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Treatment of traumatic optic neuropathy: our experience of endoscopic optic nerve decompression

Published online by Cambridge University Press:  28 April 2008

H Li ,
B Zhou ,
J Shi ,
L Cheng ,
W Wen  and
G Xu
H Li
Affiliation:
Department of Otolaryngology, The First Affiliated Hospital, Nanjing Medical University, China Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University and the Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, China
B Zhou
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
J Shi
Affiliation:
Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University and the Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, China
L Cheng
Affiliation:
Department of Otolaryngology, The First Affiliated Hospital, Nanjing Medical University, China
W Wen
Affiliation:
Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University and the Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, China
G Xu*
Affiliation:
Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University and the Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, China
*
Address for correspondence: Dr Geng Xu, Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-sen University and Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, China, 510080. Fax: 86 20 87333108 E-mail: [email protected]
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Abstract

Objective:

Traumatic optic neuropathy can be treated by various methods including steroids and surgical decompression. Endoscopic optic nerve decompression has been suggested to be effective in treating this condition. The aim of this study was to assess the outcome of treating traumatic optic neuropathy with steroids and endoscopic surgical decompression.

Methods:

Two hundred and thirty-seven patients with traumatic optic neuropathy were treated with steroids; 176 also consented to endoscopic optic nerve decompression.

Results:

The total vision improvement rate was 55 per cent in the 176 patients treated with both steroids and endoscopic optic nerve decompression, compared with 51 per cent in the 61 patients treated with steroids alone; this difference was not statistically significant (p > 0.05). Treatment with steroids plus endoscopic optic nerve decompression resulted in a significantly greater vision improvement in patients with gradual vision loss, compared with those with immediate blindness (68 vs 42 per cent, respectively). Early surgery (within one week) was an important prognostic factor for vision recovery, compared with more delayed surgical treatment (associated vision improvement rates were 60 and 31 per cent, respectively).

Conclusions:

Endoscopic optic nerve decompression is a minimally invasive, safe and efficient treatment for traumatic optic neuropathy. Used in combination with steroids, it provides effective rescue for some patients suffering visual loss. It should be undertaken as soon as possible.

Keywords

Optic NerveEndoscopyOtorhinolaryngological Surgical Procedures
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 12 , December 2008 , pp. 1325 - 1329
Copyright
Copyright © JLO (1984) Limited 2008

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References

1Chou, PI, Sadun, AA, Chen, YC. Clinical experiences in the management of traumatic optic neuropathy. Neuro-ophthalmology 1996;16:325–36CrossRefGoogle Scholar
2Sarkies, N. Traumatic optic neuropathy. Eye 2004;18:1122–5CrossRefGoogle ScholarPubMed
3Carta, A, Ferrigno, L, Salvo, M, Bianchi-Marzoli, S, Boschi, A, Carta, F. Visual prognosis after indirect traumatic optic neuropathy. J Neurol Neurosurg Psychiatry 2003;74:246–8CrossRefGoogle ScholarPubMed
4Spoor, TC, Hartel, WC, Lensink, DB, Wilkinson, MJ. Treatment of optic neuropathy with corticosteroids. Am J Ophthalmol 1990;110:665–9CrossRefGoogle ScholarPubMed
5Joseph, MP, Lessell, S, Rizzo, J, Momose, J. Extracranial optic nerve decompression for traumatic optic neuropathy. Arch Ophthalmol 1990;108:1091–3CrossRefGoogle ScholarPubMed
6Osguthorpe, JD. Transethmoid decompression of the optic nerve. Otolaryngol Clin North Am 1985;18:125–37CrossRefGoogle ScholarPubMed
7Kountakis, SE, Maillard, AA, Urso, RG, Stiernberg, CM. Endoscopic approach to traumatic visual loss. Otolaryngol Head Neck Surg 1997;116:652–5CrossRefGoogle ScholarPubMed
8Luxenberger, W, Stammberger, H, Jebeles, JA, Christian, W. Endoscopic optic nerve decompression: the Graz experience. Laryngoscope 1998;108:873–82CrossRefGoogle ScholarPubMed
9Jiang, RS, Hsu, CY, Shen, BH. Endoscopic optic nerve decompression for the treatment of traumatic optic neuropathy. Rhinology 2001;39:71–4Google ScholarPubMed
10Yip, CC, Chng, NW, Au Eong, KG, Heng, WJ, Lim, TH, Lim, WK. Low-dose intravenous methylprednisolone or conservative treatment in the management of traumatic optic neuropathy. Eur J Ophthalmol 2002;12:309–14CrossRefGoogle ScholarPubMed
11Lew, H, Lee, SY, Jang, JW, Kim, HY, Kang, SJ, Kim, SJ. The effects of high-dose corticosteroid therapy on optic nerve head blood flow in experimental traumatic optic neuropathy. Ophthalmic Res 1999;31:463–70CrossRefGoogle Scholar
12Yang, WG, Chen, CT, Tsay, PK, de Villa, GH, Tsai, YJ, Chen, YR. Outcome for traumatic optic neuropathy – surgical versus nonsurgical treatment. Ann Plast Surg 2004;52:36–42CrossRefGoogle ScholarPubMed
13Levin, LA, Beck, RW, Joseph, MP, Seiff, S, Kraker, R. The treatment of traumatic optic neuropathy: the International Optic Nerve Trauma Study. Ophthalmology 1999;106:1268–77CrossRefGoogle ScholarPubMed
14Perry, JD. Treatment of traumatic optic neuropathy remains controversial. Arch Otolaryngol Head Neck Surg 2004;130:1000CrossRefGoogle ScholarPubMed
15Thakar, A, Mahapatra, AK, Tandon, DA. Delayed optic nerve decompression for indirect optic nerve injury. Laryngoscope 2003;113:112–19CrossRefGoogle ScholarPubMed
16Rajiniganth, MG, Gupta, AK, Gupta, A, Bapuraj, JR. Traumatic optic neuropathy: visual outcome following combined therapy protocol. Arch Otolaryngol Head Neck Surg 2003;129:203–6CrossRefGoogle ScholarPubMed
17Kountakis, SE, Maillard, AA, El-Harazi, SM, Longhini, L, Urso, RG. Endoscopic optic nerve decompression for traumatic blindness. Otolaryngol Head Neck Surg 2000;123:34–7CrossRefGoogle ScholarPubMed