Cheng Jin-wei, Wei Rui-li
Department of Ophthalmology, Second Military Medical University, Shanghai, China.
Zhonghua Yan Ke Za Zhi. 2011 Aug;47(8):680-2.
Although corticosteroid therapy remains the mainstream of various treatment procedures in traumatic optic neuropathy, some patients are still unable to benefit by this procedure. Therefore, optic nerve decompression has become an important choice for treating traumatic optic neuropathy. However, several problems have been raised on optic nerve decompression, such as who is suitable for this operation; as well as when to do and how to do this operation. The answers to these questions are controversial. We systematically review the current clinical evidence, and suggest that surgical decompression is indicated in cases with late onset and progressive visual loss; it is not indicated in primary complete loss of vision. Furthermore, it has been recommended that an adequate decompression requires the addition of an optic nerve sheath incision to the osseous optic canal, and it must be undertaken within seven days after the injury.
尽管皮质类固醇疗法仍是外伤性视神经病变各种治疗方法的主流，但仍有一些患者无法从该疗法中获益。因此，视神经减压术已成为治疗外伤性视神经病变的重要选择。然而，关于视神经减压术也出现了一些问题，比如谁适合做这个手术；以及何时做和如何做这个手术。这些问题的答案存在争议。我们系统地回顾了当前的临床证据，并建议手术减压适用于迟发性和进行性视力丧失的病例；不适用于原发性完全失明的病例。此外，有人建议，要进行充分的减压，除了对视神经管进行减压外，还需要切开视神经鞘，并且必须在受伤后7天内进行。
