Wei Wang, Zhao Shang-Feng, Li Yong, 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 and Vision Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Ann Transl Med. 2022 May;10(10):542. doi: 10.21037/atm-22-1836.
The choice and efficacy of surgical or/and surgical treatments for traumatic optic neuropathy (TON) remained controversial by now. This study aims to present the outcomes of surgical and nonsurgical treatments for TON in our center.
A total of 685 consecutive patients were retrospectively included in the study. And divided into surgical and non-surgical groups. All cases were treated with corticosteroids for 3 days after admission. Endoscopic optic decompression was applied to 479 patients of surgical group; The other 206 patients of nonsurgical were administered with corticosteroids alone. The visual outcomes before and after treatment were compared with Wilcoxon rank and tests. The improvement rate between two groups were compared with chi-square test.
The visual acuity (VA) after treatment was significantly better than that before treatment (P=0.000). Overall VA improvement rate in the surgical group was better than that in non-surgical group (42.8% 35.4%) with no significant difference (P=0.072). The VA improvement rate was significant greater in the surgical group than that in the non-surgical group in the patients with NLP before treatment (P=0.028). The VA improvement rate was better in the surgical group than that in the non-surgical group (71.9% 57.8%) but with no significant difference. The final overall VA was 0.1 or better in 43 cases; 104 cases were able to count fingers; hand motion (HM) became perceivable in 132 cases; light perception (LP) was achieved in 53 cases; and no light perception (NLP) remained in 353 cases.
Endoscopic optic nerve decompression (EOND) combined with corticosteroids or corticosteroids alone could reach the improvement for patients with TON. The EOND combined with corticosteroids could achieve better VA improvement in patients with NLP.
目前，外伤性视神经病变（TON）的手术或/和手术治疗的选择及疗效仍存在争议。本研究旨在介绍我院中心TON手术及非手术治疗的结果。
本研究回顾性纳入了685例连续患者，并分为手术组和非手术组。所有患者入院后均接受3天的皮质类固醇治疗。手术组479例患者接受了内镜下视神经减压术；非手术组的另外206例患者仅接受皮质类固醇治疗。治疗前后的视力结果采用Wilcoxon秩和检验进行比较。两组之间的改善率采用卡方检验进行比较。
治疗后的视力（VA）明显优于治疗前（P = 0.000）。手术组的总体VA改善率优于非手术组（42.8% 对35.4%），但差异无统计学意义（P = 0.072）。治疗前视力无光感（NLP）的患者中，手术组的VA改善率明显高于非手术组（P = 0.028）。手术组的VA改善率优于非手术组（71.9% 对57.8%），但差异无统计学意义。最终，43例患者的最终总体VA为0.1或更好；104例患者能够数指；132例患者可感知手动（HM）；53例患者达到光感（LP）；353例患者仍无光感（NLP）。
内镜下视神经减压术（EOND）联合皮质类固醇或单纯皮质类固醇治疗可使TON患者视力得到改善。EOND联合皮质类固醇可使NLP患者的VA得到更好的改善。
