Li Xinyu, Guo Zhilin
Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
Brain Sci. 2022 Oct 26;12(11):1442. doi: 10.3390/brainsci12111442.
Traumatic optic neuropathy (TON) is damage to the optic nerve that is caused by external violence to the optic nerve during cranial and facial trauma. This kind of injury may result in impaired vision, has a high risk of blindness, and significantly impairs the neurological function of the patient. The treatment of TON is controversial, and many different approaches have been suggested. No one is considered best because the traumatic mechanism is not clear. In this retrospective study, the clinical features of 37 patients diagnosed with TON without light perception who were treated at the Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine were investigated. A comparison was made between the patient's visual results before and after therapy. In addition, using a multifactorial linear regression model, the independent risk variables for the degree of improvement in visual acuity (IDVA) following surgery were determined. After the operation, 17 people's visual acuity (VA) was lightless, 20 people's visual acuity was improved, and 13 people's visual acuity reached the standard of decerebrate. The efficiency of total optic nerve decompression was 54.1%, and the unblinded rate was 35.1%. Multiple linear regression analysis revealed that fractures of the optic canal and orbit were independent predictors of postoperative VA and IDVA. Total optic canal decompression may efficiently and safely enhance the vision of patients who have TON. Patients with TON who do not have fractures of the optic canal and orbit prior to decompression had a more favorable surgical prognosis.
创伤性视神经病变（TON）是指在颅脑和面部创伤期间，视神经受到外部暴力作用而导致的损伤。这种损伤可能导致视力受损，失明风险高，并严重损害患者的神经功能。TON的治疗存在争议，已经提出了许多不同的方法。由于创伤机制尚不清楚，没有一种方法被认为是最佳的。在这项回顾性研究中，调查了上海交通大学医学院附属第九人民医院收治的37例无光感TON患者的临床特征。比较了患者治疗前后的视力结果。此外，使用多因素线性回归模型，确定了术后视力改善程度（IDVA）的独立风险变量。术后，17人的视力无光感，20人的视力得到改善，13人的视力达到去脑标准。视神经完全减压的有效率为54.1%，复明率为35.1%。多元线性回归分析显示，视神经管和眼眶骨折是术后视力和IDVA的独立预测因素。视神经完全减压可以有效且安全地提高TON患者的视力。减压术前没有视神经管和眼眶骨折的TON患者手术预后更好。
