Levin L A, Beck R W, Joseph M P, Seiff S, Kraker R
Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, USA.
Ophthalmology. 1999 Jul;106(7):1268-77. doi: 10.1016/s0161-6420(99)00707-1.
To compare the visual outcome of traumatic optic neuropathy treated with corticosteroids, treated with optic canal decompression surgery, or observed without treatment.
Comparative nonrandomized interventional study with concurrent treatment groups.
A total of 133 patients with traumatic optic neuropathy (127 unilateral and 6 bilateral) who had an initial visual assessment within 3 days of injury. At least 1 month of follow-up was required for inclusion in the primary analysis.
On the basis of treatment received within 7 days of injury, patients with unilateral injuries were categorized as being in one of three treatment groups: untreated (n = 9), corticosteroid (n = 85), or optic canal decompression surgery (n = 33).
Visual acuity.
Visual acuity increased by > or = 3 lines in 32% of the surgery group, 57% of the untreated group, and 52% of the steroid group (P = 0.22). The surgery group had more patients whose initial vision was no light perception. After adjustment for the baseline visual acuity, there were no significant differences between any of the treatment groups. There was no indication that the dosage or timing of corticosteroid treatment or the timing of surgery was associated with an increased probability of visual improvement.
No clear benefit was found for either corticosteroid therapy or optic canal decompression surgery. The number of patients studied was sufficient to rule out major effects in the treatment groups, although clinically relevant effects in specific subgroups could have been missed. These results and the existing literature provide sufficient evidence to conclude that neither corticosteroids nor optic canal surgery should be considered the standard of care for patients with traumatic optic neuropathy. It is therefore clinically reasonable to decide to treat or not treat on an individual patient basis.
比较采用皮质类固醇治疗、视神经管减压手术治疗或未经治疗观察的创伤性视神经病变的视力转归。
设有同期治疗组的比较性非随机干预研究。
总共133例创伤性视神经病变患者（127例单侧病变，6例双侧病变），这些患者在受伤后3天内进行了初始视力评估。纳入主要分析需要至少1个月的随访。
根据受伤后7天内接受的治疗，单侧损伤患者被分为三个治疗组之一：未治疗组（n = 9）、皮质类固醇组（n = 85）或视神经管减压手术组（n = 33）。
视力。
手术组32%、未治疗组57%、类固醇组52%的患者视力提高≥3行（P = 0.22）。手术组中初始视力无光感的患者更多。在对基线视力进行调整后，各治疗组之间无显著差异。没有迹象表明皮质类固醇治疗的剂量或时机或手术时机与视力改善可能性增加有关。
未发现皮质类固醇治疗或视神经管减压手术有明显益处。尽管可能遗漏了特定亚组中的临床相关效应，但所研究的患者数量足以排除治疗组中的主要效应。这些结果和现有文献提供了充分的证据，可得出结论：皮质类固醇和视神经管手术均不应被视为创伤性视神经病变患者的标准治疗方法。因此，根据个体患者情况决定是否治疗在临床上是合理的。
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