Lee Min Ho, Lee Tae-Kyu
Department of Neurosurgery, Uijeongbu St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea.
J Korean Neurosurg Soc. 2025 Jan;68(1):19-24. doi: 10.3340/jkns.2024.0083. Epub 2024 Aug 13.
Traumatic optic neuropathy (TON) refers to a pathological condition caused by direct or indirect injury to the optic nerves. In the case of patients with traumatic brain injury, adequate vision evaluation is difficult in many cases due to altered mentality. In order to address this problem, we investigated preoperative pupillary light reflex in TON patients as a predictive factor of surgical outcomes after optic nerve decompression.
From April 2020 to September 2022, we enrolled patients who were diagnosed with TON and underwent endoscopic optic nerve decompression at our institution. Vision and pupil reflex tests were performed by an ophthalmologist before and after surgery.
Seven patients were enrolled. Their ages ranged from 9 to 78 years and all were male. Among the seven patients, the patient whose pupillary light reflex was sluggish with 6 mm-sized pupil and absent with 7 mm-sized pupil before surgery showed no improvement in vision. Patients with some response to direct reflex or contralateral indirect reflex testing preoperative showed vision improvement after operation.
Direct and indirect pupillary reflexes can be important factors determining treatment outcome for TON. In unconscious patients with a fracture involving the optic canal, timely surgical intervention based on pupillary reflex can prevent permanent loss of vision.
外伤性视神经病变（TON）是指由视神经直接或间接损伤引起的一种病理状况。对于创伤性脑损伤患者，由于意识改变，在许多情况下难以进行充分的视力评估。为了解决这一问题，我们研究了TON患者术前瞳孔光反射作为视神经减压术后手术结果的预测因素。
2020年4月至2022年9月，我们纳入了在我院被诊断为TON并接受内镜下视神经减压术的患者。术前和术后由眼科医生进行视力和瞳孔反射测试。
共纳入7例患者。他们的年龄在9岁至78岁之间，均为男性。在这7例患者中，术前瞳孔光反射迟钝，瞳孔直径为6mm，瞳孔直径为7mm时消失的患者视力无改善。术前对直接反射或对侧间接反射测试有一定反应的患者术后视力有改善。
直接和间接瞳孔反射可能是决定TON治疗结果的重要因素。对于伴有视神经管骨折的昏迷患者，基于瞳孔反射及时进行手术干预可预防永久性视力丧失。
