112 Neuropathies optiques traumatiques extra-canalaires sévères : efficacité de la stratégie chirurgicale première

Abstract

Despite numerous studies addressing intra-orbital traumatic optic neuropathy (TON) after facial trauma, therapeutic strategy is still unclear regarding use of corticosteroids, surgical treatment, or clinical observation alone in literature: recent studies recommend an observation period with corticoid therapy before surgical management, which is completely different from our primary urgent surgical management. Our work was designed to assess visual outcomes using this strategy. A 5-year retrospective review of surgically treated patients with TON following orbital fracture in maxillo-facial surgery and ophthalmology services in hospital. Visual acuities, visual outcomes, surgical technique and delay were recorded. Among 1053 patients undergoing surgery for orbital fracture, 20 patients experienced TON with dramatic visual loss and were surgically treated. Several intra-orbital mechanisms for visual loss were recorded. Complete visual recovery was reached in 80% when surgery occurred within 12 hours after amaurotic TON. Optic nerve decompression used mid-palpebral approach in all cases. After literature review, reported percentage of complete recovery after severe TON (i.e. with visual loss < counting fingers) vary from 10% to 55%. Our results (visual improvement > 80%) suggest that fast intra-orbital optic nerve decompression provides a better visual outcome as compared to clinical observation, primary 24- or 48-hours corticoid therapy, or delayed surgery. Primary urgent orbital decompression is an efficient strategy for severe, even amaurotic, extracanalar traumatic optic neuropathy, as compared to literature review.