The outcome of surgical and non-surgical treatments for traumatic optic neuropathy: a comparative study of 685 cases

Abstract

Background: The choice and efficacy of surgical or/and surgical treatments for traumatic optic neuropathy (TON) remained controversial by now. This study aims to present the outcomes of surgical and nonsurgical treatments for TON in our center.Methods: A total of 685 consecutive patients were retrospectively included in the study. And divided into surgical and non-surgical groups. All cases were treated with corticosteroids for 3 days after admission.Endoscopic optic decompression was applied to 479 patients of surgical group; The other 206 patients of nonsurgical were administered with corticosteroids alone. The visual outcomes before and after treatment were compared with Wilcoxon rank and tests. The improvement rate between two groups were compared with chi-square test.Results: The visual acuity (VA) after treatment was significantly better than that before treatment (P=0.000).Overall VA improvement rate in the surgical group was better than that in non-surgical group (42.8% vs. 35.4%) with no significant difference (P=0.072). The VA improvement rate was significant greater in the surgical group than that in the non-surgical group in the patients with NLP before treatment (P=0.028). The VA improvement rate was better in the surgical group than that in the non-surgical group (71.9% vs. 57.8%) but with no significant difference. The final overall VA was 0.1 or better in 43 cases; 104 cases were able to count fingers; hand motion (HM) became perceivable in 132 cases; light perception (LP) was achieved in 53 cases; and no light perception (NLP) remained in 353 cases.Conclusions: Endoscopic optic nerve decompression (EOND) combined with corticosteroids or corticosteroids alone could reach the improvement for patients with TON. The EOND combined with corticosteroids could achieve better VA improvement in patients with NLP.

Traumatic Optic Neuropathy: Update on Management

“…Different researchers published their surgical techniques to treat TON [ 86 – 88 ]. Wang Wei et al found that endoscopic optic nerve decompression combined with corticosteroids achieved better visual outcomes in patients with no light perception [ 89 ]. In a study by Li et al, 71% of patients treated within a week of injury showed improved vision after extracranial optic nerve decompression [ 90 ].…”

Direct vs. Indirect Etiology of Traumatic Optic Neuropathy

“…In some studies, it is observed that, based on the assumption, some patients may have spontaneous vision recovery due to natural healing processes or collateral circulation. Mild visual loss in patients may need treatment in cases of presentation contraindications to corticosteroids or surgery or a preference for noninvasive management (20). We need to keep in mind that it is advised to have Observation towards patients may also be indicated for patients with direct (TON) from penetrating injury or complete transection of the optic nerve, as these cases have poor prognoses regardless of treatment.…”

Visual-evoked potential predicts the efficacy of the optical canal decompression for traumatic optic nerve neuropathy showing blindness: A case report

“…[9] However, some studies have reported that surgical decompression is more effective than steroid therapy alone because it relieves the constriction of the optic nerve in the osseous structure, especially in cases of optic canal swelling due to edema, hematoma, or nerve swelling. [3,14] However, surgical results vary because there are no reliable criteria for surgical indication. [15] We report a unilateral TON case complaining of blindness showing approximately 50% visual-evoked potential (VEP) activity, where VEP had begun to recover immediately after decompression during OCD operation.…”

“…[ 9 ] However, some studies have reported that surgical decompression is more effective than steroid therapy alone because it relieves the constriction of the optic nerve in the osseous structure, especially in cases of optic canal swelling due to edema, hematoma, or nerve swelling. [ 3 , 14 ] However, surgical results vary because there are no reliable criteria for surgical indication. [ 15 ]…”