Therapeutic efficacy of optic nerve decompression on traumatic optic neuropathy

Abstract

Objective To evaluate the therapeutic efficacy of optic nerve decompression in patients with traumatic optic neuropathy (TON).Methods In a retrospective study,the clinical data of 24 consecutive patients (24 eyes) with TON treated with optic nerve decompression after failure of mega-dose steroid therapy were analyzed.Preoperative visual acuities were no light perception in 14 eyes,light perception in 8 eyes and counting finger in 2 eyes.Optic nerve decompression by orbital-ethmoidal sinus route were performed in 14 cases,and 10 cases were treated by transnasal endoscopic optic nerve decompression.Their visual outcomes were summarized after follow-up for 2 - 24 months.Results In total 24 patients,visual acuity improved in 17 cases,the total effective rate was 70.8％.In which 7 cases visual acuities reached 0.05 to 0.8 (29.1％) ; All 10 patients with a residual vision ( light perception or counting fingers ) preoperatively showed improvement of their visual acuities ( 100％ ).In 14 patients with posttraumatic blindness,visual acuities improved in 7 cases (50％).Decompression was performed within 3 -7 days after injury in 10 cases with posttraumatic blindness,visual acuities improved in 6 cases (60％).But decompression was performed within 8 - 23 days after injury in 4 cases with posttraumatic blindness,visual acuity improved in 1 cases (25％).Conclusion Optic nerve decompression is an effective and safe treatment for patients with TON after failure of mega-dose steroid therapy.The surgery is indicated for the patients with some posttraumatic residual visions.For the patients with posttraumatic no light perception,optic nerve decompression should be performed within 3 -7 days after injury. Key words: Optic nerve injuries; Therapy; Decompression