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Delayed optic nerve decompression for indirect optic nerve injury.

A Thakar1, A K Mahapatra, D A Tandon

  • 1Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi. meenaal@ndb.vsnl.net.in

The Laryngoscope
|January 7, 2003
PubMed
Summary

Delayed optic nerve decompression can improve vision in traumatic optic nerve injury cases with residual sight, even months after injury. However, surgery is ineffective for complete blindness unresponsive to steroids.

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Area of Science:

  • Ophthalmology
  • Neurosurgery
  • Trauma Care

Background:

  • Traumatic optic nerve injury (TONI) can lead to significant vision loss.
  • The optimal timing for surgical intervention in TONI remains debated.
  • Steroid therapy is a common initial treatment for TONI.

Purpose of the Study:

  • To evaluate the efficacy of delayed optic nerve decompression in patients with traumatic optic nerve injury.
  • To determine if surgical intervention is beneficial when performed more than two weeks after injury.
  • To assess outcomes in patients with TONI who failed conventional steroid treatment.

Main Methods:

  • A critical analysis of prospectively collected data from 35 patients with traumatic optic nerve injury.
  • Inclusion criteria: injury-to-surgery interval greater than two weeks.

Related Experiment Videos

  • Surgical decompression was performed on patients with persistent poor vision despite steroid treatment; visual acuity was measured pre- and post-operatively.

    • Main Results:

    • Surgery was ineffective in 9 patients with complete blindness and no response to steroids.
    • Of 26 patients with residual vision, 20 improved by an average of 41.0% after decompression.
    • No significant difference in visual improvement was observed based on the delay of surgery (2 weeks to over 4 months).

    Conclusions:

    • Optic nerve decompression is a viable salvage procedure for traumatic optic neuropathy cases unresponsive to steroids.
    • Vision improvement is possible with delayed surgery, even several months post-injury, in non-blinded patients.
    • Early intervention is not necessarily superior for all traumatic optic nerve injury cases.