Traumatic optic neuropathy in orbital wall fractures- diagnostic parameters and treatment outcomes: A prospective observational study

Natarajan, Srivalli; Baviskar, Padmakar Sudhakar; Gandevivala, Adil; Gupta, Himika; Vichare, Shruti N.

doi:10.1016/j.jormas.2021.06.010

Cited by 6 publications

(10 citation statements)

References 19 publications

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“…Our ndings are similar to those of previous studies by Natarajan et al and Sakong et al, who found that the highest incidence of TON was noted with lateral orbital wall involvement, and the occurrence of TON was notably elevated at 1.796% in cases involving the lateral wall (1,13). In our study, MVA was the most common injury mechanism reported in 46 patients, compared with traumatic injuries reported in 23 patients.…”

Section: Discussionsupporting

confidence: 92%

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Incidence of Traumatic Optic Neuropathy Associated with Subtypes of Orbital Wall Fracture: A Systematic Review

Alshammari,

AlRajhi,

AlNojaidi

et al. 2023

Preprint

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Background: Traumatic optic neuropathy (TON) is a rare condition with serious consequences. One common cause of TON is orbital wall fracture, which can occur at any site. This study aimed to report the incidence of TON in orbital wall fractures. Materials and Methods: A systematic search of Medline, Scopus, and the Directory of Open Access Journals (DOAJ) was conducted. The following terms were used: (traumatic optic neuropathy OR blindness) AND (craniofacial trauma OR facial fractures OR fracture pattern OR orbital wall fracture OR Visual field orbital wall fractures) AND (Visual acuity OR Visual evoked potential) AND (Mega-dose steroid therapy OR corticosteroids). This review encompassed both Randomized Controlled Trials (RCTs) and observational investigations, comprising both prospective and retrospective studies. Results: Four studies met our inclusion criteria with 2720 patients included in this study. Most of the patients were males (n = 2175, 80%). A total of 3791 orbital wall fracture subtypes were reported in the included patients. Of them, 1522 patients had multiple fractures. The highest incidence of fracture was floor fracture, with an Event Rate (ER) of 42.2%, followed by lateral fracture (ER = 37.9%), roof fracture (ER = 36.2%), and medial fracture with ER (29%). Motor vehicle accidents were the most common injury mechanism reported in 46 patients, compared with traumatic injuries reported in 23 patients. Conclusion: Lateral and superior orbital wall fractures were the most common orbital fractures in patients with TON. Periorbital hematoma and subconjunctival hemorrhage were the most frequently reported complications. Hence, ophthalmologists treating patients with TON should prepare radiological assessments and consider the surrounding structures to prevent damage to other structures.

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Section: Discussionsupporting

confidence: 92%

“…Further details can be seen in Figure 3. One study reported the severity of fractures, out of 55 fractures, 41 fractures were linear and 14 were comminated (1). In terms of management and complications, all patients in Natarajan et al and Lee et al were treated with steroids (1,4) .…”

Section: Features Of Orbital Wall Fractures In Patients With Tonmentioning

confidence: 99%

Incidence of Traumatic Optic Neuropathy Associated with Subtypes of Orbital Wall Fracture: A Systematic Review

Alshammari,

AlRajhi,

AlNojaidi

et al. 2023

Preprint

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“…Most of our patients were males with a mean age of 34 ± 17.65 years. [ 10 11 ] This was suggestive of a higher involvement of the working class population. Literature reports a higher incidence of indirect TON compared to direct TON.…”

Section: Discussionmentioning

confidence: 99%

“…Pupillary reactions, BCVA, visual field testing, and visual evoked potential testing are known to be most sensitive in diagnosing and prognostication of the visual recovery post-trauma in the absence of any obvious injury to ON. [ 11 ] However, all of these are not possible in every facility. Hence, baseline visual acuity is a very reliable predictor of visual outcome, as found in our study.…”

Section: Discussionmentioning

confidence: 99%

Clinical profile and visual outcome in patients with traumatic optic neuropathy

Shah

Sujithra

Greeshma

2023

Indian Journal of Ophthalmology

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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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“…However, numerous issues remain unresolved in clinical practice, such as surgical e cacy, indications for surgery, and optimal timing for surgical intervention [8] . Novel treatment modalities, including stem cell therapy and neurotrophic factor therapy, are also being explored; however, most are still in the experimental stage [9][10] .…”

Section: Introductionmentioning

confidence: 99%

Effects of light perception on visual function recovery in patients with traumatic optic neuropathy

Wang

Xue

Tan

et al. 2023

Preprint

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Objective This study aimed to assess the impact of light perception presence or absence on visual function recovery in patients with traumatic optic neuropathy (TON). Methods A retrospective analysis was conducted on the clinical data of 206 TON patients. Based on the presence or absence of light perception after injury, patients were categorized into a light perception group and a non-light perception group. A comparison was made between the two groups regarding visual acuity recovery before and after treatment. Results The non-light perception group comprised 63 patients, with a treatment effectiveness rate of 39.68%. The light perception group consisted of 143 patients, with a treatment effectiveness rate of 74.83%. The difference between the two groups was statistically significant (χ2 = 23.464, P < 0.01). Subgroup analysis indicated that surgical treatment appeared to be more effective than steroid hormone therapy for patients with light perception. Conversely, for patients without light perception, there was no significant difference in the effectiveness of the two methods. Conclusion The total effectiveness rate of the light perception group was significantly higher than that of the non-light perception group, suggesting that patients with light perception before treatment experience better outcomes compared to those without light perception. Treatment choices should be individualized to ensure optimal results.

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Traumatic optic neuropathy in orbital wall fractures- diagnostic parameters and treatment outcomes: A prospective observational study

Cited by 6 publications

References 19 publications

Incidence of Traumatic Optic Neuropathy Associated with Subtypes of Orbital Wall Fracture: A Systematic Review

Incidence of Traumatic Optic Neuropathy Associated with Subtypes of Orbital Wall Fracture: A Systematic Review

Clinical profile and visual outcome in patients with traumatic optic neuropathy

Effects of light perception on visual function recovery in patients with traumatic optic neuropathy

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