Abstract
ObjectiveTo evaluate potential clinical parameters having an impact on visual outcome after endoscopic optic nerve decompression in acute optic neuropathy patients.MethodsA retrospective chart review of patients with acute optic neuropathy, who underwent endoscopic optic nerve decompression between June 2001 and November 2018 at an academic center was performed. Patients were divided into groups according to visual improvement after surgical treatment (yes/no). Following clinical parameters were compared between groups: perioperative steroid use, evidence of optic nerve affection in preoperative neuroimaging, additional optic nerve sheath incision, surgery delay and preoperative C-reactive protein (CRP) levels. Further subgroups analyses were conducted based on etiology (trauma/tumor).ResultsAmong 32 included cases, 16 patients (50%) reported visual improvement after endoscopic optic nerve decompression. There was no significant difference in visual improvement between etiology subgroups (trauma: n = 9/20 (45%) vs. tumor: n = 7/12 (58.3%), p = 0.465). Tumor subgroup patients with visual improvement had a significantly higher prevalence of optic nerve affection in preoperative neuroimaging than those without visual improvement (p = 0.018, φ = 0.683). Perioperative steroid administration was negatively associated with visual outcome (p = 0.034, φ = 0.375). Nerve sheath incision, surgery delay and preoperative CRP levels did not have a significant impact on visual outcome (p > 0.05).ConclusionRadiological findings can help as an indicator for surgical treatment since an affected optic nerve in preoperative neuroimaging resulted in better visual outcome after surgery. The use of steroids should be considered more carefully since it did not show any beneficial effect.
Highlights
Acute optic neuropathy can be defined as acute damage to the optic nerve resulting in prompt ophthalmologic symptoms like blurry vision, decreased color vision, scotomas, visual field defects and visual impairment
Moreoriginal article over, there is no consensus on optimal timing of surgery and the beneficial effect of additional optic nerve sheath incision as well as perioperative corticosteroid use [12, 13]. Taking these facts into account, we retrospectively evaluated in the present study all patients, who underwent endoscopic optic nerve decompression at our department, and analyzed clinical parameters, which may have had an impact on visual outcome in order to adapt the treatment management for future cases and to help establish guidelines for this treatment modality
There was no significant association between etiology and visual improvement outcome (visual improvement/trauma: n = 9/20 (45%), visual improvement/tumor: n = 7/12 (58.3%); χ2(1) = 0.533, p = 0.465)
Summary
Acute optic neuropathy can be defined as acute damage to the optic nerve resulting in prompt ophthalmologic symptoms like blurry vision, decreased color vision, scotomas, visual field defects and visual impairment. Causes include optic nerve ischemia, inflammation, tumor compression and traumatic optic nerve injury [1]. Optic nerve injury in preoperative imaging is associated with visual improvement outcome in endoscopic. The physical examination is focused on the ophthalmological assessment, including the measurement of the visual acuity, pupillary light reaction, fundoscopy and perimetry. Neuroimaging is obligatory for evaluation of optic nerve lesions and signs of fracture. CT imaging can identify lesions nearby the optic nerve and inside the orbit, causing damage to the nerve by direct compression or infiltration [6,7,8]. In nontraumatic cases the MRI is the imaging modality of choice for a precise evaluation of the orbit, optic nerve and surrounding area [9,10,11]
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