Yip C C, Chng N W, Au Eong K G, Heng W J, Lim T H, Lim W K
The Eye Institute, National Healthcare Group, Tan Tock Seng Hospital, Singapore, Singapore.
Eur J Ophthalmol. 2002 Jul-Aug;12(4):309-14. doi: 10.1177/112067210201200410.
To compare the efficacy of low-dose intravenous methylprednisolone or conservative treatment in the management of traumatic optic neuropathy.
A non-randomized retrospective study of 21 patients (21 eyes) with traumatic optic neuropathy treated between October 95 and November 97 in a tertiary ophthalmology unit. Traumatic optic neuropathy was defined as traumatic visual loss with afferent pupillary defect in the absence of direct injury to the globe or optic nerve. The median follow-up period was one year. Nine patients were treated with 125-250 mg methylprednisolone 6-hourly intravenously for a mean of 3.3 days (range 2-5 days) and 12 patients were treated conservatively. Visual acuity (VA) was measured with a Snellen chart before and after treatment at each follow-up visit. Visual recovery was defined as an improvement of 2 or more Snellen lines one week post-injury or later.
The patients' mean age was 37.1 years (range 12-65 years). There were more males (90.5%) than females (9.5%). Traumatic optic neuropathy was in 12 right eyes and 9 left eyes. The cause of injury included traffic accidents (52.4%), falls (28.6%), assault (14.2%) and others (4.8%). The mean interval between the injury and steroid therapy was 3.6 days (range 1-11 days). Visual recovery was observed in 44.4% of eyes treated with methylprednisolone and in 33.3% treated conservatively (p = 0.673, Fisher's exact test).
Intravenous methylprednisolone at the dosage and duration used in this retrospective study did not significantly improve the visual recovery of eyes with traumatic optic neuropathy compared to conservative treatment. However, this small sample may not be sensitive enough to detect a small difference in visual recovery rates, and further studies with larger samples may be warranted.
比较低剂量静脉注射甲基强的松龙与保守治疗在创伤性视神经病变管理中的疗效。
对1995年10月至1997年11月在一家三级眼科单位接受治疗的21例（21只眼）创伤性视神经病变患者进行非随机回顾性研究。创伤性视神经病变定义为在眼球或视神经无直接损伤的情况下伴有传入性瞳孔缺陷的创伤性视力丧失。中位随访期为1年。9例患者每6小时静脉注射125 - 250毫克甲基强的松龙，平均治疗3.3天（范围2 - 5天），12例患者接受保守治疗。每次随访时，使用斯内伦视力表在治疗前后测量视力。视力恢复定义为伤后1周或更晚视力提高2行或更多。
患者平均年龄为37.1岁（范围12 - 65岁）。男性（90.5%）多于女性（9.5%）。创伤性视神经病变发生于12只右眼和9只左眼。损伤原因包括交通事故（52.4%）、跌倒（28.6%）、袭击（14.2%）和其他（4.8%）。损伤与类固醇治疗之间的平均间隔为3.6天（范围1 - 11天）。接受甲基强的松龙治疗的眼中有44.4%观察到视力恢复，接受保守治疗的眼中有33.3%观察到视力恢复（p = 0.673，Fisher精确检验）。
与保守治疗相比，本回顾性研究中使用的剂量和疗程的静脉注射甲基强的松龙并未显著改善创伤性视神经病变患者的视力恢复。然而，这个小样本可能不够敏感，无法检测到视力恢复率的微小差异，可能需要进行更大样本的进一步研究。
