Comparison of optic canal decompression and hormone shock therapy in the treatment of optic nerve injury

Abstract

Objective To observe the effect of optic canal decompression and hormone shock therapy on visual prognosis of the patients with optic canal fracture. Methods The clinical data of 68 patients with optic nerve injury treated in the Department of Neurosurgery, the First Affiliated Hospital of Xinjiang Medical University from December 2010 to May 2017 were included. All were monocular damage. Among them, there were 49 males, 19 females, 38 left eyes, and 30 right eyes. The age of the patients was 21~58 years, and the average age of the patients was (35.6±3.4) years. In the cause of injury, including 31 cases of traffic injury, 22 cases of falling injury and fall injury in 15 cases; in 12 hours after injury in 22 patients, 12 ~ 24 hours were 8 cases, 15 cases of injury after 1 to 3 days of treatment, 15 cases in 4 to 7 days after injury patients in 8 cases, seventh to thirtieth days after injury patients. According to the different methods of clinical treatment, the patients were divided into surgical treatment group and hormone shock treatment group. The surgery group 41 cases, male 28 cases, female 13 cases, average age (36.1±3.8) years old, the average duration of (6.2±2.8) days, were treated with optic nerve decompression therapy; hormone impact treatment group of 27 cases, 6 cases were male, 21 were female, the average age (34.5±3.1) years old, average course (6.7±3.1) days, were treated with hormone shock therapy. The two groups of patients all observed their visual acuity and fundus on the third, seventh and 30 days after the operation or the beginning of the treatment. After surgery or after treatment, visual improvement is found to be effective. No improvement in visual acuity after surgery or after treatment is found to be invalid. The effectiveness of the two groups was described by the number and percentage of cases, and the efficiency of the treatment was compared with the chi square test. Results In the operation group, 19 cases were effective, 22 cases were ineffective, and the recovery rate of visual acuity was 46.34%. In the hormone shock treatment group, 8 cases were effective, 19 cases were ineffective, and the recovery rate of visual acuity was 29.63%. The visual recovery efficiency of the two groups of patients was compared. There is no statistical significance in the difference(χ2=1.90, P>0.05). In the operative group, 25 patients had light perception to 0.02 of vision before operation, and 13 cases had vision improvement after treatment. Among them, 18 cases were injured within 3 days, 11 cases were effectively recovered, 7 cases were injured for 3 days or more, and 2 cases were effectively recovered. There were 16 cases without photoperfusion before operation, 6 cases recovered to some extent after surgery, 10 cases of them were injured within 3 days, 4 cases were effectively recovered, 6 cases were injured 3 days or more, and 2 cases were effective. In the steroid therapy group, before treatment, visual acuity and visual acuity of 0.02 to light perception in 13 cases, visual acuity improved after treatment had 5 cases; the injured within 3 days of treatment in 7 cases, effective recovery of 3 cases were injured; 3 days and more than 6 cases, 2 cases were effective. A total of 14 cases were not photoreceptor. After treatment with hormone pulse therapy, 3 cases recovered some visual acuity. 10 cases were injured within 3 cases, 2 cases were effectively recovered, 4 cases were injured 3 days or more, and one case had effective recovery. A total of 45 cases were injured within 3 days. Effective recovery was achieved in 27 cases, and the effective rate was 60.0%. There were 23 cases who had been injured for 3 days or more. Effective recovery was found in 7 cases, and the effective rate was 30.4%. After the chi square test, the difference between the two groups was statistically significant (χ2=5.32, P<0.05). It shows that timely treatment after injury can improve the efficiency of the operation. Conclusion Early optic canal decompression and hormone shock therapy for patients with optic nerve injury can effectively promote the recovery of the individual′s visual acuity. Key words: Optic canal decompression; Hormone therapy; Optic canal fracture; Vision