Fujitani T, Inoue K, Takahashi T, Ikushima K, Asai T
Jpn J Ophthalmol. 1986;30(1):125-34.
From 1968 through 1984, 110 cases (113 eyes) with indirect traumatic optic neuropathy were seen at the Department of Ophthalmology and Otorhinolaryngology of the Kobe University Hospital; 43 eyes were treated nonsurgically with steroid and 70 eyes were operated on by the endonasal-transethmoidal method of optic canal decompression. By comparison of the visual improvements in the two groups, the effectiveness of the surgical treatment was evaluated. In the nonsurgical group, 19 eyes showed a visual improvement, giving an overall improvement rate of 44.2%. In 9 eyes with complete visual loss at the initial visit no visual improvement could be seen. In 34 eyes with the vision better than light perception at the initial visit, vision improved in 19 eyes, ie, the improvement rate was 55.9%: the recovery occurred relatively rapidly within 3-4 weeks, and thereafter the condition remained unchanged. In 30 eyes treated within 3 weeks after trauma, 17 eyes (57%) showed visual improvement, but in 13 eyes where treatment started after 3 weeks, improvement was seen only in 15%. In the surgical group, 34 eyes showed a visual improvement; the overall rate of improvement was 47.7%. In 28 eyes where complete visual loss was seen at the first visit, 7 eyes showed visual improvement. In 38 eyes treated within 3 weeks after trauma, 18 eyes (45%) showed visual improvement, and in 32 eyes where the surgery was performed after 3 weeks, 16 eyes (50%) showed improvement. The latter improvement rate was significantly higher (P less than 0.05) than the improvement rate of 15% found in eyes of the nonsurgical group, where the treatment started 3 weeks after trauma. In cases with indirect traumatic optic neuropathy, surgical decompression of the optic canal can give a visual improvement even when complete visual loss is found in the early period. The surgery is effective in cases where visual recovery by conservative treatment is not satisfactory after 3 weeks. On this basis the criteria for surgical treatment were determined: when the vision is better than light perception in the early period, conservative treatment must first be given, but surgery is indicated when the vision does not improve to 0.5 or better within 3 weeks. In cases where complete visual loss is found soon after injury, earliest possible surgical intervention is recommended.
1968年至1984年期间，神户大学医院眼科和耳鼻咽喉科共诊治了110例（113只眼）间接性外伤性视神经病变患者；43只眼采用类固醇非手术治疗，70只眼采用经鼻-筛窦入路视神经管减压术。通过比较两组患者视力改善情况，评估手术治疗的有效性。非手术组中，19只眼视力改善，总体改善率为44.2%。初诊时完全失明的9只眼中未见视力改善。初诊时视力优于光感的34只眼中，19只眼视力改善，即改善率为55.9%：视力在3 - 4周内相对迅速恢复，此后病情未变。外伤后3周内治疗的30只眼中，17只眼（57%）视力改善，但外伤后3周后开始治疗的13只眼中，仅15%视力改善。手术组中，34只眼视力改善；总体改善率为47.7%。初诊时完全失明的28只眼中，7只眼视力改善。外伤后3周内治疗的38只眼中，18只眼（45%）视力改善，外伤后3周后手术的32只眼中，16只眼（50%）视力改善。后一组的改善率显著高于外伤后3周开始治疗的非手术组的15%（P＜0.05）。对于间接性外伤性视神经病变患者，即使早期发现完全失明，视神经管手术减压仍可改善视力。保守治疗3周后视力恢复不满意的病例，手术有效。在此基础上确定了手术治疗标准：早期视力优于光感时，必须先进行保守治疗，但3周内视力未提高到0.5或更好时则需手术。伤后不久即发现完全失明的病例，建议尽早进行手术干预。
