Schmidbauer J M, Müller E, Höh H, Robinson E
Augenklinik, Klinikum Neubrandenburg.
HNO. 1998 Feb;46(2):152-6. doi: 10.1007/s001060050214.
Indirect traumatic optic neuropathy represents a severe, potential vision-threatening disease process that requires close interdisciplinary cooperation for treatment. In general, any therapy has been discussed controversially in the literature. Based upon experiences with spinal cord trauma, high-dose steroid therapy is recommended initially to minimize secondary consequences following orbital trauma. The usefulness of surgical decompression of the optic nerve has been confirmed in several studies but is still not recommended in principle.
In nine consecutive patients with known indirect traumatic optic neuropathy and marked losses of vision, transsphenoidal optic decompressions were carried out with simultaneous systemic megadose steroid therapy.
A postoperative increase in visual acuity from 1/35 to 10/20 occurred in five patients, while no improvement in visual acuity could be achieved in the other four patients.
Previous reports have indicated that some authors will not recommend surgical decompressions if a loss of sight or no light perception occurs directly after an accident. This situation was seen in seven of our patients. The visual acuity of four patients remained no light perception in spite of surgical treatment. In three other patients, an increase in visual acuity from amaurosis improved to 1/35, 4/20 and 8/20, respectively, following early decompression combined with steroids. This experience together with the positive results of other studies supports carrying out decompressions of the optic nerve, even when an amaurosis occurs directly after trauma.
间接性外伤性视神经病变是一种严重的、可能威胁视力的疾病过程，治疗需要多学科密切合作。总体而言，任何治疗方法在文献中都存在争议。基于脊髓损伤的经验，最初建议采用大剂量类固醇疗法，以尽量减少眼眶创伤后的继发后果。多项研究证实了视神经减压手术的有效性，但原则上仍不推荐。
对9例已知患有间接性外伤性视神经病变且视力明显丧失的连续患者进行了经蝶窦视神经减压术，并同时进行全身大剂量类固醇治疗。
5例患者术后视力从1/35提高到10/20，而其他4例患者的视力没有改善。
先前的报告表明，一些作者认为，如果事故后直接出现失明或无光感，则不建议进行手术减压。我们的7例患者出现了这种情况。尽管进行了手术治疗，但4例患者的视力仍无光感。在另外3例患者中，早期减压联合类固醇治疗后，视力分别从黑矇改善到1/35、4/20和8/20。这一经验以及其他研究的阳性结果支持即使在创伤后直接出现黑矇的情况下也进行视神经减压。
