State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.
Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Acta Ophthalmol. 2022 Mar;100(2):e491-e501. doi: 10.1111/aos.14951. Epub 2021 Jun 27.
To evaluate and compare the effectiveness of endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) and steroid pulse therapy (SPT) for indirect traumatic optic neuropathy (ITON).
Prospective interventional case series.
Total 140 monocular ITON patients from January 2017 to June 2019 were recruited, including 100 patients received ETOCD (56 patients received ETOCD only and 44 patients received ETOCD combined with SPT before surgery), and 40 patients received SPT only. Their visual acuity (VA) and visual evoked potential (VEP) were analysed before and after treatments. Initial VA, lag time, causes of injuries and age were analysed for evaluating prognosis of treatment.
In contrast with patients received SPT only (15/40 = 38%), the effective rate of patients received ETOCD only and patients received ETOCD combined with SPT were both significantly better (46/56 = 82%, p < 0.001 and 30/44 = 68%, p = 0.005). Whether with SPT before ETOCD or not, after ETOCD, patients with VA improvement showed no significant difference. And 59/76 (77.6%) patients showed improvement within 24 hours. Patients who had residual visions achieved higher effective rate than those with no light perception (56/58 = 97% and 20/42 = 48%; p < 0.001) after ETOCD. For patients with long lag time of 21-90 days, 23/32 (72%) patients presented with vision improvement. Moreover, VEP was significantly improved after ETOCD. No severe complications were observed.
Endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) is an effective and safe therapy for ITON, which is more effective than SPT. Even for patients with failure in responding to SPT, the successfully physical decompression is the most effective way to rescue optical nerve from permanent damage.
评估并比较经蝶入路视神经管减压术（ETOCD）和类固醇脉冲疗法（SPT）治疗间接性创伤性视神经病变（ITON）的疗效。
前瞻性干预性病例系列研究。
2017 年 1 月至 2019 年 6 月共招募了 140 例单侧 ITON 患者，包括 100 例行 ETOCD 治疗的患者（56 例仅行 ETOCD 治疗，44 例在手术前行 ETOCD 联合 SPT）和 40 例行 SPT 治疗的患者。分析治疗前后患者的视力（VA）和视觉诱发电位（VEP）。分析初始 VA、潜伏期、损伤原因和年龄，以评估治疗预后。
与仅接受 SPT 治疗的患者（40 例中的 15 例，38%）相比，仅接受 ETOCD 治疗的患者和接受 ETOCD 联合 SPT 治疗的患者的有效率均显著提高（46/56，82%，p<0.001；30/44，68%，p=0.005）。无论是否在 ETOCD 前接受 SPT，ETOCD 后 VA 改善的患者之间无显著差异。59/76（77.6%）例患者在 24 小时内出现改善。ETOCD 后，有残余视力的患者有效率高于无光感的患者（56/58，97%和 20/42，48%；p<0.001）。对于潜伏期为 21-90 天的患者，23/32（72%）例患者的视力出现改善。此外，ETOCD 后 VEP 显著改善。未观察到严重并发症。
经蝶入路视神经管减压术（ETOCD）是治疗 ITON 的一种有效且安全的方法，其疗效优于 SPT。即使对于 SPT 治疗反应不佳的患者，成功的物理减压仍是挽救视神经免受永久性损伤的最有效方法。
