily in divided doses for three consecutive days. Results were subjected to Student’s t test and Chi–square test and their prognostic significances were analysed. Results and conclusion: 44 patients in the study with persistant absent VEPs had no visual recovery till end of 4 to 6 months.11 out of 65 patients had improvement in the waveforms over 3 weeks and consequently, improvement in vision at the end of second month. Among clinical features, RAPD grading on admission was predictive of poor visual outcome. Among imaging findings, posterior ethmoid hemmosinus is found to be a negative prognostic sign in patients affected by traumatic optic neuropathy. Thus the present study concludes that VEP can be an useful tool to prognosticate visual outcome in patients with traumatic optic neuropathy.
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Traumatic optic neuropathy (TON) is commonly associated with blunt ocular trauma and craniofacial injuries,leading irreversible visual impairment.Like other mammalian mature central nerve system (CNS) neurons,retinal ganglion cell (RGC) is normally unable to regenerate axon spontaneously after optic nerve injury.The failure of axon regeneration has been attributed to the apoptosis of RGC,loss of intrinsic growth capacity of mature neurons,lack of suitable stimuli,and inhibition of extracellular environment.Via activating the intrinsic growth capacity of mature RGC,overcoming the inhibitory extracellular environment of damaged optic nerve,and providing appropriate inflammatory stimuli to initiate the regeneration process,mature RGC can be transformed into an active regenerative state allowing these neurons to survive axotomy and to regenerate axons in the injured optic nerve.Moreover,exploiting gene therapy based on adeno-associated virus may be a promising translatable treatment strategy for TON.
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PURPOSE: We used optical coherence tomography (OCT) for longitudinal evaluation of structural changes in the peripapillary retinal nerve fiber layer (RNFL), the macular ganglion cell-inner plexiform layer (GC-IPL), and the macula in patients with traumatic optic neuropathy. METHODS: From May 2012 to April 2015, the medical records of 20 patients with monocular traumatic optic neuropathy who were followed up for over 6 months were retrospectively analyzed. Best-corrected visual acuity was checked and Cirrus high-definition optical coherence tomography (HD-OCT) was used to measure the thicknesses of the peripapillary RNFL, macular GC-IPL, and macula of both eyes at the first visit (within 4 weeks after trauma), at 10 and 24 weeks after trauma, and at the final visits. The differences over time in the parameters of the traumatic and fellow eyes were analyzed. RESULTS: The final best-corrected visual acuities of the traumatic and fellow eyes differed significantly from those at the first visit (p = 0.007). The average thicknesses of the peripapillary RNFL, the macular GC-IPL, and the macula differed significantly between the traumatic and fellow eyes commencing 10 weeks after trauma (p < 0.001, p = 0.002, p = 0.003, respectively). CONCLUSIONS: Significant changes in visual acuity preceded structural changes in the retina. Objective assessment of retinal structural changes using OCT yields helpful information on the clinical course of patients with traumatic optic neuropathy.
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Humans , Ganglion Cysts , Medical Records , Nerve Fibers , Optic Nerve Injuries , Retina , Retinaldehyde , Retrospective Studies , Tomography, Optical Coherence , Visual AcuityABSTRACT
Objective To study the curative effect and the prognostic factors of endoscopic traumatic optic neuropathy (TON). Methods The clinical data of 53 patients with TON from 2010 to 2015 years was retrospectively analyzed. Divided the patients into the surgery group and the non-surgery group, according to whether or not accept the treatment of endoscopic optic decompression. And evaluating the potential prognostic factors in chi-square test, group t-test and multiple regression analysis. Results In 53 patients (55 eyes ), 31 eyes have no visual acuity before treated: 8 eyes’ visual acuity was improved in 16 eyes (8/16) that accepted operation; 3 eyes’ visual acuity was improved in 15 eyes (3/15) that with non-operation;24 eyes have visual acuity before treated:11 eyes’ visual acuity was improved in 14 eyes (11/14) that accepted operation;3 eyes’ visual acuity was improved in 10 eyes (3/10) that with non-operation;19 eyes’ visual acuity was improved in 30 eyes (19/30) that accepted operation, the total effective rate was 63.3%, and there was no complications happened in the patients who accepted operation. The age, eye-side, sex, visual acuity, optic canal fracture , orbit fracture , all these factors have no correlation to the prognosis (P>0.05), but the interval time between injury and operation (less than 3 days) and the way of the treatment are benefit to improve vision (P<0.05). Conclusions The endoscopic optic decompression is an effective treatment in TON, and it’s better to improve vision in 3-day after TON.
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Objective To analyze the application effects of endoscopic optic nerve decompression in patients with traumatic optic neuropathy and its effect on visual acuity.Methods From January 2014 to January 2016,100 patients (100 eyes) with traumatic optic neuropathy in our hospital were selected as observation objects.According to different treatment methods,the patients were divided into observation group and control group,50 cases in each group.The control group was treated with drugs,and the observation group with endoscopic sinus decompression of optic nerve on the basis of the control group after the stability of the disease.The patients in two groups were followed up at least 1 year.The clinical efficacy,visual acuity,VEP findings and incidence of adverse reactions were compared between the two groups.Results The effective rates in the observation group and control group were 76.0％ and 36.0％,there was significant difference between two groups (P ＜ O.05).In the observation group,the visual acuity of 16 eyes were improved in 22 eyes with no light perception,9 eyes in 13 eyes with light perception,9 eyes in 11 eyes with hand movement,and 4 eyes with finger counting were all improved;In the control group,the visual acuity of 6 eyes were improved in 20 eyes with no light perception,6 eyes in 14 eyes with light perception,5 eyes in 12 eyes with hand movement,1 eye in 4 eyes with finger counting.After treatment,the incubation period and amplitude of P1O0 in the observation group were (116.85 ±7.96) ms and (5.11 ± 1.16) μV,which were better than the control group (105.62 ±6.82) ms,(4.31 ± 1.25) μV.The incidence of adverse reaction in the observation group was significantly lower than that in the control group (P =O.000).Conclusion The endoscopic optic nerve decompression has a good application effect and safety in patients with traumatic optic neuropathy,can effectively improve the patient's visual acuity,help to improve the quality of life of patients,is worthy of clinical application.
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Traumatic optic neuropathy due to missile injury typically results in unilateral visual loss.[1] We discuss an uncommon case, in which injury from retroocular passage of a single bullet resulted in bilateral orbital perforations, frozen globes, and complete blindness. A 20‑year‑old female presented with bilateral absent light perception detected immediately, following alleged accidental bullet injury. There were no cranial manifestations and sutured skin wounds were visible on the temporal aspects of both the orbits. Bilateral ocular coats were intact with normal intraocular pressure and anterior segments. However, there was bilateral complete afferent pupillary defect and vitreous hemorrhage. Noncontrast computerized tomography (NCCT) imaging revealed multiple orbital and nasal fractures, a bony fragment abutting the right globe [Fig. 1a], and bilateral temporal orbital perforations on reconstructed images [Fig. 1b and c]. The entry wound was left‑sided and slightly lower than the right‑sided exit wound [Fig. 1b and c]. Sonography revealed attached bilateral retinas. The combination of complete afferent and efferent neural dysfunction was attributed to injury of bilateral posterior orbits near the apical region. No ocular intervention was planned due to poor prognoses and absence of any foreign body.
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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.
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Humans , Accidents, Traffic , Atrophy , Fractures, Bone , Korea , Optic Nerve Injuries , Orbital Fractures , Prognosis , Retrospective Studies , Scotoma , Strabismus , Vision Disorders , Visual Acuity , Visual FieldsABSTRACT
AIM:To evaluate the efficacy of treating traumatic optic neuropathy( TON) with mouse nerve growth factor. METHODS: We searched the Cochrane Library, Pubmed, Medline, CNKI, Wanfang database and VIP to collect randomized controlled trials ( RCTs ) of using mouse nerve growth factor for TON. The quality of the included trials was assessed and poor-qualified trials were eliminated before the meta - analysis was conducted. RESULTS:Seven RCTs with a total of 399 eyes included were retrieved, and OR=3. 78 with a 95%CI of [ 2. 35, 6.06], the difference was significant (P CONCLUSION:The existing evidence supports that the prognosis of TON is better when mouse nerve growth factor are adopted in treatment, but there is still a need for well-planned, large-scale and multicenter RCTs to verify it.
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Background: There is an increase in the incidence of traumatic optic neuropathy (TON) due to increasing urbanization and rapid spurt in the number of motor vehicles on the road. Despite early presentation and ease of diagnosis the visual outcomes in TON are still limited. There is also significant confusion about the timing, dose and efficacy of steroid treatment in its management. Purpose: To provide a clinical update of the pros and cons of steroid therapy for TON. Design: The paper is a retrospective review of the currently available literature in the English language indexed in PubMed. Methods: A PubMed search was conducted by the authors using the following terms: Traumatic optic neuropathy, megadose, steroids, methylprednisolone. Relevant original articles, review articles, and case reports related to the topic of discussion were evaluated and discussed in the paper. Results: There is no prospective randomized control trial evaluating the effect of steroids in TON. There are varying reports on the effect of steroid therapy from significant improvement to no difference compared to observation. Conclusion: The decision to give steroids to patients with TON has to be on an individual case to case basis and must involve informed consent from the patient. There are documented advantages and disadvantages of steroid therapy and a prospective, randomized, controlled trial is necessary comparing steroids, surgery and observation before definitive management can be evolved.
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Proanthocyanidins is an effective antioxidants and free radical scavenger derived from kinds of plants in nature. It has some advantages that high absorptivity and bioactivity, low toxicity, which contain broad pharmacological functions such as dropping high blood pressure, reducing blood fat, anti-inflammatory, anti-cancer, anti - aging, anti - fatigue and preventing cardiovascular and cerebrovascular diseases. In this paper, we summarized its physicochemical properties, pharmacologic action and the ophthalmological studies which mainly in keratopathy, cataract, glaucoma, uveitis, retinopathy, traumatic optic neuropathy and asthenopia. With the deeper research and more unequivocal in the pharmacological mechanism of proanthocyanidins, it should make the most of its values in medicine. And some more economical and effective drugs are expected to be provided for the clinical ophthalmology in the near future.
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Objective To analysis the cause of injury of traumatic optic neuropathy and explore the main factors affecting the prognosis of visual acuity. Methods We retrospectively collected clinical data of 104 cases (108) of traumat-ic optic neuropathy from January 2007 to December 2012 in the Renhe Hospital of Three Gorges University. We then ex-amined the cause of injury and analyzed risk factors for poor prognosis of visual acuity in traumatic optic neuropathy us-ing multivariate Logistic regression analysis. Results The mean age of patients was 33.6 ± 12.8 years and 95 cases (91.3%) were males. The injury was mainly caused by non-motor vehicle and motor vehicle accidents (84 cases, 80.8%). Most of the patients came to the hospital within 3 days after the injury (81 cases, 77.9%). Overall efficacy rate of treat-ment was 45.4%(49/108). The effective rate was 29.9%(20/67) for visual acuity without light perception and 70.7%(29/41) for visual acuity with light perception, respectively. Logistic regression analysis showed that the time to treatment≥24h, orbital hemorrhage or orbital fracture, ethmoid or sphenoid sinus bleeding and no light perception vision were an in-dependent prognostic factors. Conclusion Time to treatment time and severity of injury are the independent risk factors for poor visual prognosis of traumatic optic neuropathy whereas controlling these risk factors has important clinical signifi-cance to the treatment and prognosis of traumatic optic neuropathy.
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Traumatic optic neuropathy is a complication resulting from facial trauma, with an incidence of 2% to 5%. The most widely accepted treatments include observation, high dose steroid, surgical decompression and combination therapy of steroid and surgical treatment. However, there has been no established mode of treatment and there are still debates about what the best treatment should be for the patients with optic canal fracture. We experienced two cases of traumatic optic neuropathies due to intracanalicular fracture of the optic canal after trauma. Surgical decompression was performed using an endoscope int-ranasally one day after injury as required for minimal invasive surgery. We report the results and progression of these two cases.
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Humans , Decompression , Decompression, Surgical , Endoscopes , Incidence , Optic Nerve , Optic Nerve InjuriesABSTRACT
·AIM: To evaluate the clinical presentations of traumatic optic neuropathy and to assess the visual outcome of three groups of patients managed differently (conservative, intravenous corticosteroids only and combination of intravenous and oral corticosteroids) at an academic tertiary care referral centre.·METHODS: A retrospective study was conducted involv-ing 24 consecutive patients (27 eyes) with traumatic optic neuropathy attending Hospital Universiti Sains Malaysia from January 2007 till December 2009.·RESULTS: Twenty-four patients (27 eyes) were included. All cases involved were male. Mean age was 33 years old. Motor vehicle accident was the major cause (83%). Both eyes were equally involved. Most of the eyes had poor vision on presentation (HM-NPL, 82%) with associated periorbital haematoma (22 eyes) and subcon-junctival haemorrhage (20 eyes). Majority of patients (19 patients, 79%) presented with more than one bony fracture of skull or orbit and 5 patients (21%) had no fractures. None of the patients had evidence of optic nerve compression on CT scans or MRI done. Eleven patients (46%) had been treated with intravenous and oral corticosteroids. The other 7 patients (29%) were treated conservatively and the third group (6 patients, 25%) was on intravenous corticosteroids only. Eleven of 12 eyes (92%) treated with intravenous and oral corticosteroids had showed 1 line improvement of visual acuity. Those eyes treated conservatively (78%) had showed 1 line improvement of visual acuity. As for patients treated with intravenous corticosteroids only, four patients remained NPL, one patient had mild visual improvement and the other one's vision remained the same. The visual improvement in patients treated with conservative management was not significant (P=0.386). Patients treated with intravenous corticosteroids alone have shown no statistical visual improvement (P<0.05). Patients treated with intravenous followed by oral corticosteroids had significant visual improvement (P<0.05). There was no statistically significant difference in visual outcome between patients treated with corticoster-oids and patients treated conservatively (P=0.368). No patient underwent surgical decompression of the optic nerve. In this series, the follow-up ranged from 6 months to 3 years.·CONCLUSION: Most of the traumatic optic neuropathy patients are presented with periorbital haematoma, subconjunctival haemorrhage and orbital wall fractures. Patients treated with intravenous followed by oral corti-costeroids have better visual outcome compared to conservative management.