Steinsapir K D, Goldberg R A
Orbital and Ophthalmic Plastic Surgery Division, Jules Stein Eye Institute, UCLA School of Medicine.
Surv Ophthalmol. 1994 May-Jun;38(6):487-518. doi: 10.1016/0039-6257(94)90145-7.
Knowledge concerning the pathophysiologic mechanisms of traumatic optic neuropathy is limited. The optic nerve is a tract of the brain. Therefore, the cellular and biochemical pathophysiology of brain and spinal cord trauma and ischemia provide insight into mechanisms that may operate in traumatic optic neuropathy. The dosage of methylprednisolone (30 mg/kg/6 hours) which was successful in the National Acute Spinal Cord Injury Study 2 (NASCIS 2) evolved from the unique pharmacology of corticosteroids as antioxidants. The management of traumatic optic neuropathy rests on an accurate diagnosis which begins with a comprehensive clinical assessment and appropriate neuroimaging. The results of medical and surgical strategies for treating this injury have not been demonstrated to be better than those achieved without treatment. The spinal cord is a mixed grey and white matter tract of the brain in contrast to the optic nerve which is a pure white matter tract. The treatment success seen with methylprednisolone in the NASCIS 2 study may not generalize to the treatment of traumatic optic neuropathy. Conversely, if the treatment does generalize to the optic nerve, NASCIS 2 data suggests that treatment must be started within eight hours of injury, making traumatic optic neuropathy one of the true ophthalmic emergencies. Given the uncertainties in the treatment, ophthalmologists involved in the management of traumatic optic neuropathy are encouraged to participate in the collaborative study of traumatic optic neuropathy.
关于外伤性视神经病变病理生理机制的知识有限。视神经是大脑的一部分。因此，脑和脊髓创伤及缺血的细胞和生化病理生理学有助于深入了解外伤性视神经病变可能涉及的机制。在全国急性脊髓损伤研究2（NASCIS 2）中取得成功的甲泼尼龙剂量（30mg/kg/6小时）源自皮质类固醇作为抗氧化剂的独特药理学特性。外伤性视神经病变的治疗依赖于准确的诊断，而准确诊断始于全面的临床评估和适当的神经影像学检查。治疗这种损伤的药物和手术策略的效果尚未被证明优于未经治疗的效果。脊髓是大脑中灰质和白质混合的神经束，而视神经是纯白质神经束。NASCIS 2研究中使用甲泼尼龙取得的治疗成功可能无法推广到外伤性视神经病变的治疗。相反，如果该治疗方法确实能推广到视神经，NASCIS 2的数据表明治疗必须在受伤后8小时内开始，这使外伤性视神经病变成为真正的眼科急症之一。鉴于治疗方面的不确定性，鼓励参与外伤性视神经病变管理的眼科医生参与外伤性视神经病变的合作研究。
