Ophthalmic Plastic and Reconstructive Surgery, Ocular Oncology and Facial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
Ophthalmic Plastic and Reconstructive Surgery, Ocular Oncology and Facial Aesthetics, Sri Sankaradeva Nethralaya, Guwahati, Assam, India.
Br J Ophthalmol. 2024 May 21;108(6):779-787. doi: 10.1136/bjo-2023-323282.
To determine the surgical outcomes using navigation-guided transcaruncular orbital optic canal decompression (NGTcOCD) and investigate the relationship between visual prognosis. visual evoked potential (VEP), association with DeLano type of optic canal and Onodi cells in patients with indirect traumatic optic neuropathy (TON).
Prospective observational.
Fifty-two consecutive patients with indirect TON unresponsive to steroid therapy were divided into three groups where Group I comprised of cases with optic canal fracture who underwent NGTcOCD, Group II without optic canal fracture who underwent NGTcOCD and Group III, no-decompression group who chose not to undergo NGTcOCD. An improvement in visual acuity (VA) at 1 week, 3 months and 1 year and amplitude and latency of VEP at 1 year were considered as primary and secondary outcomes, respectively.
The mean VA improved from 2.55±0.67 and 2.62±0.56 LogMAR at presentation to 2.03±0.96 and 2.33±0.72 LogMAR at final follow-up among Group I and Group II patients, respectively (p<0.001 and p=0.01). Statistically significant improvement observed among both the Groups in VEP amplitude (p=<0.01) and among Group II in VEP latency (p<0.01). Both Group I and Group II patients have better outcomes than patients in no-decompression group. VA at presentation and Type 1 DeLano optic canal were observed as significant prognostic factors.
NGTcOCD serves as a minimally invasive transcaruncular route to the optic canal which enables ophthalmologists to perform decompression from the anterior-most orbital end under direct visualisation. Patients with indirect TON with or without optic canal fracture and unresponsive to steroid therapy when managed with NGTcOCD have shown comparable and superior outcomes.
确定导航引导经泪阜眶内视神经管减压术（NGTcOCD）的手术效果，并研究间接创伤性视神经病变（TON）患者的视觉预后、视觉诱发电位（VEP）与 DeLano 型视神经管和 Onodi 细胞之间的关系。
前瞻性观察。
52 例对类固醇治疗无反应的间接 TON 连续患者分为三组，其中 I 组为有视神经管骨折的患者，行 NGTcOCD；II 组为无视神经管骨折的患者，行 NGTcOCD；III 组为未行 NGTcOCD 的非减压组。术后 1 周、3 个月和 1 年的视力（VA）改善和术后 1 年的 VEP 振幅和潜伏期改善被认为是主要和次要结果。
I 组和 II 组患者的 VA 分别从就诊时的 2.55±0.67 和 2.62±0.56 LogMAR 提高到最终随访时的 2.03±0.96 和 2.33±0.72 LogMAR（p<0.001 和 p=0.01）。两组患者的 VEP 振幅均有显著改善（p<0.01），II 组患者的 VEP 潜伏期也有显著改善（p<0.01）。I 组和 II 组患者的结果均优于未减压组患者。就诊时的 VA 和 1 型 DeLano 视神经管被认为是重要的预后因素。
NGTcOCD 是一种经泪阜进入视神经管的微创方法，使眼科医生能够在直视下从前眶端进行减压。对于对类固醇治疗无反应的间接 TON 患者，无论是否伴有视神经管骨折，行 NGTcOCD 治疗均可获得相当或更好的效果。
