Risk Factor Analysis for the Outcomes of Indirect Traumatic Optic Neuropathy with No Light Perception at Initial Visual Acuity Testing

Lai, I-Li; Liao, Han-Tsung

doi:10.1016/j.wneu.2018.04.121

Cited by 13 publications

(9 citation statements)

References 36 publications

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“…Observation without intervention is a valid management option for patients with posterior TON. Many patients (>50% in some series) improve spontaneously, 23,28,34,51 and although patients with no light perception from TON have a worse visual prognosis than patients with some residual vision, [52][53][54] even patients with well-documented no light perception may improve to useful vision without treatment. 9,23,55,56 Indeed, there is no convincing evidence that any medical or surgical intervention is superior to observation.…”

Section: Observationmentioning

confidence: 99%

Traumatic Optic Neuropathy

Miller

2021

J Neurol Surg B Skull Base

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A host of different types of direct and indirect, primary and secondary injuries can affect different portions of the optic nerve(s). Thus, in the setting of penetrating as well as nonpenetrating head or facial trauma, a high index of suspicion should be maintained for the possibility of the presence of traumatic optic neuropathy (TON). TON is a clinical diagnosis, with imaging frequently adding clarification to the full nature/extent of the lesion(s) in question. Each pattern of injury carries its own unique prognosis and theoretical best treatment; however, the optimum management of patients with TON remains unclear. Indeed, further research is desperately needed to better understand TON. Observation, steroids, surgical measures, or a combination of these are current cornerstones of management, but statistically significant evidence supporting any particular approach for TON is absent in the literature. Nevertheless, it is likely that novel management strategies will emerge as more is understood about the converging pathways of various secondary and tertiary mechanisms of cell injury and death at play in TON. In the meantime, given our current deficiencies in knowledge regarding how to best manage TON, “primum non nocere” (first do no harm) is of utmost importance.

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Section: Observationmentioning

confidence: 99%

Traumatic Optic Neuropathy

Miller

2021

J Neurol Surg B Skull Base

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“…As an effective and safe therapy for ITON, ETOCD has been widely used as one of the most important treatments of ITON for decades [7][8][9][10][11][12]. However, the associated Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic trans-ethmosphenoid optic canal decompression (ETOCD), an effective and less invasive approach of optic canal decompression, has become a trend in recent decades. Various studies reported positive outcomes from ETOCD surgery for ITON cases [7][8][9][10][11][12]. However, the underlying principle of ETOCD has not yet been proven.…”

Section: Introductionmentioning

confidence: 99%

The retinal vasculature pathophysiological changes in vision recovery after treatment for indirect traumatic optic neuropathy patients

Gao

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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Purpose To evaluate the retinal vasculature pathophysiological changes of indirect traumatic optic neuropathy (ITON) patients after effective surgery. Methods Monocular ITON patients who underwent endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) or conservative treatments in Zhongshan Ophthalmic Center from January 2017 to June 2020 were recruited. Visual acuity (VA), visual evoked potential (VEP), oxygen saturation of retinal blood vessels (SO2), and optical coherence tomography angiography (OCT-A) were measured. All patients were followed up at least 3 months after treatments. Results A total of 95 ITON patients were recruited, including 77 patients who underwent ETOCD and 18 patients who underwent conservative treatments. After treatments, more patients received ETOCD (59/77 = 76.6%) presented with improved VA compared with the patients with conservative treatments (6/18 = 33.3%). Compared with the pre-therapeutic measurements, VEP were significantly improved after surgery in ETOCD-treated patients (P < 0.05). Latent periods of P1 and N2, as well as amplitude of P2 of VEP parameters, showed more sensitive to vision recovery (P < 0.05). Retinal artery SO2 and the differences between arteries and veins were improved in ETOCD-treated patients (P < 0.05). Meanwhile, with OCT-A examination, the retinal thickness and retinal vessel density were notably better in ETOCD-treated patients after surgery than that in patients received conservative treatments (P < 0.05). Conclusions Vision recovery after effective treatment of ITON patients was associated with the increased oxygen saturation of retinal vessels, better availability of oxygen in the retina, greater vessel density, and thicker retinas, which might further underlie the vasculature mechanism of vision recovery in ITON patients.

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“…However, importantly, several studies that compared decompression with observation and corticosteroid therapy did not demonstrate any significant advantage compared with surgical therapy. 14,16,19,20,25 Moreover, several complications were reported with optic canal decompression, including cerebrospinal fluid leakage, infection, and bleeding. As with corticosteroid therapy, optic canal decompression should be undertaken only after a frank discussion with patients about the potential benefits, drawbacks, and lack of strong evidence for this method's efficacy.…”

Section: Discussionmentioning

confidence: 99%