Department of Ophthalmology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Department of Biostatistics,, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Indian J Ophthalmol. 2023 Aug;71(8):3046-3052. doi: 10.4103/IJO.IJO_3318_22.
To analyze the visual outcome in patients with traumatic optic neuropathy (TON) with respect to different treatment modalities, to study the correlation of initial visual loss with the final visual outcome, and to find out the predictor of final visual outcome in patients with indirect TON.
A retrospective analysis of 36 eyes with TON was done. Data on clinical profile, including demographics, mode of trauma, best corrected visual acuity (BCVA), pupillary reflex examination, and anterior and posterior segment examination, was collected. Presence and location of orbital and cranial fractures were identified from computed tomography scan. Visual outcomes following steroid therapy, optic nerve (ON) decompression, and in untreated patients were analyzed. Pre- and post-treatment BCVA were divided into three groups based on logarithm of the minimum angle of resolution (logMAR) as follows: group A: 3, group B: 2.9-1.3, and group C<1.3. BCVA values at follow-up visits were taken as the primary outcome measure. Association between various risk factors and final visual outcome in patients with indirect TON was also analyzed.
Out of 34 patients whose 36 eyes were studied, three (8.8%) patients were females and 31 (91.2%) patients were males. Most common mode of trauma was road traffic accident (RTA; 91.2%), which was followed by fall (8.8%) and assault (2.9%). Pre- and post-treatment BCVA values of 36 eyes were compared, and improvement in BCVA after treatment was found to be statistically significant. Also, 28.6% of patients with presenting BCVA of no light perception showed improvement compared to 94.1% and 100% in groups B and C, respectively. Orbital wall fractures were seen in 80.5% (n = 29) of the patients, with lateral wall fracture being the most common (58.3%) followed by medial wall (33.3%), roof (27.7%), floor (27.7%), and optic strut (5%).
Baseline BCVA had significant association with final vision improvement. Lateral wall fracture was the most common fracture associated with indirect TON. Patients treated with high-dose corticosteroids, irrespective of the time of presentation, had a better visual outcome.
分析外伤性视神经病变（TON）患者不同治疗方式的视力结果，研究初始视力损失与最终视力结果的相关性，并找出间接 TON 患者最终视力结果的预测因素。
对 36 例 TON 患者进行回顾性分析。收集临床资料，包括人口统计学资料、创伤方式、最佳矫正视力（BCVA）、瞳孔反射检查以及眼前段和眼后段检查。从计算机断层扫描中确定眶壁和颅骨折的存在和位置。分析皮质类固醇治疗、视神经减压和未治疗患者的视觉结果。根据最小分辨角对数（logMAR）将治疗前后的 BCVA 分为三组：A 组：3，B 组：2.9-1.3，C 组<1.3。随访时的 BCVA 值作为主要观察指标。还分析了间接 TON 患者各种危险因素与最终视力结果的关系。
在研究的 36 只眼中，34 例患者中 3 例（8.8%）为女性，31 例（91.2%）为男性。最常见的创伤方式是道路交通意外（RTA；91.2%），其次是跌倒（8.8%）和殴打（2.9%）。比较了 36 只眼的治疗前后 BCVA 值，发现治疗后 BCVA 提高有统计学意义。此外，在 BCVA 无光感的患者中，28.6%的患者有改善，而 B 组和 C 组分别有 94.1%和 100%的患者有改善。80.5%（n=29）的患者有眶壁骨折，其中外侧壁骨折最常见（58.3%），其次是内侧壁（33.3%）、顶壁（27.7%）、底壁（27.7%）和视神经柱（5%）。
基线 BCVA 与最终视力改善有显著相关性。外侧壁骨折是最常见的与间接 TON 相关的骨折。无论就诊时间如何，接受大剂量皮质类固醇治疗的患者视力预后更好。
