Gupta Sangeeta, Tripathi Alka, Gupta Gaurav
Physiology, All India Institute of Medical Sciences, Gorakhpur, IND.
Ophthalmology, All India Institute of Medical Sciences, Gorakhpur, IND.
Cureus. 2023 Feb 23;15(2):e35344. doi: 10.7759/cureus.35344. eCollection 2023 Feb.
Introduction Traumatic optic neuropathy (TON), with indirect TON as its more prevalent form, is a dreadful cause of severe visual dysfunctions. The condition is known to have a contentious treatment plan and poor visual sequelae; hence, the assessment of prognostic signs becomes valuable. Prospective studies evaluating important predictors of visual recovery after traumatic optic nerve injury can particularly be helpful in a longitudinal observation. The possible roles of clinical variables need to be assessed. Absent visual evoked potential (VEP) records as a crucial finding associated with TON has reportedly valuable prognostic significance. This also needs to be explored. Hence, the study sought to determine the role of prognosticators in the visual outcome of the patients, with a focus on evaluating the role of VEPs in the severity and prognosis of indirect TON. Methods A prospective observational study involving 40 patients with indirect TON was conducted. Ocular, neuro-ophthalmological, radiological, and neurophysiological variables, including flash VEP, were investigated at their initial visit and followed up until the end of six months. Final visual acuity was the primary outcome variable studied. Paired t-test was used to perform the comparison between the flash VEP variables for normal and affected eyes at the initial visit. Pearson correlation coefficient was computed for obtaining the association of initial visual acuity and flash VEP variables with the outcome variable. Relative risk was calculated and analysed for the prognosticators in univariate analysis. Statistical significance was defined as p < 0.05. Results Statistically significant variations in mean P100 latency, N75-P100, and P100-N145 amplitudes compared between normal and affected eyes in the patients at the initial visit were obtained (p < 0.0001; paired t-test). Pearson correlation coefficient for initial visual acuity and flash VEP variable as independent variables and final visual acuity as the dependent variable were statistically significant (p < 0.05). The relative risks for prognosticators with a statistically significant range of confidence intervals were poor initial visual acuity, greater relative afferent pupillary defect (RAPD) grades, deranged flash VEP variables (absent VEP, reduction in amplitude ratio (>50%), and increased interocular latency differences), loss of consciousness during injury, age greater than 40 years, and lack of improvement after 48 hours of steroid treatment. Conclusion The identified negative prognosticators may be helpful in deciding the kind of therapeutic approach and predicting the visual outcome in patients with indirect TON.
引言 创伤性视神经病变（TON），以间接性TON更为常见，是导致严重视觉功能障碍的可怕原因。已知该病症的治疗方案存在争议且视觉后遗症较差；因此，评估预后体征变得很有价值。评估创伤性视神经损伤后视觉恢复的重要预测因素的前瞻性研究在纵向观察中可能特别有帮助。临床变量的可能作用需要评估。据报道，视觉诱发电位（VEP）记录缺失作为与TON相关的关键发现具有重要的预后意义。这也需要进行探索。因此，本研究旨在确定预后因素在患者视觉结果中的作用，重点是评估VEP在间接性TON的严重程度和预后中的作用。
方法 对40例间接性TON患者进行了一项前瞻性观察研究。在初次就诊时对眼部、神经眼科、放射学和神经生理学变量，包括闪光VEP进行了调查，并随访至六个月结束。最终视力是研究的主要结局变量。采用配对t检验对初次就诊时正常眼和患眼的闪光VEP变量进行比较。计算Pearson相关系数以获得初始视力和闪光VEP变量与结局变量的关联。在单因素分析中计算并分析预后因素的相对风险。统计学显著性定义为p<0.05。
结果 在初次就诊时，患者正常眼和患眼之间的平均P100潜伏期、N75 - P100和P100 - N145振幅存在统计学显著差异（p<0.0001；配对t检验）。以初始视力和闪光VEP变量为自变量、最终视力为因变量的Pearson相关系数具有统计学显著性（p<0.05）。具有统计学显著置信区间范围的预后因素的相对风险包括初始视力差、相对传入性瞳孔障碍（RAPD）等级较高、闪光VEP变量异常（VEP缺失、振幅比降低（>50%）和双眼间潜伏期差异增加）、受伤时意识丧失、年龄大于40岁以及类固醇治疗48小时后无改善。
结论 所确定的负面预后因素可能有助于决定治疗方法的类型并预测间接性TON患者的视觉结果。
