Pandey Sameer, Reddy Gosla S, Chug Ashi, Dixit Ashutosh, Raja Balgovind S
Discipline of Craniomaxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, India.
GSR Institute of Craniofacial Surgery Saidabad, Hyderabad, India.
Craniomaxillofac Trauma Reconstr. 2023 Dec;16(4):306-316. doi: 10.1177/19433875221142682. Epub 2022 Nov 28.
A systematic review and meta-analysis.
Treatment of traumatic optic neuropathy (TON) has been a subject of debate for many decades due to the scarcity of evidence-based treatment protocols. This review compares surgical decompression (SD) and steroid therapy (ST) as treatment approaches in TON patients.
A PRISMA-guided systematic review using PubMed, Embase, Ovid and Scopus databases was performed till the last search date of July 31st 2021. The outcome of interest was an improvement in visual acuity. A meta-analysis of the odds ratio was performed using a random-effect model and sub-group analysis based upon criteria for assessment of improvement in visual acuity.
Sixteen studies (including 1046 patients) were included in the review. The review could identify 590 patients treated with SD and 456 treated with ST. In addition, there was a second cohort of patients presenting with NLP (no light perception). A meta-analysis with a sub-group analysis revealed that there was statistically no significant difference between the two treatment approaches in terms of improvement in VA.
There is no difference in treatment results of SD or ST for TON. Several treatment protocols and different criteria for assessing visual acuity led to difficulty in generating evidence for selecting the correct treatment approach.
系统评价与荟萃分析。
由于缺乏循证治疗方案，外伤性视神经病变（TON）的治疗数十年来一直是一个有争议的话题。本综述比较了手术减压（SD）和类固醇疗法（ST）作为TON患者的治疗方法。
在2021年7月31日最后一次检索日期之前，使用PubMed、Embase、Ovid和Scopus数据库进行了一项受PRISMA指导的系统评价。感兴趣的结果是视力改善。使用随机效应模型对优势比进行荟萃分析，并根据视力改善评估标准进行亚组分析。
该综述纳入了16项研究（包括1046例患者）。该综述能够确定590例接受SD治疗的患者和456例接受ST治疗的患者。此外，还有第二组无光感（NLP）患者。一项包含亚组分析的荟萃分析显示，两种治疗方法在视力改善方面在统计学上没有显著差异。
TON患者接受SD或ST治疗的结果没有差异。多种治疗方案以及评估视力的不同标准导致难以生成选择正确治疗方法的证据。
