Zimmerer Rüdiger, Rana Majeed, Schumann Paul, Gellrich Nils-Claudius
Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.
Facial Plast Surg. 2014 Oct;30(5):518-27. doi: 10.1055/s-0034-1393702. Epub 2014 Nov 14.
Decreasing visual acuity secondary to orbital trauma or orbital and anterior skull base surgery may be caused by either sudden space-occupying intraorbital lesions, including retrobulbar hemorrhage (RBH), or direct damage to the prechiasmatic pathway. Contrary to traumatic optic neuropathy, RBH must be diagnosed and treated immediately to prevent permanent damage to the visual system. Therefore, monitoring and handling of visual pathway damage are mandatory. Flash visual evoked potentials and electroretinograms can provide evidence of the status of conductivity of the visual pathway when clinical assessment is not feasible. Both are thus essential diagnostic procedures not only for primary diagnosis but also for intraoperative evaluation. In case of RBH surgical decompression is compulsory. However, traumatic optic neuropathy does not respond to either corticosteroids or optic canal surgery. Modern craniomaxillofacial surgery requires detailed consideration of the diagnosis and treatment of traumatic visual pathway damage with the ultimate goal of preserving visual acuity.
因眼眶外伤或眼眶及前颅底手术导致的视力下降，可能是由突然出现的眶内占位性病变（包括球后出血，RBH）或视交叉前通路的直接损伤引起的。与创伤性视神经病变不同，必须立即诊断并治疗RBH，以防止视觉系统受到永久性损伤。因此，对视觉通路损伤的监测和处理是必不可少的。当临床评估不可行时，闪光视觉诱发电位和视网膜电图可以提供视觉通路传导状态的证据。因此，这两者不仅是原发性诊断的重要诊断程序，也是术中评估的重要诊断程序。如果发生RBH，手术减压是必须的。然而，创伤性视神经病变对皮质类固醇或视神经管手术均无反应。现代颅颌面外科手术需要详细考虑创伤性视觉通路损伤的诊断和治疗，最终目标是保留视力。
