Zhao Shang-Feng, Yong Li, Zhang Jia-Liang, Wu Jiang-Ping, Liu Hao-Cheng, Sun Si, Song Gui-Dong, Ma Jian-Min, Kang Jun
Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Beijing Ophthalmology & Vision Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Ann Transl Med. 2021 Jan;9(2):136. doi: 10.21037/atm-20-7810.
The aim of the present study was to discuss the efficacy of delayed wider endoscopic optic decompression in traumatic optic neuropathy (TON).
A total of 479 patients were treated with corticosteroids and delayed wider endoscopic optic decompression, including the injury-to-surgery interval, within 2 weeks in patients with no light perception (NLP), and within 1 month in patients with residual eyesight. Based on the traditional decompression range, the superior wall of the optic canal was further decompressed. The preoperative and postoperative visual acuities (VAs) were reviewed, and the therapeutic efficacy was analyzed.
The final VA was 0.1 or better in 29 cases, finger count in 79 cases, hand motion in 99 cases, light perception (LP) in 25 cases, and NLP in 247 cases. A total of 136 patients (136/383, 35.5%) recovered after NLP treatment, and 78 patients (69/96, 71.9%) had improved residual eyesight. The improvement rate in patients with residual eyesight was significantly higher than that of patients with NLP (P<0.01). Moreover, the total VA after treatment was better than that before surgery (P<0.01).
Delayed wider optic nerve decompression plus corticosteroids remains an effective and safe therapeutic strategy for patients with delayed treatment intervals of more than 1 week, especially for those with residual eyesight within 1 month.
本研究旨在探讨延迟扩大内镜下视神经减压术治疗外伤性视神经病变（TON）的疗效。
共有479例患者接受了皮质类固醇及延迟扩大内镜下视神经减压术治疗，其中无光感（NLP）患者伤后至手术间隔在2周内，有残余视力患者在1个月内。在传统减压范围基础上，对视神经管上壁进一步减压。回顾术前和术后视力（VA），并分析治疗效果。
最终视力为0.1或更好者29例，指数者79例，手动者99例，光感（LP）者25例，NLP者247例。NLP治疗后共有136例患者（136/383，35.5%）视力恢复，78例残余视力患者中有69例（69/96，71.9%）视力改善。残余视力患者的改善率显著高于NLP患者（P<0.01）。此外，治疗后的总视力优于手术前（P<0.01）。
对于治疗间隔超过1周的延迟治疗患者，尤其是1个月内有残余视力的患者，延迟扩大视神经减压联合皮质类固醇仍然是一种有效且安全的治疗策略。
