Lee Kok Foo, Muhd Nor Nor Idahriani, Yaakub Azhany, Wan Hitam Wan Hazabbah
Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
Int J Ophthalmol. 2010;3(2):175-8. doi: 10.3980/j.issn.2222-3959.2010.02.20. Epub 2010 Jun 18.
To evaluate the clinical presentations of traumatic optic neuropathy and to assess the visual outcome of three groups of patients managed differently (conservative, intravenous corticosteroids only and combination of intravenous and oral corticosteroids) at an academic tertiary care referral centre.
A retrospective study was conducted involving 24 consecutive patients (27 eyes) with traumatic optic neuropathy attending Hospital Universiti Sains Malaysia from January 2007 till December 2009.
Twenty-four patients (27 eyes) were included. All cases involved were males. Mean age was 33 years old. Motor vehicle accident was the major cause (83.3%). Both eyes were equally involved. Most of the eyes had poor vision on presentation (HM-NPL, 81.5%) with associated periorbital haematoma (22 eyes) and subconjunctival haemorrhage (20 eyes). Majority of patients (19 patients, 79.2%) presented with more than one bony fracture of skull or orbit and 5 patients (20.8%) had no fractures. None of the patients had evidence of optic nerve compression on CT scans or MRI done. Eleven patients (45.8%) had been treated with intravenous and oral corticosteroids. The other 7 patients (29.2%) were treated conservatively and the third group (6 patients, 25.0%) was on intravenous corticosteroids only. Eleven of 12 eyes (91.7%) treated with intravenous and oral corticosteroids had shown 1 line improvement of visual acuity. Those eyes treated conservatively (77.8%) had shown 1 line improvement of visual acuity. As for patients treated with intravenous corticosteroids only, four patients remained NPL, one patient had mild visual improvement and the other one's vision remained the same. The visual improvement in patients treated with conservative management was not significant (P=0.386). Patients treated with intravenous corticosteroids alone have shown no visual improvement statistically(P<0.05). Patients treated with intravenous followed by oral corticosteroids had significant visual improvement (P<0.05). There was no statistically significant difference in visual outcome between patients treated with corticosteroids and patients treated conservatively (P=0.368). No patient underwent surgical decompression of the optic nerve. In this series, the follow up ranges from 6 months to 3 years.
Most of the traumatic optic neuropathy patients presented with periorbital haematoma, subconjunctival haemorrhage and orbital wall fractures. Patients treated with intravenous followed by oral corticosteroids have better visual outcome compared to conservative management.
评估创伤性视神经病变的临床表现，并在一所学术性三级医疗转诊中心评估三组接受不同治疗（保守治疗、仅静脉注射皮质类固醇以及静脉注射与口服皮质类固醇联合治疗）的患者的视力预后。
进行一项回顾性研究，纳入2007年1月至2009年12月期间在马来西亚理科大学医院连续就诊的24例（27只眼）创伤性视神经病变患者。
纳入24例患者（27只眼）。所有病例均为男性。平均年龄33岁。机动车事故是主要原因（83.3%）。双眼受累情况相同。大多数眼在就诊时视力较差（手动-无光感，81.5%），伴有眶周血肿（22只眼）和结膜下出血（20只眼）。大多数患者（19例，79.2%）存在颅骨或眼眶一处以上骨折，5例患者（20.8%）无骨折。所有患者的CT扫描或MRI检查均未发现视神经受压迹象。11例患者（45.8%）接受了静脉注射与口服皮质类固醇联合治疗。另外7例患者（29.2%）接受了保守治疗，第三组（6例患者，25.0%）仅接受静脉注射皮质类固醇治疗。接受静脉注射与口服皮质类固醇联合治疗的12只眼中有11只（91.7%）视力提高了1行。接受保守治疗的眼（77.8%）视力提高了1行。至于仅接受静脉注射皮质类固醇治疗的患者，4例患者仍无光感，1例患者视力有轻微改善，另1例患者视力不变。保守治疗患者的视力改善不显著（P=0.386）。仅接受静脉注射皮质类固醇治疗的患者在统计学上未显示视力改善（P<0.05）。先静脉注射后口服皮质类固醇治疗的患者视力有显著改善（P<0.05）。接受皮质类固醇治疗的患者与保守治疗的患者在视力预后方面无统计学显著差异（P=0.368）。无一例患者接受视神经减压手术。在本系列研究中，随访时间为6个月至3年。
大多数创伤性视神经病变患者伴有眶周血肿、结膜下出血和眶壁骨折。与保守治疗相比，先静脉注射后口服皮质类固醇治疗的患者视力预后更好。
