Asswss the effects of high-dose steroids in the management of traumatic optic neuropathy

ABSTRACT

This study was carried out in 47patients (47 eyes) with traumatic optic neuropathy admitted Cho Ray Hospital from March 2003 to March 2004, among them 39 cases were treated by high-dose corticoids. The percentage of traumatic optic neuropathy was 0.32% of all head trauma cases. Among 47 patients, there were 44 males, 3 females, mean age 30 years old, lesions were in 18 right eyes and 29 left eyes, traffic accidents were in 46 cases (97.9%), mainly were motorcycle accidents. The mean duration for finding lesions is 20 hours and mean duration for treating is 37 hours. Visual acuity was severely decreased 76.6% patients with no light perception, 85% patients with no light perception and light perception. Concomitant traumas included injuries in ear, nose and throat trauma (51.1%), teeth (40.4%), head (38.3%). CT scan finding revealed fractures of orbit in 19 cases (40.4%), of optic canal in 6 cases (15%). Treatment with high-dose corticoids (methyl-prednisolone IV 500mg-1999mg a day) for 39 cases had more effective than no treatment or low-dose corticoids (< 500mg) in 8 cases. The percentage of vision recovery in high-dose corticoid group was 38.5%, with 2 cases had complications of high glycaemia (5.1%). Early treatment within 8 hours after trauma could give higher rate of recovery. Prognostic factors for no recovery included vision acuity after trauma was no light perception, 4-grade soft tissue lacerations and no response after 48 hours of high-dose corticoids. In the optic neuropathy, the rate of vision recovery in high-dose corticoid group was 38.5%, and treating by high-dose corticoids had few complications, more effective than low-dose corticoids (p<0.05)